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As of May 2023,COVID-19 is a pandemic, but could become endemic in a future phase. The observed behavior of SARS-CoV-2, the virus that causes COVID-19, suggests it is unlikely it will die out, and the lack of a COVID-19 vaccine that provides long-lasting immunity against infection means it cannot immediately be eradicated; thus, a future transition to an endemic phase appears probable. In an endemic phase, people would continue to become infected and ill, but in relatively stable numbers. Precisely what would constitute an endemic phase is contested.
On May 5, 2023, the World Health Organization ended the public health emergency of international concern regarding COVID-19, but still considered the outbreak to be a pandemic. Since 2021, some politicians and health officials in some countries have said that COVID-19 is endemic locally or that their country was beginning to transition to an endemic phase. These include officials in Croatia,Indonesia,Malaysia,Mexico, the Philippines,Singapore, and Vietnam.
Definition and characteristics
An infectious disease is said to be endemic when the number of infections is predictable. This includes diseases with infection rates that are predictably high (called hyperendemic), as well as diseases with infection rates that are predictably low (called hypoendemic).
In January 2022, paleovirologist Aris Katzourakis wrote that the word "endemic" is one of the most misused of the COVID-19 pandemic, and that it is dangerously complacent to assume that COVID-19 endemicity is inevitable, or that it means the disease will necessarily become less of a threat to public health. A stable infection rate can be associated with any level of disease severity and any level of mortality rate among affected people. Additionally, if a disease becomes endemic, there is no guarantee that the disease will remain endemic forever. A disease that is usually endemic can become epidemic or pandemic in the future.
There is no single agreed definition of what it means for COVID-19 to become endemic. According to historian Jacob Steere-Williams, what endemicity means has evolved since the 19th century and the desire to label COVID-19 as being endemic in early 2022 was a political and cultural phenomenon connected to a desire to see the pandemic as being over.International Nursing Review journal editor Tracey McDonald warned in a 2023 paper on achieving an endemic status for COVID-19 how, "Traps for unwary politicians and commentators include statements on scientific matters that fall well outside their knowledge and experience, and the danger of adopting and misusing esoteric terminology that has nuanced meanings within professional circles."
During the course of the COVID-19 pandemic, it became apparent that the SARS-CoV-2 virus was unlikely to die out, but was more likely to become endemic. Endemicity is characterized by the continued existence of the virus, but with more predictable numbers of infection than in the preceding epidemic. People continue to become infected because of changes and movement within populations, and endemic disease may have seasonal infection patterns, but the largest determinant of how endemicity manifests itself is the levels of immunity people have, both as a result of vaccination and infection. In the absence of a vaccine that provides long-lasting immunity against infection from COVID-19, it will be impossible to eradicate the disease.
The severity of a disease in an endemic phase depends on how long-lasting immunity against severe outcomes is. If such immunity is lifelong, or lasts longer than immunity against infection, then reinfections will be mild, resulting in a mild endemic phase. In other existing human coronaviruses, protection against infection is transient, but observed reinfections are mild.
Alternatives
Not all infectious diseases become endemic. Common infectious disease patterns include:
- Disease eradication – an unlikely outcome for COVID-19
- Sporadic spread – unpredictable outbreaks that tend to die out relatively quickly
- Local or regional spread – unpredictable outbreaks, or epidemics, that are sustained for a significant period of time in local or regional areas, without global spread
- Pandemic – global outbreaks
- Endemic – steady, predictable infection levels, including seasonal patterns.
Global status
On 14 April 2022, the World Health Organization (WHO) said that COVID-19 is far from becoming an endemic disease and could still trigger large outbreaks around the globe. The WHO declared that COVID-19 no longer represents a public health emergency of international concern on 5 May 2023, but stated that it remains a pandemic. (The WHO does not declare the beginning or end of pandemics.)
An article in Human Genomics said that the endemic phase of COVID-19 would require worldwide vigilance and cooperation, especially in emerging countries", and suggested that developed countries should assist in boosting COVID-19 vaccination rates worldwide.
In October 2022, a report on COVID-19 commissioned by The Lancet assessed that COVID-19 endemicity was likely but that the course of the pandemic was still not predictable. The report said endemicity could give rise to a new pandemic of long COVID that would cause significant strain on nations' economies and healthcare systems because of the health and social care required to treat people.
As of March 2023, it was not possible to predict the infection patterns COVID-19 would settle on, though as with other coronaviruses it seemed possible the pattern would not be a seasonal one of the kind seen with influenza.
Countries
Indonesia
During a press conference on 3 March 2023, Indonesian Health Minister Budi Gunadi Sadikin announced the government has lessened its role in intervening in health programs as the COVID-19 pandemic has turned endemic. He stated that "[COVID-19 is] the same as the flu. We don't rule it. It’s on the community [if they need to wear a mask or not]" and continued that "people have a bigger role to protect themselves. The responsibility of maintaining health lies on each of them".
Macau
At a press conference on 5 January 2023, the Macau Health Bureau director Alvis Lo Iek Long stated that COVID-19 has become an endemic disease in Macau, and announced the cancellation of almost all entry curbs and measures. The statement follows a transition period that began on 8 December with the gradual easing of transmission curbs.
Malaysia
In September 2021, Malaysian Minister of Health Khairy Jamaluddin announced that the government would transition to treating COVID-19 as if it was in an "endemic phase" by the end of October 2021, after vaccinating 80% of the population. In March 2022, Khairy said that Malaysians could start "to live with COVID-19" while maintaining some public health measures.
Netherlands
On 24 February 2023, the Outbreak Management Team in the Netherlands observed the Omicron variant and its subvariants to be endemic in their 146th set of recommendations since the pandemic began. The advisory team stated that "measures against COVID-19 should be...in line with the generic measures for the prevention of other infections of the airways". They dropped recommendations for quarantine, self tests, and mask requirements for healthcare workers.
Philippines
In February 2022, the Philippines Department of Health began shifting toward the endemic phase of COVID-19, despite caution from the WHO that it may be too early to declare. During a media briefing, Health Undersecretary Maria Rosario Vergeire said that the "transition to an endemic state for COVID-19 does not mean that the government would stop its interventions or even remove minimum health protocols such as masking, physical distancing, and hand sanitation." WHO Acting Philippine Representative Rajendra Yadav said that while the continued drop in the number of new cases is "encouraging," but the country should be careful in moving from the "acute phase" of the pandemic.
See also
- COVID-19 pandemic by country and territory
- Public health mitigation of COVID-19
- Treatment and management of COVID-19
