- metadata: - source: https://www.bloomberg.com/news/articles/2022-01-19/is-covid-becoming-endemic-what-would-that-mean-quicktake --- # What Does Endemic Mean? Can We Live With Virus? Covid Pandemic Shifts Explained - Bloomberg > ## Excerpt > Two years into the pandemic, weary governments are hoping the fast-spreading but less severe omicron variant marks a turning point, a shift toward a more predictable and manageable phase. Determined to escape the crisis and avoid more restrictions, officials in some countries suggest it’s approaching time to treat Covid as an endemic disease, like seasonal flu. World Health Organization experts say that’s premature. With omicron ripping through populations and vast parts of the planet still unva --- Two years into the pandemic, weary governments are hoping the fast-spreading but less severe [omicron variant](https://www.bloomberg.com/news/articles/2021-11-26/what-we-know-about-the-new-virus-variant-that-s-rocking-markets "What We Know About the Omicron Variant Now: QuickTake") marks a turning point, [a shift toward](https://www.bloomberg.com/news/articles/2022-01-15/from-pandemic-to-endemic-can-2022-succeed-where-2021-failed "From Pandemic to Endemic: Can 2022 Succeed Where 2021 Failed?") a more predictable and manageable phase. Determined to escape the crisis and avoid more restrictions, officials in some countries suggest it’s approaching time to treat Covid as an endemic disease, like seasonal flu. [World Health Organization](https://www.bloomberg.com/quote/0751538D:SW "Company Overview") experts say that’s premature. With omicron ripping through populations and vast parts of the planet still unvaccinated, the pandemic isn’t over. The bottom line: the path to reaching that endemic stage is full of uncertainties, posing tough questions for policymakers everywhere. ### 1\. What does endemic mean? In [an epidemic](https://www.publichealth.columbia.edu/public-health-now/news/epidemic-endemic-pandemic-what-are-differences "Columbia school of public health primer"), a disease spreads rapidly and unexpectedly in a given location; it becomes [a pandemic](https://www.bloomberg.com/news/articles/2020-02-26/what-it-means-if-the-coronavirus-is-called-a-pandemic-quicktake "What It Means Now That the Coronavirus Is a Pandemic: QuickTake") when it spreads globally, or over a very wide area. A disease that’s endemic is continuously present in a given population at a lower and more stable level, even if cases spike under certain conditions. Scientists expect that when enough people gain at least some protection from the coronavirus through vaccines or prior infections, [it will blunt the spread](https://www.hsph.harvard.edu/news/features/what-will-it-be-like-when-covid-19-becomes-endemic/ "Harvard School of Public Health interview") of the virus and reduce hospitalizations and deaths, so that over time Covid will pose less of a threat. The virus won’t go away entirely, however, and endemic diseases can still take a serious toll. Tuberculosis and malaria, which are endemic in some parts of the world, claimed an estimated [1.5 million](https://www.who.int/news-room/fact-sheets/detail/tuberculosis#:~:text=A%20total%20of%201.5%20million,with%20tuberculosis%20(TB)%20worldwide. "WHO factsheet") and [627,000 lives](https://www.who.int/news-room/fact-sheets/detail/malaria "WHO factsheet"), respectively, in 2020. “Endemic in itself does not mean good. Endemic just means [it’s here forever](https://www.bloomberg.com/news/articles/2022-01-18/novartis-ceo-sees-world-in-better-place-with-covid-by-year-end "Novartis CEO Sees ‘Better Place’ With Covid by Year-End (1)"),” said Mike Ryan, executive director of the WHO’s health emergencies program. ### 2\. When might Covid become endemic? In mid-January, Covid was taking about [50,000 lives](https://covid19.who.int/ "WHO Covid tracker") a week globally. Learning to live with the virus shouldn’t mean enduring that much death, WHO Director-General Tedros Adhanom Ghebreyesus said. Countries are likely to start considering Covid endemic at different points in time, based on their levels of immunity. While [two-thirds](https://data.undp.org/vaccine-equity/ "UN data") of people in wealthy countries had received at least one dose of vaccine as of Jan. 12, just 11% had in low-income nations. In Portugal, where 89% of the population is fully vaccinated, Covid already looks like an [endemic illness](https://www.wsj.com/articles/endemic-covid-19-has-arrived-in-portugal-this-is-what-it-looks-like-11635073461 "Wall Street Journal article"). In Africa, [about 85%](https://www.who.int/publications/m/item/covid-19-virtual-press-conference-transcript---12-january-2022 "WHO report") of people have yet to receive a single dose. China, the world’s most populous country, is in a category of its own: It has stuck to a [zero-Covid strategy](https://www.bloomberg.com/news/articles/2022-01-13/china-s-covid-absolutism-is-making-it-a-no-go-zone-for-airlines "China’s Covid Absolutism Makes It a No-Go Zone for Airlines (2)"), using strict lockdowns and extensive quarantines to quell outbreaks. So infections are few, but natural immunity is also scant. While 87% of the population is fully vaccinated, it’s unclear how effective China’s shots are.   WATCH: The world is desperate to move beyond Covid. When will the pandemic become endemic? Source: Bloomberg ### 3\. What’s the role of the omicron variant?  Data show the latest iteration of the coronavirus is [less virulent](https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1045619/Technical-Briefing-31-Dec-2021-Omicron_severity_update.pdf "UK data") than previous variants, which means it’s less likely to cause hospitalizations and deaths. Because omicron is also more transmissible, it’s creating surges in infections. But that feature could also mean it could speed a transition to an endemic stage by outcompeting the more harmful delta variant, which became dominant worldwide in mid-2021. There’s an important caveat, however. It’s [not yet clear](https://nymag.com/intelligencer/2021/12/is-omicron-a-new-wave-or-a-parallel-pandemic.html "New York magazine article") whether omicron is spreading so quickly because it’s inherently more fit than delta [or whether](https://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMdo006395&aid=10.1056%2FNEJMe2200149&area= "NEJM podcast") it’s just better at evading the immunity some have from vaccination and previous infections. If it’s the latter, as some populations build up immunity to omicron, it may lose its advantage, allowing delta to resurge.  ### 4\. What else could complicate the path? The latest in global politics Get insight from reporters around the world in the Balance of Power newsletter. It’s impossible to know what the next variants will look like, and how infectious and virulent they may be. The slow rollout of vaccines among poor countries raises the risk that shot-evading variants could emerge. Another unknown is how durable immunity will be. The coronavirus may prove to be similar to the [flu virus](https://www.bloomberg.com/news/articles/2021-06-02/how-flu-s-mutations-threaten-birds-pigs-and-humans-quicktake "How Flu’s Mutations Threaten Birds, Pigs and Humans: QuickTake"), which produces a relatively steady number of cases annually but also has the potential to cause epidemics and even pandemics when it mutates sufficiently to evade the immunity large numbers of people have from vaccination and prior infections. ### 5\. Which countries are re-evaluating their view of Covid? Spain’s Prime Minister Pedro Sanchez said it’s time to think about new ways of living with Covid given that the rise in omicron cases hasn’t led to an equivalent surge in hospitalizations and deaths. U.K. cabinet minister Nadhim Zahawi hopes his country will become one of the first major economies to show the world “how you transition from pandemic to endemic,” adding that testing, vaccines including boosters, and antiviral drugs will be key parts of the strategy. U.S. President Joe Biden said he believes the virus can be managed with new tools. It’s important to remember, however, that leaders have underestimated Covid throughout the pandemic. Last July, [Biden declared](https://www.whitehouse.gov/briefing-room/speeches-remarks/2021/07/05/remarks-by-president-biden-celebrating-independence-day-and-independence-from-covid-19/ "Click to view webpage.") that the U.S. was close to achieving “independence” from the coronavirus. Researchers warn that rapidly lifting Covid countermeasures could contribute to a [rise in cases](https://www.medrxiv.org/content/10.1101/2021.12.18.21268002v1.full.pdf "Preprint of scientific paper"). ### 6\. What might living with the virus look like? Waning immunity, pockets of unvaccinated people and variants could drive future outbreaks. [Countries might respond with regular boosters,](https://www.gov.scot/publications/coronavirus-covid-19-scotlands-strategic-framework-update-november-2021/pages/11/ "Click to view webpage.") careful tracking of mutations, ongoing surveillance and better ventilation in buildings. Most infections could be relatively mild, like the flu, but a small fraction resulting in severe illness would add up. Endemic Covid could mean 40,000 to 100,000 deaths per year in the U.S., [Trevor Bedford](https://twitter.com/trvrb/status/1448297978419101696?lang=en "Click to view webpage."), a specialist on viral evolution at the [Fred Hutchinson Cancer Research Center](https://www.bloomberg.com/quote/0220223D:US "Company Overview") in Seattle, estimated in October. By comparison, the flu kills from [12,000 to 52,000](https://www.cdc.gov/flu/about/burden/index.html "CDC estimate").  ### The Reference Shelf - Related QuickTakes on the [omicron variant](https://www.bloomberg.com/news/articles/2021-11-26/what-we-know-about-the-new-virus-variant-that-s-rocking-markets "What We Know About the Omicron Variant Now: QuickTake"), [vaccine mandates](https://www.bloomberg.com/news/articles/2020-12-18/can-i-be-required-to-get-vaccinated-against-covid-19-quicktake "Vaccine Mandates and Backlash in U.S., Austria, Italy: QuickTake") and [U.S. mask guidance](https://www.bloomberg.com/news/articles/2022-01-12/should-i-be-wearing-an-n95-mask-the-evolving-advice-quicktake "Should I Be Wearing an N95 Mask? The Evolving Advice: QuickTake"). - U.S. scientists [lay out](https://jamanetwork.com/journals/jama/fullarticle/2787944?guestAccessKey=12a4a5c4-0110-4efa-aca0-ff9f2c090c8f&utm_source=silverchair&utm_medium=email&utm_campaign=article_alert-jama&utm_term=mostread&utm_content=olf-widget_01102022 "JAMA article") a national strategy for a “New Normal” of living with Covid in the Journal of the American Medical Association. - German virologist Christian Drosten [expounds on](https://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMdo006395&aid=10.1056%2FNEJMe2200149&area= "NEJM podcast") the significance of  omicron’s fitness advantage -- or lack thereof -- in a New England Journal of Medicine podcast.