Covid-19 May Soon Be Endemic Worldwide

by Riley Sandoval ‘22

After two years of the coronavirus pandemic, people are eager to move on with their lives. The more transmissible Omicron variant is bringing many hope for a finish line. Some countries are looking towards Covid-19 as endemic rather than as a pandemic. While it is too early to deem Covid-19 as endemic worldwide, some countries, including the United States are moving forward with less restrictions surrounding the virus.

The Centers for Disease Control and Prevention (CDC) outlines an endemic as “the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area,” while a pandemic is more defined by rapid and widespread transmission. It is important to understand that endemic does not mean there will be no more cases of Covid-19, but instead there will be a lower, more stable, and predictable level of cases. It also does not mean the virus will be milder, just less frequent.
Endemic would mean living with Covid-19 similar to how the world lives with other viruses like the flu and malaria, both of which still infect people and cause deaths each year. The flu is an endemic disease that still infected an estimated 35 million people in the United States from 2019 to 2020 according to the CDC. And like Covid-19, there is a vaccine to help minimize the number of cases, hospitalizations, and deaths from the flu.

There is no exact threshold as to when a virus becomes endemic. It can be reached, however, when enough people have built immunity to the virus either through vaccination or prior infections. This will reduce the number of people who are getting infected, as well as the number of hospitalizations and deaths. The rollout of vaccines, especially in developing countries, will help to reach endemic levels of the virus. As of January 12, two-thirds of people in wealthy countries have been vaccinated, compared to only 11 percent of those in low- income countries.
While that disparity in vaccination rates across the country seems worrisome, one country in Africa shows it is possible to reach endemic status due to prior infections. Malawi is a country that seemingly was never hit hard by Covid-19 because of a lack of available tests and little reporting of cases.
A study by an immunologist in Malawi found that most people had already been infected even before the emergence of the Omicron variant. Most of the population is younger with a median age of 18, so most of the cases were either asymptomatic or not severe enough for people to get tested or go to the hospital.
Last summer, the immunologists looked at blood samples collected from their national blood bank where they found that 80 percent of the population had antibodies from prior infections. With only five percent of Malawians being fully vaccinated, their resistance mainly comes from prior exposure. Similar studies done in other African countries like Kenya, Madagascar, and South Africa all show similar results.

The World Health Organization warns that it is too early to deem Covid-19 an endemic virus as there are still outbreaks around the world and a predictable level has not yet been seen. Future variants may also disrupt the path to endemic status.

Nonetheless, it is up to individual countries to move forward based on their own levels of immunity from vaccines or prior infections. Political leaders are moving forward with an endemic mindset in regulations. This includes the United States and several European countries, where mask mandates and restrictions have been removed or are in the process of being removed. It seems as though a combination of vaccinations and infections help countries to progress closer to the end of the pandemic, as the vaccine helps reduce the severity of the virus and getting sick will also build immunity. Portugal is one example of a country that initially reached endemic status because of their high vaccination rates.

As of February 26, a little over 90 percent of Portugal’s population is fully vaccinated. After reducing restrictions, however, the country is now facing a massive wave of cases. Similarly, China has high vaccination rates but a low tolerance for a rise in cases, resulting in repeated lockdowns. Although they have a highly vaccinated population, scientists are unsure as to how effective their shots are without any exposure to the virus.

Malawi may have hit the jackpot to move towards endemic, but other low-income countries as well as countries facing civil unrest have very low vaccination rates that might prolong the pandemic status of Covid-19, causing even more suffering around the world.