Covid will become endemic. The world must decide what that means

A month ago, it felt like we could see the future. They were getting louder. School-age children were given a second chance in time to see their grandparents during the winter break. Life in the United States was sliding towards something that seemed to be normal – not normal before the pandemic, of course, but perhaps an insight into the post-pandemic.

And then he came Omicron variant, stifling hopes for the holidays completely as Delta cooled the hot summer in July. Weeks later, we’re still not sure what exactly it represents. Its to much more portable. Maybe or maybe not be more virulent. IT IS tearing through countries and spread through groups of friends and sending universities back online for the spring semester.

This is not the end of the year we wanted, but this is the end of the year we have. In it, like a gift basket that was accidentally left too long under a tree, hides a burning truth: vaccines, which looked like salvation in 2021, worked, but they were not enough to save us. If we want to save 2022, we will also have to accept masking, testing and maybe sometimes staying at home, what epidemiologists generally call non-pharmaceutical interventions or NPIs.

Recognizing that complexity will allow us to exercise for the day Covid enters circulation, endemic virus. That day had not yet arrived; enough people remain vulnerable that we have to prepare for variants and jumps. But at some point we will strike a balance that represents how much work we are willing to do to control Covid and how much disease and death we will tolerate to stay there.

“The key question – which the world has not had to face on this scale in vivid memory – is how to proceed, rationally and emotionally, from a state of acute [emergency] into a state of transition to an endemic state? ” says Jeremy Farrar, an infectious disease doctor who is the director of the global health philanthropy Wellcome Trust. “This transition period will be very difficult and it will look very, very different around the world.”

To begin with, let’s clarify what is endemic and what is not. Endemicity does not mean that there will be no more infections, let alone diseases and deaths. Nor does it mean that future infections will cause a milder disease than now. Simply put, it indicates that immunity and infections will reach a stable state. Not enough people will be immune to deny the virus to the host. Not enough people will be vulnerable to spread the epidemic.

Colds are endemic — and since some types of colds are caused by other coronaviruses, there has been speculation that this coronavirus could in the end moderate also. (Coronavirus OC43, introduced to humans in the late 1800s, took a century to do so.) But the flu is also endemic, and in the years before we all began to disguise ourselves, it was killing anywhere 20,000 to 50,000 Americans every year. Endemicity, in other words, is not a promise of security. Instead, as epidemiologist Ellie Murray argued, it’s a guarantee you’ll have to be careful constantly.

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