Even if we could be certain that endemicity was on the horizon, that assuredness doesn’t guarantee the nature of our post-pandemic experience of COVID. There are countless ways for a disease to go endemic. Endemicity says nothing about the total number of infected people in a population at a given time. It says nothing about how bad those infections might get—how much death or disability a microbe might cause. Endemic diseases can be innocuous or severe; endemic diseases can be common or vanishingly rare. Endemicity neither ensures a permanent détente nor promises a return “to 2019,” Abraar Karan, an infectious-disease physician and global-health expert at Stanford, told us. Its only true dictate—and even this one’s shaky, depending on whom you ask—is a modicum of predictability in the average number of people who catch and pass on a pathogen over a set period of time.
Endemicity, then, just identifies a pathogen that’s fixed itself in our population so stubbornly that we cease to be seriously perturbed by it. We tolerate it. Even catastrophically prevalent and deadly diseases can be endemic, as long as the crisis they cause feels constant and acceptable to whoever’s thinking to ask. In a rosy scenario, reasonably high levels of population immunity could bring the virus to heel, and keep it there; its toll would be roughly on par with the flu’s. As coronavirus cases drop from their Omicron highs in the United States and other countries, there’s at least some reason to hope things are bending in that direction. But at its worst, endemicity could lock us into a state of disease transmission that is perhaps as high as some stretches of the pandemic have been—and stays that way.
If endemicity contains a world of possibilities, not all of them good or even better, then it makes a poor goal, and an impractical conceptual framework for any action aimed at managing COVID in the months, years, and decades ahead.
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