When does a pandemic become an endemic?

ELLSWORTH — What is an endemic? The word is getting a lot of use lately, both from politicians and from members of the public who want to know what is next in the ongoing COVID-19 pandemic.

Maine Center for Disease Control and Prevention (CDC) Director Dr. Nirav Shah has said people could be attracted to the term because it has the word “end” in it.

The definition, on the contrary, means that COVID-19 will not be eradicated and will be in society forever. However, life in the endemic phase can mean effectively fighting the disease but in a less disruptive way, said Dr. Jens Rueter, chief medical officer at The Jackson Laboratory.

“It’s an active process,” Rueter told The American. “At the end of the day, it becomes endemic, but we also make specific decisions that define it as an endemic.”

Here in Maine, we are in that transition, Rueter said.

Currently, the number of patients in the hospital, intensive care or on a ventilator because of COVID (a distinction from “with” COVID) is on a downward slope.

“That is a good sign that we are heading toward an endemic phase,” Rueter said.

It is important to continue surveilling for other concerning variants, but those have not cropped up since Omicron was discovered.

Another factor to consider when determining if we are in an endemic is the population’s immunity. If more people are immune to the disease, the chance it will become endemic is higher, Rueter explained.

“I think Omicron has really contributed to that balance,” Rueter said.

In Maine, the high vaccination rate helped residents who got infected (despite being vaccinated) have a milder reaction to COVID. That hybrid immunity — immunity from vaccination and infection — appears to be most effective, Rueter said.

The societal response to COVID-19 — the choices we collectively make to continue the transition to an endemic phase — will require public and personal health adaptions to keep the disease under control, Rueter said.

Living with an endemic disease doesn’t mean throwing away the mitigation strategies we have accumulated along the way, Rueter explained, but to utilize them when needed, though not necessarily every day.

Those tools, including vaccines, therapeutics, testing strategies (including the noninvasive method of testing municipal wastewater) and masking, will be needed to help the disease from spreading uncontrollably.

The topic of masking has been emotionally charged since the onset of the pandemic, with many wondering if the recommendation to wear a face covering in public will ever end.

Rueter explained that while masking will likely only need to happen during peaks of COVID, some places, such as hospitals, may maintain it as a universal practice.

Masking in other venues, such as stores, may be left to individual choices or to the storeowner’s discretion, as has been the case in Maine since the state lifted its mask mandate, something that Rueter said has worked reasonably well.

Rueter noted that misconceptions about the endemic phase have come from individuals with vastly different perspectives on COVID. There are the people that say we just “need to live with COVID” on one side and those who are still operating in a state of panic on the other.

It could come as welcome news to the public that the truth of the situation is not so polarizing and is somewhere in the middle, Rueter said.

“We live with endemic diseases,” Rueter said. “So, we know how to do this, but it doesn’t mean we shouldn’t worry about it anymore.”

Monitoring the spread of the coronavirus as an endemic will remain important, especially as some models predict that endemic COVID could still claim 50,000 to 100,000 lives per year in the U.S. That is compared to 12,000 to 50,000 annual deaths from the flu.

Other examples of endemic diseases include tuberculosis, including cases in the U.S.

There will always be a certain level of TB and people will always die from it, Rueter explained, but we know how to better identify it and take precautions, such as isolating TB patients in hospitals.

Malaria is another disease that claims lives every year, but society has adapted by developing medications.

Rebecca Alley

Rebecca Alley

Reporter at The Ellsworth American
Rebecca is the Schoodic-area reporter and covers the towns of Eastbrook, Franklin, Hancock, Lamoine, Sorrento, Sullivan, Waltham, Winter Harbor and Trenton. She lives in Ellsworth with her husband and baby boy who was joyously welcomed in June 2020. Feel free to send tips and story ideas to [email protected]

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