Covid Will Become Endemic. The World Must Decide What That Means
The task of 2022 will be figuring out how much action we’re willing to take and how much disease and death we’ll tolerate.
This is not the year-end we wanted, but it’s the year-end we’ve got. Inside it, like a gift basket accidentally left under the tree too long, lurks a rancid truth: The vaccines, which looked like the salvation of 2021, worked but weren’t enough to rescue us. If we’re going to save 2022, we’ll also have to embrace masking, testing, and maybe staying home sometimes, what epidemiologists broadly call nonpharmaceutical interventions, or NPIs.
“The key question—which the world hasn’t had to deal with at this scale in living memory—is how do we move on, rationally and emotionally, from a state of acute [emergency] to a state of transition to endemicity?” says Jeremy Farrar, an infectious disease physician who is director of the global health philanthropy the Wellcome Trust. “That transition period is going to be very bumpy, and will look very, very different around the world.” (...)
To start, let’s be clear about what endemicity is, and isn’t. Endemicity doesn’t mean that there will be no more infections, let alone illnesses and deaths. It also doesn’t mean that future infections will cause milder illness than they do now. Simply put, it indicates that immunity and infections will have reached a steady state. Not enough people will be immune to deny the virus a host. Not enough people will be vulnerable to spark widespread outbreaks.
Colds are endemic—and since some types of colds are caused by other coronaviruses, there’s been speculation this coronavirus might eventually moderate too. (The coronavirus OC43, introduced to humans in the late 1800s, took a century to do that.) But flu is also endemic, and in the years before we all started masking, it killed anywhere from 20,000 to 50,000 Americans each year. Endemicity, in other words, isn’t a promise of safety. Instead, as epidemiologist Ellie Murray has argued, it’s a guarantee of having to be on guard all the time. (...)
*Researchers argue that we are late in explaining to people what endemicity actually represents. “We should have been trying, from a very early stage, to teach people how to do risk calculation and harm reduction,” says Amesh Adalja, a physician and senior scholar at the Johns Hopkins University Center for Health Security. “We still should be trying, because people have gone back to their lives. They have difficulty understanding that no activity is going to have zero Covid risk—even though we’ve got great tools, and more of them coming in the new year, that are going to allow us to make Covid a much more manageable illness.”*
But endemicity will be a daily grind, whenever we get there: a painstaking repetition of frequent testing, sometimes masking, and never quite being free of the need to think about the virus, like an annoying neighbor whom you wish would move away.
If we resolve to do this better in the next round, we nevertheless are left with how we play out this one. “If we keep going as we are doing, it will be protracted and painful and prolonged,” Farrar says. “We need to commit to making sure everybody in the world has access to their two doses of vaccines by the end of March 2022. A level playing field isn’t just sort of a nice thing to do. It’s the only way to reduce the chance of other new variants coming.”