An ‘endemic’ COVID doesn’t mean we stop fighting

Governors of several states are proposing that we treat COVID-19 as an endemic disease, meaning it will always be with us and we must “learn to live with it.”

Certainly SARS-CoV-2, the virus that causes COVID-19, will eventually become endemic. But suddenly claiming the virus is endemic, without a serious campaign to encourage worldwide vaccination and mitigation, is asking us to accept — or forget — inadequate public health policies, misuse of COVID relief funds, and the staggering morbidity and mortality that this virus has wrought. We are asked to accept that the U.S. has allowed more COVID-19 deaths than any other wealthy nation. Rushing to declare the virus endemic belies the 900,000+ COVID-19 deaths in the U.S.

Although SARS-CoV-2 will become endemic, that does not mean the disease threat goes away. Endemic pathogens are always present in a population, and while they may fluctuate seasonally, they do not typically have the dramatic spikes in disease and death associated with the COVID-19 pandemic. Common cold viruses are endemic, but so are more threatening viruses like chikungunya, Dengue and Lassa fever in many parts of the world. Flu is endemic, but the threat that a highly virulent strain will arise is ever-present.

Many endemic viruses still require strong public health mitigation to prevent disease and death, such as the seasonal flu vaccines. While not a virus, malaria, spread by mosquitos, is endemic in equatorial regions where public health campaigns as straightforward as the distribution of insecticide-treated bed netting are critical to controlling outbreaks. As SARS-CoV-2 becomes endemic, it will not disappear, nor will it necessarily become a milder disease. New variants will still arise, the nature of which we cannot predict. Ongoing public health mitigation measures will be important to protect us, especially the most vulnerable.

One way to achieve endemicity is for a large proportion of the population to be unsusceptible to infection. This typically occurs through vaccination or previous infection. Smallpox was a dreaded endemic virus until vaccination ended its reign; the same is true for polio in much of the world. In an immune population, viruses struggle to find susceptible individuals, thus thwarting transmission. With less than 60 percent of the U.S. population properly vaccinated against COVID-19, and even fewer boosted, we are far from the point where SARS-CoV-2 will cease to be a threat.

Harboring the hope that future SARS-CoV-2 variants will become “milder” is not only wishful thinking, it assumes that there is such a thing as a mild viral infection. The problem is that viral infections often leave some sort of lasting effect, change us in some way, leave some damage. After infection by any member of the herpesvirus family, the viruses remain with you for life, recurring as many different maladies, including periodic cold sores, genital sores, shingles, predisposition to cancers and potentially multiple sclerosis. Measles can have many severe complications, including severe damage to established immunity and, in rare instances, predisposition to SSPE, a fatal neurological disease. Every respiratory virus infection can leave lung and bronchial damage that can cause lifelong problems. SARS-CoV-2 infection, even when “mild,” can lead to a multitude of post-COVID long-term problems that have not yet been fully characterized. The list of lasting damage by viral infections is long.

In reality, it is always better to avoid viral infection. Vaccines and public health mitigation offer protections, but besides these there are many commonsense personal safeguards, like avoiding obviously sick people, staying home when sick, staying out of crowds during flu season and simply washing hands. Again, with malaria, it was the simple public health initiative of distributing mosquito netting that contributed significantly to its control. Similarly, we must continue to mitigate SARS-CoV-2 spread with all resources at our disposal so that we save lives — and eventually establish a new normal.   

Politics must not dictate avoiding a viral infection, any viral infection. It’s about preserving one’s long-term health. We should share a sense of responsibility for ourselves and our community. In protecting ourselves from viral infections, we protect each other. In the end, it is more important to relearn to live for each other than to “learn to live with it.”

James Alwine is a virologist and a fellow of the American Academy for Microbiology and of the American Association for the Advancement of Science. He is a professor emeritus at the University of Pennsylvania and a visiting professor at the University of Arizona.

Felicia Goodrum Sterling is a virologist, president of the American Society for Virology, and a fellow of the American Academy of Microbiology. She is a professor and scientist at the University of Arizona.