‘There will be an end in sight, it’s just unclear when’ — what endemic really means for COVID-19

Of all the new words that have become part of the pandemic lexicon over the last two and a half years, endemic is perhaps one of the most charged.

When asked about its definition, Dr. Catherine Hankins chuckles.

It's actually interesting because if you look at it, it means in the people" from the Greek en demos," said the Montreal-based epidemiologist and McGill professor. Unfortunately it has the word end,' which implies that it's some kind of end, but it's absolutely not."

The term endemic has been presented, or at least perceived, as a kind of shining hope on the horizon, the promise of a return to normal life and even slang for COVID is over."

But Hankins and other experts say it actually just means that a disease settles into a more predictable pattern.

And while global deaths from the disease are dropping, they agree it's not yet in an endemic state. It's impossible to know when that will happen (although there are some tools to get there faster). But that question is maybe less important than you think.

It's something that's staying in the people, it's nothing to do with whether it is something that is really bad, or something that's not so bad," said Hankins of the word endemic.

At a recent press conference in Geneva, World Health Organization officials were asked if the world is already safely" in that stage.

We're still in the middle of this pandemic, we all wish that we weren't, but we are not in an endemic stage," said Maria Van Kerkhove, technical lead for the COVID-19 responses. She was speaking remotely from the U.S., where she herself is isolating with the disease. She noted there were hot spots such as China, and said that although cases are declining, there were still 7.2 million reported around the world the previous week, amid concerns about under-reporting.

Her colleague Dr. Mike Ryan, executive director of the WHO health emergencies program, added that the decline in deaths is a really good sign," but there were still 21,000 reported the previous week.

This terminology of pandemic, epidemic, endemic, they're really just descriptions of what's happening, they're not absolute categories," he said.

When we say something is pandemic, it means it's an epidemic occurring at a global level, pan demos, everybody is included. When we talk about an epidemic it means that we've got an acute outbreak of disease, that's affecting a defined population so it's a very rapid increase in cases and it's very unusual and very noticeable."

Ancient epidemics often settle down into what's called an endemic pattern, he added, because so many people in the population are protected by natural infection and more recently by vaccination." Sometimes they become diseases of childhood, like measles, for example, because kids are the ones left who are vulnerable, before they can be vaccinated.

Endemic also doesn't always mean mild, said Dr. Syra Madad, senior director of special pathogens for the New York City Health System, and the lead health expert for Netflix documentary Pandemic."

Although the flu is an example of an endemic disease, so are tuberculosis and malaria, which in some parts of the world still kill hundreds of thousands of people every year.

Madad noted COVID is the number three killer in the U.S., behind only heart disease and cancer, according to the most recent data from the Centers for Disease Control and Prevention.

As for how to get to endemic, she agrees with Ryan that it depends on the immunity wall that builds in a particular population or community." This in turn depends on making sure that vaccines reach every corner of the globe.

We often put these arbitrary times, you know, by summer we're going to be free of this virus and we can go back to our life as we know it, but that's the human timeline, not the viral timeline," she said.

The viral timeline" can potentially take years and we need to prepare for that," said Madad. But that doesn't mean the virus needs to dominate our lives as we have tools to fight it: namely vaccines but also masks, and new treatments.

At the same time we need to continue to be cognizant that we are still in a pandemic," she said.

Are we ever going to get out of this? Are we going to get out of the pandemic spiral? You know, it just seems like there's no end in sight but I would argue that there will be an end in sight, it's just unclear when that end is going to be."

Potential new variants and how they behave make predictions hard, said Timothy Sly, professor emeritus in the School of Occupational and Public Health at Ryerson University.

If another, more contagious one - different enough from other variants to evade immunity from previous infections and vaccines - comes along, it could extend the pandemic.

Already Omicron has led to a rise in reinfections, because it is able to do just that. But this is also connected to vaccination, and not letting the virus run amok, Sly said. If you look at the recent variants, they've all come from areas of very hot, steamy viral replication in the world at the time," he said.

We certainly need to make sure the rest of the world is vaccinated because we're under threat from that," he added.

If a new variant is both more contagious and more serious, all hell could break loose, but let's hope it doesn't, and meanwhile let's try to stop the damn thing spreading by wearing a mask."

Otherwise, Sly thinks that the disease will eventually settle down into a yearly booster shot for everybody," perhaps combined with a flu vaccine.

As for when COVID might finally fade more into the background? The world can learn from historical pandemics, but many of them did not have vaccines or testing, said McGill's Hankins.

I think you need a crystal ball - you can take bets, how about that?"

May Warren is a Toronto-based breaking news reporter for the Star. Follow her on Twitter: @maywarren11