Is COVID endemic?

Most public health experts agree that infection from SARS-CoV-2 is now at endemic, rather than pandemic, levels. However, calling COVID “endemic” risks encouraging a lackadaisical public response to a disease that still has serious consequences.

Let’s review the state of COVID-19 in 2024 and what the COVID endemic means for clinicians and the general public.

COVID: from pandemic to endemic

We’ve all become accustomed to the phrase “COVID-19 pandemic.” But, increasingly, we speak about it in the past tense. “During COVID...” we say, implying that the COVID-19 pandemic is over.

Calling a disease a “pandemic” requires two conditions: a sudden increase in cases (above expected levels of disease) and the spread of the disease over a large geographic area (usually several continents). 

Endemic, on the other hand, refers to the usual or expected prevalence of a disease. Influenza is endemic, for example, because it spreads across the U.S. in a predictable way each winter. 

If you think the definition of endemic seems fuzzy, you’re right. Epidemiologists say there is no objective definition of endemic, no specific number of cases or rate of spread that marks the transition from pandemic. Still, top public health officials mostly agree that COVID is endemic. 

“At this point, COVID-19 can be described as endemic throughout the world,” CDC coronavirus expert Aaron Hall told NPR in a recent interview. As Ashish Jha, dean of the Brown University School of Public Health, put it, this means COVID-19 is “something that’s just around that we have to manage on an ongoing basis.”

Of course, not everyone agrees. Some epidemiologists say the virus is still too unpredictable to reach a conclusion yet. For example, the summer of 2024 saw a surge of COVID cases that was much bigger than expected.

CDC data show persistent COVID-related hospitalizations, though at lower levels than during the pandemic.

50,000 deaths a year

Regardless of the “endemic” label, SARS-CoV-2 continues to be a serious public health risk. The virus still accounts for around 50,000 deaths per year in the U.S., down from a peak of over 400,000 in 2021. COVID-19 is still the 10th leading cause of death in the U.S., putting it about on par with influenza and pneumonia. 

Experts emphasize that messaging matters. Calling COVID endemic risks sending a signal to the public that the risk is gone, when it’s not. If you’ve traveled recently, you probably noticed that masks are sparse, even in crowded airports. Test kit sales are down, and most people don’t bother to isolate after an exposure. 

Even though COVID has become more like a “normal” respiratory virus, apathy is the wrong response. Getting vaccinated, isolating when sick, and masking in public are still valuable prevention strategies. 

What the COVID endemic means for healthcare workers

As a doctor or clinician, how you talk about COVID-19 matters. Research shows that trusted healthcare experts can effectively change people’s health-related beliefs and behaviors, especially around COVID-19. Ensure you’re up to date on how you talk with patients about preventing the spread of respiratory viruses when they’re sick. 

In addition to being an effective messenger, clinicians should continue to follow CDC infection control guidance for SARS-CoV-2. Posted guidance is still relevant, even though the federal government ended the official COVID-19 Public Health Emergency in May 2023. 

As we move into the COVID endemic, staying up-to-date on vaccinations, wearing PPE, and testing can help prevent the virus from spreading and save lives.