Is the virus endemic?

New York Times, August 3, 2022

Even though people across the world are trying to move on from Covid, it’s still here, all around us.

Case in point: Half of all infections during the pandemic have taken place this year, as noted by my Times Opinion colleague David Wallace-Wells. Given the current pace, it’s possible that more than 80 percent of all Covid cases will ultimately take place in 2022, he said.

David writes a newsletter for Times subscribers that explores science, climate change, technology and the pandemic. He recently wrote about what endemic Covid would be like. (It’s not good.) I caught up with him to learn more.

Have we reached endemicity?

That’s a complicated and controversial question, in part because it means different things to different people. But one way of thinking of it is that endemicity is what happens when the average infected person infects fewer than one other person. And that is not the case. With these new variants, the average person has been infecting many more than one person. So, by that standard, we’re not in an endemic state.

But we are in a place where the basic footprint of the disease has been pretty consistent. We’ve been at roughly the same number of hospitalizations and deaths in the country since the end of the initial Omicron wave in the winter. And because so much of that has to do with how much better our immune systems are working against Covid than in the past, there’s probably no reason to think that those dynamics are going to dramatically change unless there’s an out-of-left-field new variant like the original Omicron.

And I think that fits the layperson’s understanding of what an endemic disease is: It’s circulating, but it’s sort of in the background, and while there are some little peaks and some little valleys, they aren’t so dramatic that they threaten to really upend life at a community level, let alone at a national level. That’s a pretty fair description of where we are right now.

So by some definitions we have made it to endemicity. Now what?

Now we can begin to see the tragic outline of what it means to live through a once-in-a-generation or once-in-a-century pandemic. Epidemiologists I’ve spoken to have cited an annualized death rate of 100,000 a year. That would make Covid our most deadly infectious disease. It puts it in the neighborhood of things like diabetes. It’s as though we’ve never heard of diabetes in the fall of 2019, and all of a sudden, we have diabetes. That’s despite the incredible pharmaceutical interventions and innovations from the vaccines and therapeutics. And it’s quite grim to think about that.

What do the coming months look like?

There are a lot of variables. But if I had to sort of synthesize all of them, I would say that I think it’s likely that, for the foreseeable future, we’re living primarily with Omicron variants. That means the virus will find new ways to evade our immune response without totally eliminating the immune protections that we carried before.

In the fall, we will begin to see some limited rollout of new next-generation vaccines, but they won’t fundamentally change the trajectory of immune protection going forward. And we have very limited implementation of other social and political measures, such as mandating better air quality in schools and transportation systems and things along those lines.

Where does that leave us?

If I were telling the narrative, ironically, it would probably be the same story I would have told in the spring of 2020, which is to say that this is really an old person’s disease now. That was true at the beginning of the outbreak, but it’s becoming even more true now. It’s quite possible that we’ll see increasing relative vulnerability among the old, which is to say people who are in middle age are going to feel pretty safe living a totally normal life. But people of their parents’ generation may not ever. That’s because they have a much harder time building up immunity, which means they lose the benefits of the vaccines and previous exposure much more quickly.

We’re also seeing a significant death toll this year. We’ve more or less normalized it. We could have roughly equivalent numbers of especially elderly people dying as we did in the first years of the pandemic — and that’s tragic.