With prospects of herd immunity fading, endemic COVID-19 is upon us, and new “whole of society” approaches are needed.
A world that has been fervently hoping for a clean break with the COVID-19 pandemic may be disappointed. In many places, the pandemic continues unabated; some countries are currently suffering their highest rates of hospitalization and death. And even in areas where it has subsided, the end point continues to recede into the future. As we wrote in our most recent update to “When will the COVID-19 pandemic end?,” few locations are likely to achieve herd immunity against SARS-CoV-2.
The highly transmissible nature of the Delta variant, ongoing vaccine hesitancy, and incomplete protection against transmission by current public-health measures mean that a goal of “zero COVID-19” is very likely unachievable without stringent public-health measures. Most societies, including the United Kingdom, the United States, and much of Europe, will need to learn to live with COVID-19, at least over the medium term.
What’s happening now is not unusual. Epidemics end in one of two ways—either we close off all chains of transmission and drive cases to zero, as with all Ebola epidemics to date, or the disease becomes an ongoing part of the infectious-disease landscape, or endemic, as tuberculosis is today.¹ Occasionally, as with smallpox, a previously endemic disease is eradicated.² But, for the most part, endemic diseases are here to stay. The shift from pandemic to endemic entails a number of practical considerations, as we discuss in this article. But the shift is also psychological, as we will be deprived of the satisfaction that a clean pandemic end point would bring. Instead, societies will have to adapt to living alongside COVID-19 by making some deliberate choices about how to coexist.
Endemic disease does not mean unmanaged disease. Rather, what’s needed is a shift from viewing COVID-19 as a one-time threat that defines society to seeing it as a part of everyday life that we must learn to endure. Around 38,000 Americans die every year in road-traffic accidents—far fewer than from COVID-19 over the past year but still a significant number.³ As a society, we