Health·CBC Explains

People say they want COVID-19 to become 'endemic.' But what does that really mean?

Canada is not yet at a stage where people can live with the coronavirus and return to normal activities and it's dangerous to misuse the word "endemic" to suggest that, infectious disease experts and epidemiologists warn.

'Dangerous' to misuse term and become complacent at this stage, experts warn

People wearing masks as a countermeasure to COVID-19 walk through the snow in Toronto on Dec. 8, 2021. Two years into the global coronavirus pandemic, Canadians are weary and want to know when they can get more normalcy back. (Evan Mitsui/CBC)

As Canadians grow increasingly weary after two years of COVID-19, many people are tossing around the term "endemic" as an expression of hope that we're moving into a stage where we pull back public health restrictions and live with the virus.   

"The word 'endemic' has become one of the most misused of the pandemic. And many of the errant assumptions made encourage a misplaced complacency," Aris Katzourakis, a professor of evolution and genomics at the University of Oxford in the United Kingdom, wrote in an article published in the journal Nature earlier this week. 

"Thinking that endemicity is both mild and inevitable is more than wrong, it is dangerous: it sets humanity up for many more years of disease, including unpredictable waves of outbreaks."

It also falsely suggests the pandemic is nearing an end in Canada and other wealthy countries, infectious disease specialists and epidemiologists say — but this is a stage when public health measures remain critical. 

"Here's what [endemic] doesn't mean: It doesn't mean where we're at right now," said Dr. Isaac Bogoch, an infectious diseases specialist with Toronto General Hospital. 

"We're seeing health-care systems stretched and society significantly impacted by the virus. That's not endemic. That's still pandemic."

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"Endemic" means a virus is present in a region at a stable level, without the rising and falling waves of infection that we've seen so far throughout the coronavirus pandemic, experts say. 

Endemicity occurs when "the natural replication of a virus is balanced out by the built-up immunity in the population, resulting in an overall stasis — a constant number of cases in the community," Katzourakis said in an interview with CBC News. 

That immunity is achieved through vaccination and recovery after natural infection.

A seven-year-old girl gets her first COVID-19 vaccine at Ma Mawi Wi Chi Itata Centre in Winnipeg on Nov. 25, 2021. (Marina von Stackelberg/CBC)

In an endemic state, the reproduction number of the virus — a measure of how contagious it is —hovers around one, "so it's not declining and it's not increasing," said Dr. Raywat Deonandan, an epidemiologist at the University of Ottawa. 

Endemicity says nothing about how badly the disease affects people, he said. 

For example, malaria is endemic in many parts of the world and is one of the most deadly diseases for young children, according to UNICEF.   

"Politically, the word [endemic] seems to be being conflated with: 'We're done with this and let's move on,'" Deonandan said. 

That's clearly not the level we're at with COVID-19 right now, which is unsustainable for health-care systems, both Deonandan and Katzourakis said. 

What could endemic COVID-19 look like?

When many people say "endemic," they often mean they want to see COVID-19 brought under control, said Deonandan. 

That's the point when a disease "pesters us all the time but we have a handle on it," he said. 

Some people will still get sick, especially those who are particularly vulnerable. 

For example, seniors, young children and people who are immunocompromised are at higher risk of becoming seriously ill with the flu and need to be protected — including with vaccination. It will likely be a similar situation when COVID-19 is brought under control, Bogoch said. 

How do we get to that point with COVID-19?

Experts agree that COVID-19 will continue to be a threat in rich countries like Canada until significantly more people in all countries are vaccinated. 

If rich countries truly made global vaccination a priority, Deonandan said, the virus could be under control within months.

A man registers at a COVID-19 vaccination centre in Douala, Cameroon, on Dec. 29, 2021. Experts say the faster people in developing countries get access to COVID-19 vaccines, the faster the coronavirus will be under control everywhere. (Josiane Kouagheu/Reuters)

Dr. Tedros Adhanom Ghebreyesus, director general of the World Health Organization, recently made a similar statement, saying that if a global target of 70 per cent vaccination is met, the "acute phase" of the pandemic could end this year.   

"You cannot solve a global problem locally," Deonandan said. 

In undervaccinated countries, coronavirus spread cannot be controlled — and that's where new variants arise and then rapidly travel. 

"If we help the rest of the world control COVID well, there'll be no variants coming out of those countries anymore," Deonandan said. "This horrible, atrocious movie can come to an end."

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We've now seen the damage variants can do even in countries where the majority of the population has been vaccinated, including Canada and the U.K., Katzourakis said. 

"The Omicron variant is a shot across the bow of what vaccine inequity might do. 

"You could spend a huge amount of resources and effort to vaccinate everybody in Canada and the U.K. but then be threatened by a variant that's arisen elsewhere that is able to evade your vaccination efforts. And that is an incredibly wasteful way of trying to solve the problem."

Helping developing countries vaccinate their population means not only providing enough vaccine doses, but also sending them with enough lead time to get them into people's arms.

Vaccine donations can't be 'table scraps'

"You can't give table scraps," said Bogoch, who has worked extensively in developing countries in Africa. 

"You have to give vaccines that don't expire imminently.

"Sadly we've seen many lower-income countries receive these donations and they've had to discard these vaccines because they had such a short time to expiration, which is tragic." 

In an emailed response to CBC News, a spokesperson for federal International Development Minister Harjit Sajjan said that Canada has "already made 98.8 million doses available to COVAX [the agency co-ordinating COVID-19 vaccine donations to developing countries]."

Canada has committed to providing up to 200 million doses — in actual vaccines or monetary support — by the end of 2022, the statement said.

"Minister Sajjan has raised vaccine equity and the need to ensure timely delivery of vaccines to the Global South when meeting with his counterparts and partners," the email said. 

"We continue to collaborate with COVAX and the global community so that vaccine dose rollout is done in an equitable and timely manner."


Nicole Ireland is a reporter with The Canadian Press.

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