The word "endemic" is one of the most misused of the pandemic, contributing to a dangerous complacency about COVID-19's potential future toll, Aris Katzourakis, PhD, professor of evolution and genomics at St. Hilda's College Oxford in the U.K., wrote in a Jan. 24 op-ed published in Nature.
The CDC defines a pandemic as "an event in which a disease spreads across several countries and affects a large number of people." In contrast, an endemic is the "constant presence and/or usual prevalence of a disease or infectious agent within a geographic area."
An endemic can be wide-reaching and deadly, Dr. Katzourakis wrote, citing examples such as malaria and tuberculosis. He added that the "endemic" classification doesn't mean a return to "normal."
"There is a widespread, rosy misconception that viruses evolve over time to become more benign," Dr. Katzourakis wrote. "This is not the case: there is no predestined evolutionary outcome for a virus to become more benign, especially ones, such as SARS-CoV-2, in which most transmission happens before the virus causes severe disease."
An "endemic" classification gives no indication of duration, case rate, severity, vulnerability or death rates, according to the professor, who added that health policies and behavior determine what form endemic COVID-19 takes.
The "lazy optimism" about endemic COVID-19 must be replaced with more realistic projections on future levels of death, disability and illness, according to Dr. Katzourakis. The world must recognize the risk for new variants to emerge when considering reduction targets and invest in vaccines to protect against a broader range of variants, among other actions, he said.
"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," he concluded. "It is more productive to consider how bad things could get if we keep giving the virus opportunities to outwit us. Then we might do more to ensure that this does not happen."
View the full op-ed here.