What’s the Difference Between a Pandemic and Endemic?

On March 11, 2020, the World Health Organization said the word that has haunted us on repeat for nearly two years: Pandemic. Now, with more Americans catching the less severe (but still very contagious) Omicron variant, another -emic is making headlines. Enter: Endemic. But what does that mean? We’re breaking down the concept. And how a virus’s spread can move from pandemic to endemic. 

Pandemic vs Endemic: What's The Difference?

Time for a quick vocab lesson. First, to understand what a pandemic is, we have to talk about epidemics. (Yes, another ‘-emic’). That’s when a disease spreads quickly at a high rate. Specifically, when the case number of a disease surpasses what’s normally expected in a population. Past examples are yellow fever, smallpox, measles, and polio. 

A pandemic is basically a traveling epidemic. It’s when an epidemic spreads across multiple countries or continents. And when large groups of people are infected. See: The 1918 Spanish flu, HIV/AIDs, and the 2009 swine flu.

• COVID-19’s transformation: When the virus first began spreading in Wuhan, China in December 2019, it was an epidemic. But when it spread across several countries a few months later, it became a pandemic.

Now, for our next ‘-emic’ let’s define endemic: That’s when a virus is always hanging around. But it’s limited to particular areas. And spreads in predictable patterns at an expected baseline. This usually happens when a community reaches herd immunity — both from vaccinations and natural infection. One example: Malaria is considered endemic in certain countries like India, Indonesia, and Myanmar.

• Flu knew?: The seasonal flu is another common example of an endemic in the US. But, plot twist: Different strains of the flu can result in epidemic or pandemic status. Rumor has it, COVID-19 could follow a similar path.

Dr. Kavita Patel is a primary care physician in DC and a former policy director in the Obama admin. She told our team on the “Skimm This” podcast that “endemic means that [the virus] exists and it's out there, but it's not a threat. Save for certain people — people who are older, not vaccinated, etc. But it becomes limited.”

The Future of An Endemic COVID-19

The big Q everyone’s asking is: If or when will COVID-19 go from pandemic to endemic?

For that to happen, case numbers would have to first drastically decrease. Vaccinations have been widely available in the US since 2021 — giving people hope that there was light at the end of the tunnel. But the Omicron and Delta variants have caused major setbacks in the country’s COVID-19 journey — fueling another spike in cases, hospitalizations, and deaths. Example: More people died in 2021 from COVID-19 than 2020, despite widespread vaccine access.

Like we said above: Vaccinations and natural infection can help a virus become endemic. And Omicron is more transmissible than other variants — even leading to breakthrough cases. So some experts believe the variant will actually help the US reach endemic level quicker. 

Top White House medical adviser Dr. Anthony Fauci agreed that COVID-19 will probably never fully go away (aka, could become endemic). At the World Economic Forum's Davos Agenda in January, he said, “if you look at the history of infectious diseases, we've only eradicated one infectious disease in man, and that's smallpox. That's not going to happen with this virus."

If and when the US reaches an endemic phase, it doesn’t mean the coast is clear from the virus. Similar to the flu, people could need annual boosters. Or have to take other precautions day to day. Like keeping distance in high-risk areas or regularly washing hands. But it’s still unclear what an endemic COVID-19 world would look like.

“It'll feel a little more like the flu. In a bad year, when I was in the hospital, we had about 60,000 deaths in the United States from the flu,” Patel said. “That would be a ‘great year’ if it was just COVID deaths — 60,000 only. But that's where we hope we can get to when it becomes more endemic.”

Some European countries with high vaccination rates like Portugal and Denmark have begun moving toward the endemic realm. Many COVID-19 restrictions have been dialed back, while some remain. In Portugal, this means masking up in closed spaces. And providing proof of vaccination in nearly all establishments. Denmark is lifting most restrictions, but keeping restaurants and bars to limited hours.

But the road to recovery will be much longer for poorer countries (like in parts of Africa). Vaccine inequity has remained a huge problem through the pandemic, leaving low-income countries unvaccinated. Unless they get access to vaccines soon, it could take years to develop immunity.

Meanwhile, the very wealthy US (Read: ripe with both vaccines and vaccine hesitancy) will play the waiting game. Still TBD on if the end(emic) is near.

“There's…this sense that the entire world will not be paralyzed by the disease of COVID — that we have moved on from where everybody is vulnerable to where some people call it ‘endemic,’” Patel said. “Instead of the entire map going red with COVID cases, there's just little pockets of orange and red. And they’d go out as quickly as they came up. That's what we're moving towards — we hope.”

theSkimm

The past few years have been littered with various ‘-emics.’ And we're all tired of hearing about them. Experts are hopeful that we'll be able to stop calling COVID-19 a pandemic at some point. But that doesn't mean it's time to stop being vigilant against the contagious and deadly virus.

PS: Listen to the full “Skimm This” episode featuring Dr. Patel here.