Most leading immunologists predict that COVID-19 will one day become endemic, a persistent but manageable threat comparable to seasonal flu, likely by the end of 2022.
That would be quite a turnaround from today. The coronavirus remains one of the leading causes of death in the United States with cases and deaths reported nearly the same this holiday season as last. All things considered, the possibility of COVID-19 becoming endemic (just another American annoyance) should be cause for great celebration.
So why isn’t the impending transition from pandemic to endemic not great news?
Part of the answer involves the news media themselves: ‘That SARS-CoV-2 may be with us forever is a grim thought,’ read the New York Times the same day Health magazine asked “When will this be over? and replied, “Unfortunately…never.”
Why so sullen? You see, at the start of the pandemic, the headlines reflected what experts believed to be true: that the pandemic would soon end thanks to herd immunity. All we needed was for 70% of the American population to get vaccinated or recover from COVID-19. And as recently as the summer of 2021, this destination seemed accessible. We thought we had COVID-19 on the ropes, ready to deliver a knockout blow. So, our nation’s collective hope, flickering one moment and gone the next, helps explain why the news of endemicity is now so grim.
Humans have a natural tendency to experience losses, even perceived ones, with far greater intensity than they experience gains. In this context, it is understandable that the label “endemic” smacks of failure rather than victory.
After all, Americans don’t compare their feelings about an endemic COVID-19 future to their wildest fears in March 2020. Instead, the benchmark — that thing that gave hope before to be ripped off – is newer. For some, it might have been a Wall Street Journal headline from February 2021: “We will have herd immunity by April.” Or the joys of May when even the most cautious among us went maskless and prepared for “Hot Vax Summer.” Or maybe some believed President Joe Biden in June when he said, “We are closer than ever to declaring our independence in the face of a deadly virus.
As the saying goes, unrealistic expectations are premeditated resentments. Here we are now, contemplating the possibility of rampant COVID with dismay and disappointment rather than unbridled optimism that one day we will have fought this formidable foe to a draw.
What the collective mental state of our nation needs now is a healthy dose of perspective. For that, here is a trio of useful reminders:
— We would never reach endemicity without an effective vaccine. It’s hard now to appreciate how ominous the COVID-19 forecast was for most of 2020. In June of that year, the US government bet $18 billion on a public health moonshot called Operation Warp Speed with the hope that scientists would develop and deliver 300 million safe and effective vaccine doses by the new year.
Success was far from a foregone conclusion. Before COVID-19 vaccines, the fastest ever developed was four years (mumps). Almost all took five years or more. Without incredible luck and even more incredible science, we would still be years away from a safe and effective vaccine.
— Whatever the variant, the number of deaths will fall with endemicity. In our current reality, the delta variant causes over 1,000 daily COVID-19 deaths (based on a seven-day rolling average). This will not be the case when our nation reaches endemicity. According to White House chief medical adviser Dr. Anthony Fauci, Americans living in an endemic world “will still be infected” and “could still be hospitalized,” but the rates of new cases and hospitalizations will be so low that COVID-19 will not have a negative impact on our society, our economy or our daily lives.
— Endemic COVID-19 will be no worse than seasonal flu. Through a combination of increased vaccinations, boosters and new antiviral treatments, the probability of dying from endemic COVID-19 will be 90% to 95% lower than in early 2020. This reflects a mortality rate between 0, 05% and 0.1%, similar to what Americans experience with the flu.
Ask yourself: if we were hoping that COVID-19 wouldn’t be more dangerous than the flu at the start of the pandemic, shouldn’t we be celebrating that outcome when it actually happens?
Of course, COVID-19 won’t be exactly like the flu when it’s rampant. For example, cases of COVID-19 will not completely disappear each summer and return the following winter like the flu. Instead, the variation will be more geographic and locally manageable. But, in terms of risk, the two diseases will be equivalent, which is cause for celebration.
It’s easy to understand Americans’ difficulty embracing rampant COVID-19. Regardless of the opponent, it’s hard to accept a draw when victory once seemed imminent. But make no mistake, endemicity will be a triumph for our nation. Whether it takes a year or more, don’t mourn the opportunity when it comes. Celebrate accomplishment.
Robert Pearl is a Clinical Professor of Plastic Surgery at Stanford University School of Medicine and on the faculty of the Stanford Graduate School of Business. From Fulcrum, a non-profit, non-partisan news platform.
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