The US’s pandemic era is phasing out. Here’s what that means

Erica Carbajal for Becker’s Hospital Review

CDC models predict the nation’s daily COVID-19 cases will drop about 20 percent by Nov. 13, perhaps an early signal of the beginning of the end of COVID-19’s pandemic-level status.

The seven-day average for COVID-19 cases has declined for five consecutive weeks, reaching 73,079 as of Oct. 22, CDC data shows.

After 19 months of living in a pandemic world, any other terms to describe the virus’ prevalence almost seem misconstrued. As the number of new infections continues to drop, and terms other than “pandemic” enter the lexicon used to describe COVID-19, here’s a look at what they mean and what deescalation of the virus’s spread could look like:

Pandemic 

The CDC defines a pandemic as “an event in which a disease spreads across several countries and affects a large number of people.” As COVID-19 began to spread outside of Wuhan, China, — where the novel SARS-CoV-2 virus first appeared — no country was left untouched. Now, confirmed global cases sit at more than 244.6 million, according to data from Johns Hopkins University’s Coronavirus Resource Center.

A disease is declared a pandemic when growth is widespread and exponential, though the term does not necessarily communicate information about a disease’s severity. For COVID-19, that declaration came from the World Health Organization on March 11, 2020. In the U.S., a national emergency declaration came behind the global pandemic announcement on March 13.

The travel restrictions, stay-at-home orders, widespread mask-wearing and other preventive measures that have characterized COVID-19’s pandemic-level status quickly followed.

Globally, more than 4.9 million people have died of COVID-19 as of Oct. 26, including more than 738,000 deaths in the U.S.

Public health officials have pointed to increased vaccination rates as the exit path out of the coronavirus’s pandemic-level status and to fend off the emergence of new variants.

Epidemic

When COVID-19 was first identified in Wuhan, China, and its spread was limited there, the outbreak was an epidemic.

Epidemic-level outbreaks refer to a sudden increase in the number of cases within a geographical area. When the COVID-19 outbreak crossed borders, it elevated from an epidemic to a pandemic.

In the U.S., historical epidemics include measles and polio outbreaks. Nearly all children in the nation got measles by the time they were 15 years old in the decades before 1963, when a vaccine became available.

The term is also used to describe outbreaks related to health-related behaviors rather than disease spread. Smoking, for example, is often called an epidemic in certain regions where rates are high.

The term “epidemic” won’t be used to describe COVID-19 even as the rate of infection slows in the U.S. because it was a global outbreak. Thus, each country or region that continues to experience its own outbreak or epidemic collectively makes up the global pandemic.

Endemic

Health officials have said COVID-19 will always be around. Rather than the virus completely disappearing, it will likely always be in the background, circulating at a manageable rate much like the flu.

As the CDC puts it, an endemic is the “constant presence and/or usual prevalence of a disease or infectious agent within a geographic area.”

Moving down into an endemic-level phase is largely considered a mark of success when it comes to COVID-19 in the U.S., because it means a transition out of pandemic emergency mode with high hospitalizations and strained healthcare resources.

“We’re seeing it more as a chronic problem than as an immediate, huge pandemic problem like we were before,” Mangala Narasimhan, DO, a critical-care pulmonologist and director of critical-care services at New Hyde Park, N.Y.-based Northwell Health, said of the latest COVID-19 surge.

In New York City, COVID-19’s move toward an endemic is starting to unfold, with the number of confirmed cases reported at the height of the delta surge in late summer and early fall of this year about one-third of the peak during last year’s surge. The city’s high vaccination rates and potential immunity from infections during previous waves are likely why COVID-19 has become a much more manageable problem, epidemiologists and physicians told The Wall Street Journal.

“The expectation that COVID-19 will become endemic essentially means that the pandemic will not end with the virus disappearing; instead, the optimistic view is that enough people will gain immune protection from vaccination and from natural infection such that there will be less transmission and much less COVID-19-related hospitalization and death, even as the virus continues to circulate,” said Yonatan Grad, MD, PhD, an associate professor of immunology and infectious diseases at Boston-based Harvard University T.H. Chan School of Public Health.