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 By Alex Guerrero

COVID-19 seems like it’s been around forever even though it’s only been two years. And while the virus is here to stay, there’s good news. We could be reaching an endemic.

According to Dr. John O’Horo, an infectious disease specialist at Mayo Clinic in Rochester, an endemic is defined as an infectious disease circulating in a predictable manner, meaning it’s around but not seen at high levels like in the current pandemic.

“We have endemics of several illnesses frequently, like influenza is typically endemic in most years,” he said.

But in order for COVID-19, and all its variants, to reach an endemic, O’Horo and other specialists want to see rates fall and stay low. 

“When we say it’s the endemic we’re not looking for rates of zero by any means,” he said. “We’re assuming there’s going to be an ongoing background level. But we’re not seeing the same high peaks that we saw with omicron or delta before that.”

That means for a endemic to be declared, infection levels need to stay flat, whatever that number is, and that the virus not develop a new peak.

“Pandemics are really marked by unexpected spread that’s above what we would normally expect to see,” he said. “That’s why we say that whenever there’s a spike of influenza that goes above the seasonal norms for that, it’s more typical of pandemic influenza.”

And because COVID is so new, infectious disease experts such as O’Horo don’t have those numbers.

“Since we don’t have any historic comparisons for it where it’s been an endemic phase, it’s pre-mature guesswork right now for me to say. There’s not a magic number where I can point to and say ‘we’re clearly in the endemic phase.’ This is based on a trend as much as any individual number.”

But O’Horo was certain of the two causes driving the idea for an endemic.

“We are starting to see case rates fall, and given the high degree of cases that we had with omicron and prior waves and us not seeing an immediate next wave on the horizon like during delta,” he said.

The other factor is vaccinations. And that, along with the falling rates and a population becoming less susceptible to the disease through those vaccines, makes the current situation less likely to see another severe peak in the near future, according to O’Horo.

“When you talk about an endemic though, that means that it’s not over,” he said. “It’s just that it then moves into the background. … There’s always the potential for it to come back.”

He said current rules such as masking may need to stay for awhile.

“Once we hit that endemic phase I don’t expect masks to come off in hospitals or chemotherapy centers right away because the threshold for safety is a little bit different  when you’re dealing with vulnerable patients in the general community,” he said.  

But make no mistake, an endemic doesn’t mean a return to pre-pandemic normal will be on the way.

“There’s going to be some changes in several areas,” he said. “One of them is to keep an eye on vaccine eligibility and booster recommendations. For those individuals who haven’t gotten vaccinated are of course encouraged to continue to get vaxed, and those who have will have to keep an eye on that developing story of [when the next booster is available or if there will be a seasonal shot].”

And because there is seasonality to the virus, he said it wouldn’t be out of the realm of possibility to see another surge in the fall, as is common with colds and flus.

He noted an endemic can become a pandemic disease again if there were to be a shift in the disease with a new variant, as was the case with a surge of influenza in 2009.

“Fortunately that one ended up not being as bad as predicted,” he said.