COVID-19 Becoming Endemic Is a Matter of When, Not If

With the omicron surge and possible future variants, it's a matter of stabilizing the number of cases, says one medical director.

As we enter year three of the pandemic, amid the spread of the most infectious variant of the virus, signs could be pointing toward COVID-19 becoming endemic, says one medical director.

According to Dr. Sachin Nagrani, medical director for primary care provider Heal, during a pandemic the number of COVID cases rise and fall across the world at an unstable rate. However, for a virus to become endemic, there needs to be a prevalence of it at an expected level.

"A good example to bring it home for people is that endemic doesn't mean that its constant all the time. You can have [seasonal] variants," Nagrani said.

He noted that while 12,000 to 50,000 individuals die of the flu each year, it's an infectious disease we've come to live with as a society. COVID-19 becoming endemic will depend on the number of cases stabilizing, as well as the progression—or further mutation—of the virus.

The omicron variant has proven to be the most contagious variant of COVID by far, yet with less severe symptoms. As for new variants, Nagrani stated there will be more in the future.

"Viruses are routinely undergoing mutation as they spread around and so there are different strains of it," he said. "Strains are just changes in the DNA or mutation [of the virus]. The way we've been using the word variant is to define a strain that has spread significantly around the population."

While 'deltacron' has been mentioned in recent news as cause for concern, Nagrani explained that it's not a new variant, but rather a popularized term used to describe the infectivity of the current omicron variant and the severity of the delta variant.

COVID-19 becoming endemic is dependent on infections arriving at a stabilized state, which can happen naturally or steadily with the use of preventive measures.

"Preventive measures affect not only COVID, but also other [infectious agents]," Nagrani said, noting that there was a drop in the number of flu cases for the 2019–2020 flu season—right when individuals began taking precautions for COVID. "The trifecta of impacting the virus is preventative measures, testing, and treatments—and preventive measures are generally the most important."

As hospitals everywhere struggle to accommodate the surge of omicron variant COVID cases, healthcare workers are being stretched to their limits while also having an increased risk of getting sick. While the staffing strain is a result of COVID, looking at things from a policy perspective, Nagrani explained how the pandemic seems to have disrupted the systems previously in place.

'We have hospitals that have been traditionally designed, such that you don't have excess capacity. Having extra staff, extra beds—is not a good operating model for a hospital," he said. 'When you see surges like this from public health emergencies, we're not well equipped to handle it. So going forward, what type of public health policies are taken not just from a prevention measure but from a responsiveness measure, will be something that will be interesting to see."

He added while certain measures may not have a fixed cost, like building a bigger hospital, they may be more along the lines of setting up field hospitals and emergency centers that can be easily deployed to areas that need additional assistance.

Editor's note: This story was updated on January 26, 2022.