Pandemic vs Endemic

Why Covid is now being called endemic instead of pandemic, and why that's even worse: 

TL/DR: Endemic means we've plateaued instead of having sudden waves of cases over and over. BUT we're plateauing at a very high rate. It means that it might not go up much, but it also means, without some serious immediate protections in place (mask, vax, and ventilate!), it also won't go down. Our current health care system cannot manage current caseload levels. 

Dr. David Fisman (check out his credentials here!) was on the Re-Sisters a couple days ago. It's an amazing podcast, and Dr. Nili Kaplan-Myrth was also on, so do give it a listen, but I'm just going to focus on Dr. Fisman's explanation of endemic here:

I actually don't disagree with Joe Biden's statement that the pandemic as a pandemic is over. I think if you look at the data in terms of deaths qualitatively, globally, we've been in a very different place for about the last 3-4 months, and I think that's great. You know, pandemics have beginning, middle and end. I think the difficulty is when a president says the pandemic's over. Everybody's eager to be done with this thing and go and time child back to 2019, and I think that's mostly how that's interpreted.

 

But you can't go back to 2019, and I think that's the difficulty as we now have a highly virulent, highly transmissible virus that infects blood vessels, that's an endemic threat. It's everywhere in the world, and it's infecting people at high, stable levels. So it's not causing these huge, massive waves.  

I do think we need to pivot to meet this different threat because we can't sustain high levels of public health mitigation indefinitely, but I also don't think that we need to. There are a whole raft of tools that we have available to us, especially in rich countries and hopefully soon in poor countries, that could be applied to make this much less impactful. Ultimately I hope we can eliminate it and eradicate it as vaccines evolve. I don't think he's wrong in saying the pandemic's over, but we're now in the era of endemic COVID, which is not a happy place to be by any means. . . .  

Epidemics are processes where infection spreads faster and faster, and the more infection you have, the more infection you get because there's more and more infectious people around and you get these massive waves that go up, burn through susceptibles and then come back down. You get these great big things that look like big waves in the ocean. An epidemic is when your reproduction number initially is greater than one and you get this explosive growth and then things coming down.

 

Endemic doesn't say anything about disease burden. . . . All endemic means is the reproduction number is sitting around one, which it is for COVID right now. That just means that each old case replaces itself with a new case before it gets better. You can have endemicity at all different levels. You can have endemicity when immune protection's relatively short, or you can have high levels of endemicity in the population, which is what we have now. So there's a lot of people around to have COVID all the time. You're not getting these wave phenomena anymore, but what you're getting is a baseline high level massive public health problem that is probably going to get a bit worse through the winter, maybe come down a little bit in the summer just because of indoor air stuff. But it's with us all the time. It's like tuberculosis 100 years ago when tuberculosis was the leading cause of death in North America, and we got rid of that. It's like, you know, a cholera in the Ganges River Delta. You know, it's there all the time. People die from it all the time. It's just a constant public health threat.

 

A lot of people are sick from this; a lot of people continue to die. The US is at 500 people a day, right 3000 people a week. Globally doing the math just based on reported deaths right now we're sort of at between 2 and 3000 global reported deaths a day. That's probably something like four or five fold underreported. So if we have 8000 or 10,000 people dying of this today, globally, you multiply that by 365, you get a couple million deaths a year. And then you have to start to factor in the fact that yeah most people don't die, but this is a bad virus so people who don't die are still injured by this virus or many of them are. So people who don't die are still injured by this virus, or many of them are. And we don't know what the percentage is who go on to have long COVID and who sustained brain damage and who sustained heart damage and who sustained lung damage. 

 

We know the figures for long COVID are probably hovering around 5-10%. They're some comments that are much much higher than that, but let's say 5-10%. Let's say it's even lower than that . . . let's just say that one or two percent will get it. We have 40 million people in Canada. We know from the BBC Sero-prevalence data that we're pushing towards infection more or less being universal. I mean, 1% of 40 million is 400,000 people. You're potentially introducing a massive amount of morbidity into the population. It's a 3 year old virus. We don't know what we know. Covid infects the brain. We know those of us, this includes me, who have had anosmia, who lost their sense of smell, we know that that's because of actual brain injury, that the virus is invading our brain. We don't know what that does long-term. 

Keep wearing your mask in public, kids!! 

ETA: BUT, I came across this thread, a year old, from Dr. Ellie Murray, with a different definition of endemic: 

Endemic means "controlled at or below an acceptable level." Acceptable differs .  .  . over time and between disease, and it may not always be explicit, but there is a threshold! . . . I don't know about you, but for me--this is too much death."

If we're calling it as endemic now, then does that indicate this level of daily deaths is acceptable?? The important thing to find out is which definition Biden, and other influential figures, are using. Did he just notice that it's in a steady state, or does he think 500 deaths/day is the new normal we have to get used to. If that's the case, then we need more hospitals and healthcare professionals, stat!