From Pandemic to Endemic

Updated 20-Sep-2023

In February, the state of California announced it was going to begin measures treating the Covid-19 pandemic as endemic though it did not use that word. The realization that there is no end date is poignant.

> There is no end date for Covid-19

Resignation in the face of an Endemic Pandemic

In some sense this is resignation to the fact that we've done all we can, that those who will not help keep our countries and our people safe have stopped us from the goal of eradication or herd immunity, if either were ever possible. China continues to strive with a zero covid approach, but they have much greater command over their society, in terms of communication, police, and people. It seems that reason and reasonableness can only take us so far, in the face of relentless disinformation spread through mainstream news (Fox) and social media. The weaknesses of the open society have never been so clearly revealed.

Endemic Public Policies

That said, public policies will continue, for the foreseeable future, to navigate what is a workable line between public health restrictions and economic stability. In Thailand, with 20,000+ new cases per day and eight times that amount in reported ATK tests, it is a question of what to do about provincial restrictions and the ongoing restrictive policies for inbound tourism. The infection rates have prompted the US government to recommend only necessary travel to Thailand, while at the same time it has four times the death rate of Thailand with nearly the same number of new cases (though with a much larger population).

Declaring a pandemic endemic is an issue of semantics, as all the hard questions are left unanswered: what does that mean? What do we do next? It seems the old answers are still relevant: vaccinations, masking, social distancing, and testing. The questions remain as to how much or how enforced these actually should be. It seems obvious to me that all these should be mandatory if there is a risk of serious disease or death. That does seem astoundingly obvious, but obviousness is not everyone's strong suit.

Endemic Vaccinations

For the rational human, vaccinations should be done as per doctor recommendations. Masking should be done in public settings. Social distancing when possible in crowded conditions and especially when unmasked. For those settings which require hours-long close proximity, such as schools, then regular tests should be performed. I do see the obvious problem when perfectly healthy people show up as positive. Because of previous contact, should a classroom and all the children's family be quarantined? Should an entire school shut down? When most people are asymptomatic, this of course makes no sense. At the same time, some people willfully disregard public health standards and senselessly infect others, while ignorant of their status. This is true of other viruses and infections, where parents send sick children to school with wanton abandon. However, with Covid-19 the risks are much higher, with severe illness and death occurring, even in the vaccinated.

Still a Pandemic

The extreme takeoff of Covid-19 recently in Vietnam, South Korea, and in Europe portend that while we have shifted from Pandemic to Endemic, the war is not over, and new serious outbreaks worthy of the term pandemic are still with us. Ultimately, endemic means we have to grapple with these issues interminably.