Why Endemic Covid Could Lead To Another Deadly Outbreak

Topline

As more and more countries ease Covid restrictions and prepare to “live with the virus,” experts warn Covid-19 will remain a permanent fixture in our lives and could still cause widespread and serious disease, possibly even giving rise to another coronavirus pandemic in the future.

Key Facts

Endemicity “is a pattern, not an intrinsic trait of a virus,” Dr. Aris Katzourakis, an evolutionary virologist at the University of Oxford, told Forbes, and it’s possible endemic Covid could become pandemic again.  

Worrisome mutations in “endemic strains can certainly seed new” outbreaks and potentially new pandemics, he explains. 

Animals could be a potential source of these new coronaviruses with “pandemic potential,” Dr. Elizabeth Halloran, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle, told Forbes, pointing to the family of influenza viruses able to “recombine in other animal hosts” and then spread between humans.

The potential for endemic Covid to seed new pandemics adds to the experts who overwhelmingly say it is premature to treat Covid as an endemic disease at the moment—which broadly means a stable and predictable number of infections—and worry the word is being mistakenly or misleadingly used to paint an overly optimistic picture of what life after the pandemic might look like. 

“There is a misconception that endemicity is just a natural endpoint… that the disease will, on its own, become a minimal health burden,” Katzourakis says.

The virus will still need to be carefully managed to mitigate its impact on public health and Dr. John Swartzberg, an infectious disease expert at the University of California at Berkeley, told Forbes the term endemic “says nothing about how much disease [there is] or how severe the disease may be.” 

Crucial Quote

Endemic infectious diseases can become epidemic and pandemic and vice versa,” says Swartzberg. 

What We Don’t Know

How likely another Covid pandemic is. A lot remains unknown about the ongoing Covid-19 pandemic and the coronavirus behind it. While most scientists believe there is more evidence supporting the idea the coronavirus spread from animals into humans in China, we still don’t know crucial details about the virus’ origins and scientists are unsure where the fast-spreading omicron variant—which has a constellation of unusual mutations not present in other variants—came from and how it was able to emerge unnoticed. As Halloran notes, animal reservoirs can play important roles in the evolution of viruses—the coronavirus has been found in a wide array of species including mink, domestic cats and dogs, hamsters and deer—and little is known about how serious this might be or the implications it could have in managing the virus. Vaccines will also play a key role in reducing the risk of a future Covid pandemic, Swartzberg said. “Vaccinating the world’s population will reduce the chance of a new variant occurring… [which]

Crucial Quote

Though a lot of uncertainties remain, Swartzberg told Forbes “it is not uncommon for infectious diseases that are contagious to shift back and forth between endemic, epidemic, and pandemic.”

Surprising Fact

Infectious diseases affecting humans rarely go away for good, particularly once they are established. The drivers of past pandemics like cholera, plague—which caused the Black Death—and various strains of influenza are still around and infecting people today, as are other pathogens like Ebola virus, polio, malaria and HIV, which is considered a pandemic by some experts (the World Health Organization calls HIV a “global epidemic”). Just one human disease has been successfully eradicated as the result of deliberate effort: smallpox. It is “incredibly unlikely” humans will be able to eradicate Covid, Katzourakis told Forbes. Halloran told Forbes many working in the field have known eradicating Covid would be “impossible” for years. Swartzberg concurred and said eliminating the disease—effectively removing it from a specific area, like with polio in the U.S.—is “also not now feasible.”  

Tangent

Endemic Covid does not mean the disease will be infrequent or mild. Many of the world’s biggest killers are endemic diseases, including malaria and tuberculosis. Tuberculosis kills around 1.5 million people around the world every year, according to the WHO, and around 630,000 people die from malaria.  

Further Reading

Pandemic Endgame: What ‘Endemic’ Covid Means—And When We May Get There (Forbes)

How sneezing hamsters sparked a COVID outbreak in Hong Kong (Nature)

The search for animals harbouring coronavirus — and why it matters (Nature)

New York Deer Infected With Omicron, Study Finds (NYT)

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