February 24, 2022
On February 25, 2022, the Centers for Disease Control and Prevention (CDC) updated its guidelines for COVID-19 risks and best practices, and now only recommends indoor masking in public for “high risk” communities. At the time of the announcement, about 70% of Americans were located in counties with low to medium risk.
Some health experts view this new guidance as a step toward the endemic phase of COVID-19, which would put it in the same category as diseases like influenza and malaria. “Endemic” status does not mean zero risk, especially to the unvaccinated, but it does mean that healthcare professionals and employers may begin to change their practices and policies.
During a U.S. Chamber of Commerce Foundation panel on this topic, members of the medical and health community discussed what “endemic COVID” actually means and what employers need to know about keeping the public healthy and safe.
Fluctuations in Transmissibility and Severity Directly Impact the Endemic
Matt Craven, a partner at McKinsey & Company, said COVID-19 went from being a transmissible infectious disease to one of the most infectious diseases among humans — especially with the Omicron variant.
“We've seen fluctuations in the severity, and that average severity really does matter for the severity of the overall waves,” he explained.
In terms of immunity, some variants are more forgiving than others.
“Omicron was pretty unforgiving for anyone who wasn't up-to-date vaccinated — meaning three doses,” Craven stated. “[It] didn't pay much attention to prior infections with other variants. This is kind of a blank slate as a population, which is part of the reason it was able to spread so quickly.”
‘Long COVID’ Is Impacting Many Recovering COVID-19 Patients
Many patients who battled COVID ended up with long-term symptoms of the virus, which professionals are referring to as “long COVID,” long-haul syndrome, or post-COVID-19 condition.
“The World Health Organization defines [long COVID] as … symptoms beginning within three months [of the onset of COVID-19] and [persistent symptoms] lasting for two months or longer,” said Francesca L. Beaudoin, M.D., M.S., Ph.D. and chair of the Department of Epidemiology at Brown University.
Medical professionals must first rule out other possible diagnoses before diagnosing someone with long COVID. Common symptoms include fatigue, shortness of breath, cognitive dysfunction, pain, anxiety, depression, and poor sleep, though they are variable and can fluctuate over time, said Beaudoin.
“We are still trying to address why this is happening, but we're learning more about who gets this,” she explained. “We know certain people are more at risk to develop these persistent COVID symptoms than others.”
Some risk factors include vaccination status, comorbidities, age, the severity of a case, and length of hospitalization. For those with severe cases, especially cognitive impairments, long COVID is now considered a disability.
COVID-19 As We Know It Will End by Becoming Endemic
According to Katelyn Jetelina, M.P.H., Ph.D., founder of Your Local Epidemiologist, and assistant professor at the University of Texas Health Science Center at Houston, the U.S. is well past its latest peak with COVID-19, as cases continue to nosedive.
“They are descending as quickly as Omnicon ascended, and so thankfully hospitalizations also continue to descend because they lag cases,” she said.
However, though death rates have also started to decrease, they are still incredibly high, with about 2,000 Americans dying every day from a vaccine-preventable disease.
“We’ve vaccinated our way out [of other pandemics],” Jetelina said. “For example … in 1955, we had a 90% effective vaccine that was introduced [for Polio]. By the end of the 1970s, Polio was eradicated in the United States. Smallpox is also a textbook example of eradicating a virus through vaccination. This takes time though, and a ton of global teamwork.”
However, she noted, because of animal reservoirs, it would be close to impossible to fully eradicate COVID-19 with vaccines alone.
“Other pandemics have ended by going into an endemic state,” she explained. “However, there are a number of misconceptions [about] what endemic means. … It doesn't mean this is game over. It doesn't mean we'll have zero cases. It doesn't mean we'll have a flat horizontal line [from] here on out.”
Instead, Jetelina noted, an endemic is a steady-state with relatively low spread, no unpredictable waves, no state-wide crises, and no calls for help from frontline workers.
“This pandemic will end, too,” she said. “So I hope that you can hold that fact close to you.”