From pandemic to endemic: this is how we might get back to normal

U.S. News by Yasmin Tayag Updated for January 2022

Covid-19 is unlikely to be eradicated, experts say, but societies in the past have learned to live with diseases.

First, the bad news. With unpredictable outbreaks still occurring around the world, and variants like Omicron raising questions about the virus’s contagiousness, we are very much still in a pandemic.

The good news: while it’s difficult to predict the exact timing, most scientists agree that the Covid-19 pandemic will end, and that the virus will become endemic. That means the virus will probably never be eliminated entirely, but as more people get vaccinated and become exposed to it, infections will eventually arise at a consistently low rate, and fewer people will become severely ill. An area where vaccination and booster rates are high will probably see endemicity sooner than a region with lower rates.

What does that transition look like?

In practical terms, there will be an announcement. The World Health Organization and local health agencies will officially declare the global pandemic over, a designation informed by certain biological and statistical benchmarks: the virus’s contagiousness, mortality rate, and power to overwhelm hospitals, to name a few.

In some places, like the US and other wealthy nations with ready access to vaccines and antiviral treatments, endemicity could look a lot like the present: People emerging from despair, diners piling into restaurants, and vaccine cards being checked with decreasing rigor. But there could be other, more profound societal changes as well.

To understand how daily life will change if Covid-19 becomes endemic, we can turn to history for a useful (if imperfect) guide.

A shift in attitudes and behaviors

People generally respond to epidemics with fear and panic, on the individual level and as a society. According to Charles Kenny, a director at the Center for Global Development and author of The Plague Cycle, these reactions reliably take shape in some now-recognizable ways: shutting down borders, sequestering the sick, and withdrawing from society.

Until the advent of modern medicine, all people could do was hope (and pray) for outbreaks to subside on their own. When it became clear that a disease was inescapable –or endemic– societies would often make strides to reframe the illness as a regular part of life. This may also become true of Covid-19.

Kenny’s book offers one potential preview. In 17th-century Japanese cities, attitudes about smallpox shifted as the disease became endemic; by then, most people had already been exposed as children and subsequently recovered. Once people accepted “that everyone’s going to get smallpox”, Kenny says, they ritualized and normalized it as a childhood milestone, making it a part of the “growing-up story”.

It’s too soon to say how this process of normalization will unfold regarding Covid. However, if infections turn out to become a normal part of the winter months, they may simply get absorbed into what’s known as cold and flu season. Much as with smallpox in Japanese cities, that change will be reflected in people’s language and day-to-day expectations. Already, some are beginning to use the term “Covid season”.

Effective medical interventions also make it easier for societies to accept the thought of coexisting with illness. “My parents were terrified [of polio],” says Nancy Tomes, a history professor at Stony Brook University and author of The Gospel of Germs. Tomes, on the other hand, was a part of “the generation that went to the local high school and got the sugar cube,” referring to a common dispensation method for an orally administered polio vaccine.

“We stopped worrying about polio after that,” Tomes says.

Though Covid remains prevalent, the advent of effective vaccines swiftly altered the scope of its threat. In March, when just 9.2% of Americans were fully vaccinated, the Centers for Disease Control and Prevention relaxed its social distancing guidance to allow immunized people to gather indoors. And on Thanksgiving, Joe Biden declared that the US was “back” from pandemic hibernation – despite the nearly 100,000 new Covid-19 cases still being confirmed each day.

Finger-pointing and misinformation

Unfortunately, history suggests that some negative pandemic-related behaviors tend to persist after a disease becomes endemic or is eliminated. One of these is the disproportionate targeting of groups perceived as “outsiders” within the dominant society. When the pandemic subsides, says Kenny, the social restrictions likely to remain “are the ones that affect minority groups”.

Imposed in 1987, America’s xenophobic and homophobic travel ban on people with HIV lasted for 22 years. And today, people wrongfully associated with Covid, like those from Asia or Africa, are still being harassed and shut out despite the full understanding that the coronavirus isn’t discerning of race.

A propensity for misinformation and conspiracy theories has also been associated with epidemics – “a shit show”, says Tomes, with a legacy “that goes all the way back to every epidemic that we have any written records of”. Some of these mistruths prove to have staying power. “There are still people who don’t believe that HIV causes AIDS,” she says.

During pandemics, groups of people also become susceptible to developing extreme views on topics that stir up strong opinions – like vaccination and personal liberty – which they may not have initially held. Even once a pandemic has ended, that phenomenon of “group polarization” may remain “lingering in the background,” says Steven Taylor, a psychology professor at the University of British Columbia and author of The Psychology of Pandemics. That polarization is liable to “get stirred up again when something similar arises” in the future.

Knowing what we can’t know (yet)

Importantly, the return to normalcy won’t happen evenly across the globe. After people in wealthy nations ease into endemicity, those in the global south may continue to grapple with the coronavirus for a long time, as has been the case for a host of tropical diseases that have been all but forgotten in places like the US.

Like all the infectious diseases that gripped the world before it, Sars-CoV-2 will hopefully fade into distant memory, for better or worse. This forgetfulness can bring relief, growth, and recovery, but it could also leave us woefully unprepared for the next pandemic. The 1918 flu taught us that masking and social distancing could reduce deaths, says Kenny – a lesson that we relearned too late in 2020.

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