Short Wave - What COVID Going Endemic Means For You

Episode Date: August 21, 2024

U.S. health officials now say COVID-19 is an endemic disease. That means it's here to stay – circulating fairly regularly like the flu. Even though that changes how public health officials think about managing the virus, they say it doesn't mean being less cautious or vigilant during surges, like the current one this summer. COVID still poses significant risks for older individuals and those with underlying conditions — and anyone who gets COVID is at risk of developing long COVID. NPR science correspondent Rob Stein reported this story. Read Rob's full story here.Interested in hearing more COVID or health news? Email us at [e-mail]. See pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences.NPR Privacy Policy

You're listening to Shortwave from NPR. Hey, shortwaivers, Regina Barber here with NPR health correspondent Rob Stein. Hey, Rob, welcome back. Hey, Regina. It's so great to be back. Do you remember something called COVID-19? Yes, I definitely do. That is this disease that caused a pandemic that devastated the world, I believe.

That's right. Okay, so why the trick question, Rob? What's going on? Because you don't really. hear much talk about COVID anymore, right? That's true. Even though we're in the midst of yet another big wave of infections and lots of people are still getting it. Yeah, funny enough, I had it last week and I wasn't in headquarters all last week. Luckily, I'm testing negative now and I'm back to work, but it is strange. Like, it's, it's as if everyone has it yet really no one's really

talking about it in the public conversation. Yeah, yeah, exactly. But gosh, Regina, I'm so sorry that you had COVID again. I had it in April. and then again in early July. So I know it is no fun, but I'm glad you're feeling better. And, you know, Regina, all this kind of got me thinking. Rob, you know, thinking can be dangerous. Tell me about it. That is so true. Okay, but seriously, what have you been thinking about exactly? About whether COVID is here to stay on a regular kind of permanent basis and has become

what epidemiologists call endemic, kind of like, you know, the flu. So let me guess. Today on the show has COVID. God endemic. Exactly. Okay, Rob, I'm looking forward to you walking us through the evolution of COVID and what it means for how we should navigate it in the future. You're listening to Shortwave, the science podcast from NPR. Rob, I'm thinking it might make sense to start with some basic definitions. Oh, I love definitions. You know, just call me Rob Medical Dictionary Stein.

That is your legal middle name, I think. Yeah, yeah. My parents were very prescient. They're like, this is what you're going to do. Okay, medical dictionary. So since COVID first erupted and started spreading across the globe four years ago, we've been referring to this new, highly infectious respiratory disease as causing a pandemic. Like, what does that mean exactly? Yeah.

So a pandemic is basically when a new disease starts spreading widely in different countries around the world. The world has seen, you know, many pandemics over the years, including the notorious Spanish flu pandemic that began in 1918. and the AIDS pandemic that started in the early 80s, and of course the COVID pandemic that erupted in 2020. So it's kind of like denoting the dynamics of a disease at like a specific moment or period in time, right? Yeah, yeah. That's basically it.

That's basically it. Okay. So what is the definition of endemic? So the definition of endemic is much fuzzier. You can get different definitions depending on who you asked. But generally it's a disease that's become kind of entrenched in a problem. place, forcing people to learn how to live with it, like, you know, malaria is in many countries in Asia and sub-Saharan Africa.

Here's how Caitlin Rivers defines endemic. She's an epidemiologist at the Johns Hopkins Center for Health Security. Indemic means that a bug circulates regularly. It's not a sometimes event. It's most of the time event. And that, to me, sounds a lot like COVID these days, doesn't it? Yeah, totally. But what do, like, health officials?

Like, what do they say? Good question. I was wondering the same thing. So I reached out to the Centers for Disease Control and Prevention to ask. The CDC put me in touch with one of their top experts, Aaron Hall. He's the deputy director for science at the CDC's coronavirus and other respiratory viruses division. And here's what he told me. You know, at this point, COVID-19 really can be described as endemic throughout the world.

Oh, wow. Okay. So he thinks it's not just endemic in the U.S., but also, like, globally. That's right. And he said that kind of shifts how public health officials think about managing COVID. It is still a very significant problem, but one that can now be managed, you know, against the backdrop of many public health threats and not as a sort of a singular pandemic threat. And so how we approach COVID-19 is now very consistent with how we approach other endemic diseases.

Wow. So what do other experts think about this assessment? You know, I was wondering that as well. So to find out, I reached out to Dr. Ashish Jha. He's the dean of the Brown University School of Public Health who served as President Biden's COVID-19 response coordinator. Yeah, I think in the way that most people think about the notion of endemic, something that's just around that we have to manage on an ongoing basis. Yeah, absolutely. COVID is endemic in that way. Wow. So it seems like there's like no debate anymore. Is there like a consensus that COVID is now considered endemic? Well, not quite so fast. There definitely is still a little.

debate about this. Some say, look, this virus is still pretty unpredictable. This summer surge, for example, started surprisingly early, and it's turning out to be way bigger than expected. Caitlin Jenelina is an epidemiologist who writes the newsletter, your local epidemiologist. There's still a lot of unpredictability with this virus. And a lot of scientists, including myself, think it's going to take at least a decade for SARS-CoV-2 to really find this really predictable pattern. I hope that over time it will fade into the background, but we're just, we're just not there yet. Ooh, okay, fade into the background. Like become a disease we're just much more used to managing. We know how to do that that we don't acutely stress out about.

Yeah, yeah. She's making the argument that COVID would have to settle into some kind of predictable pattern in order to be considered endemic, you know, kind of like the flu every winter. Okay, so what do, like, public health experts that you talk to, like Ashish and the CDC say about that argument then? Ashish and Aaron from the CDC ignores that COVID remains unpredictable, but they argue it's predictable enough at this point to be considered endemic. Yeah. And so we're just seeing waves every winter and summer now and have been seeing them for years. Yeah. Here's Aaron again.

The best way to describe COVID-19 right now is as endemic, but with these periodic epidemics. And those epidemics can vary in terms of their timing and magnitude. And that's exactly why ongoing vigilance and surveillance is critical. Endemic doesn't mean like COVID's nothing to worry about anymore, right? No, not at all. I talked about this with William Hannage. He's an epidemiologist at the Harvard Chan School of Public Health in Boston. Endemic doesn't necessarily mean good.

Tuberculosis is endemic in some parts of the world. And malaria is endemic in some parts of the world. and either of those are good things. You know, Gina, malaria kills more than 600,000 people each year. Diberculosis kills more than 1.3 million annually. So, you know, just because the disease is endemic doesn't mean it's not a nasty thing. Right. I mean, COVID is clearly not a good thing either, like by a long shot.

Not at all. You know, according to a new CDC report, COVID did drop from the third leading cause of death to the 10th spot in 2023, but it's still killing close to 50,000 people. a year in the U.S., mostly older people. So COVID's still a bigger threat than, say, you know, the flu. Here's Michael Ulsterholm. He runs the Center for Infectious Disease Research and Policy at the University of Minnesota. We have to be very careful in just writing this off and saying, well, it's now a mild infection. It's not. It is particularly a significant risk for serious illness among those who are older, those who have underlying immune conditions. They still really run the

risk of serious illness. The good news is, for most, you know, younger, otherwise healthy people, this will be like having a, you know, a flu virus infection for a couple of days in bed. Yeah, I mean, even though some people might not get like sick or even die, it's pretty miserable. Like, it'll knock you out of work and school. It did for me, right? That's right. That's right. And we can't forget about long COVID. You know, that remains the real boogeyman for a lot of people out there. It's the thing I kind of worry about. Yeah. And the risk for long COVID doesn't go away, no matter how many times you've had it. I talked about this with Sam Scarpino.

He studies infectious diseases at Northeastern University in Boston. And just like some of the other experts I talked to, he was pretty wary about writing off the seriousness of COVID just because it's an endemic disease. I certainly hope that this is not our new normal for COVID. You know, I had it a few weeks ago, and just about everybody that I know has had it. It would be a real bummer if we're in the situation where we've got, you know, COVID, and then we get into the fall with RSV and then we've got influenza, and it's basically like year-round respiratory infection risk.

And you know, Tina, whether we call COVID endemic or not, scientists are going to have to keep a close eye on the virus for any, you know, new dangerous variants that emerge. And people are going to need to think about protecting themselves for the foreseeable future by, you know, getting an updated vaccine once or twice a year, like one of the vaccines that's going to get approved or authorized later this week and then become available right after.

that. And, you know, people are still have to think about masking up in dangerous, risky situations like crowded bus stations or theaters or airports or also around people who are at high risk to protect them. Right. Well, I am kind of excited about the booster. But, I mean, it's going to be an uphill battle, right? Because I remember, like, most people skipped the last booster, didn't they? And like, I don't know about you, but I'm not seeing many people masking anymore, you know, during the summer and this big surge. So. You know, let's hope. Let's hope. But, you know, it's true. Most adults that were eligible for the last COVID vaccine update never got one. So clearly there's not a lot of demand anymore. And most people are clearly done with the whole mass thing. Here's a sheesh again from the Brown University School of Public Health.

We just say, okay, learning to live with it means we're just going to let it do what it's doing. The burden on our society is going to be very high. We're going to see, you know, majority of Americans get infected every year. we're going to see a lot of older Americans die unnecessarily. A lot of kids are going to miss school. A lot of adults are going to miss work. We can do better and we should do better. We should demand and expect that we can do better than that.

So he's hoping that, you know, by encouraging more people to get vaccinated and to wear masks when it makes sense and things like developing better treatments and maybe even new vaccines and also improving the ventilation buildings, all that could really make a big difference. Yeah. And actually, like speaking of vaccines, I was hoping that this year they'd be one shot. that had like the COVID booster and the flu shot in one? Is that going to happen anytime soon? Yeah. It probably is going to happen eventually. A lot of companies and researchers are working in that sort of thing.

But it probably won't be ready. It definitely won't be ready this year. Maybe next year we'll have to see how the research goes. Oh, well, at least I can get my booster shot and my flu shot at the same time this fall, right? Yeah, totally. And so folks, please get those vaccines, wear masks. It will make the holiday plan so much better, not to mention help those, like you said, with immune systems that are not doing so well during this huge surge now and maybe a huge surge in the future. This isn't going to go away.

That's right. That's right. It's totally safe to get both vaccines, maybe at the same time, maybe one in one arm, one in the other arm, whatever is more convenient. And, you know, this is the sort of thing people are going to have to think about because if COVID is an endemic disease, we're going to have to live with this maybe forever. Well, Rob, we're going to have to leave it on that, like, serious note. And I want to thank you so much for sharing your reporting with us today. Oh, sure, Regina. It's great to be back with you. This episode was produced by Rachel Carlson and edited by our showrunner Rebecca Ramirez. Rob checked the facts. Diane Weber edited the broadcast version and the audio engineer was Robert Rodriguez.

What do you think about this show? Why don't you tell us? Write to shortwave at npr.org. I'm Regina Barber. Thank you for listening to Shortwave. from NPR.