Covid-19 could become “endemic”: what does that mean?

The Covid-19 pandemic in Francedossier

We have heard a lot in recent days that Covid could become an endemic disease. An evolution that is presented as a possible way out of the crisis.

Question asked by Thomas, on January 13

The frenetic rate of contagion linked to the omicron and the less dangerous nature of this new variant could open a way out of the health crisis. The European Medicines Agency (EMA) estimated, during a press conference this Tuesday, that we were going “towards an endemization of the virus”, before recalling that Sars-CoV-2 “still behaves like a virus pandemic and the emergency of the omicron makes this clear”.

“We must not forget that we are still in a pandemic. However, with the increase in population immunity, and with omicron there will be a lot of natural immunity in addition to vaccination, we will move quickly towards a scenario closer to endemicity”, continued Marco Cavaleri, head of vaccine strategy at EMA.

This idea is not new, because already in May 2020, the World Health Organization indicated that “this virus could become endemic in our communities, [et] never disappear”. At that time, when the hope of eradicating the virus still seemed possible, the news had not been enthusiastically broadcast by the media.

Permanent and stable circulation

What is an endemic? The term endemic allows, above all, “to designate a space where a virus spreads”, explains virologist Bruno Lina. It is a permanent resident virus in a certain geographical area or population, such as dengue in transit areas where mosquitoes are carriers.

In the scientific literature, this expression also describes a permanent and stable circulation. “It refers to a virus whose presence is relatively constant in a population with largely predictable patterns and with a stable group of infected hosts capable of transmitting it to others,” adds the European Medicines Agency. But “this endemicity can be accompanied by epidemic outbreaks, which for respiratory viruses easily acquire a seasonal character when lower temperatures favor the circulation of viruses”, notes Arnaud Fontanet, professor at the Institut Pasteur. Thus, an endemic disease can also cause the emergence of an epidemic during a certain period, as in the case of the flu or the common cold.

In these situations, we can then speak of an endemo-epidemic disease. This is one of the hypotheses mentioned for Sars-Cov-2, since in Spain the health authorities are preparing a Covid management plan similar to that of other winter respiratory diseases. Note that the adjective endemic characterizes the mode of circulation of a disease and not its severity. Thus, life-threatening diseases (AIDS, tuberculosis, malaria) are considered endemic in certain regions of the world.

“Russian flu analogy”

However, according to the analysis of the scientists interviewed, the endemization of Sars-Cov-2 could be accompanied by a decrease in its severity. “This permanent circulation of the virus means that our immunity is regularly stimulated and strengthened with each encounter with the virus. In fact, the clinical manifestations of the disease are attenuated over time in people who are increasingly better protected”, Arnaud Fontanet develops.

Then only a booster dose of the vaccine would be necessary for the most fragile people, in the fall, before the virus circulation accelerates. “We can make the analogy with the OC43 virus [présumé responsable selon certaines études d’une très grave épidémie, aussi appelée grippe russe, ndlr] that emerged at the end of the 19th century. One hundred and twenty years later, this virus that produces a mild infection is still present. Eventually, Sars-CoV-2 can do the same”, analyzes Bruno Lina. As long as, in particular, a new variant “very different from the previous ones that could temporarily call into question this balance that is being installed due to a very pronounced virulence and immune escape capacity” does not appear, says Arnaud Fontanet.


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