10 Things You Should Know About Endemicity & COVID-19 Response
On March 9, Boston University’s Center for Emerging Infectious Diseases Policy and Research (CEID) and Harvard Kennedy School Belfer Center for Science and International Affairs hosted What is endemicity? What are the shared goals of COVID-19 Response? Dr. Nahid Bhadelia, Founding Director of CEID, provided opening remarks, and the event was moderated by CEID Faculty and Belfer Center Fellow Dr. Syra Madad. Panelists included Dr. William Hanage (Harvard T.H. Chan School of Public Health), Dr. Celine Gounder (Kaiser Health News, NYU & Bellevue Hospital Center) and Dr. Rodgers Ayebare (Infectious Diseases Institute, Makerere University, Kampala, Uganda).
So, what should you know about endemicity? We’ve compiled 10 key takeaways from the discussion:
1. Endemicity Can Mean Different Things To Different People.
“The epidemic phase of a disease in a theoretical environment consists of this up and down of infections, driven by immunity…and that period at the end when the amount of disease is determined by how many people are becoming susceptible because there are new people being born or people have waning immunity is considered to be the endemic phase to a [mathematical] modeler…If you talk to a field epidemiologist, they will say it just means: a relatively stable amount of disease transmitting within the community…[The] folk definition of endemicity is the amount of disease that we are willing to ignore or that we’re willing to accept as the price of living the lives that we do…” -Dr. Hanage
2. It Does Not Equate To ‘The End’ Of COVID Infections Or Deaths.
“…[Those] kinds of strategies that have been used with other infectious diseases, really are not practical with COVID and so our best hope is to control it. But then, the question is: do you control it at a high level, or at a low level?..endemicity, essentially a state of control, can still lead to a lot of disease and death.” -Dr. Gounder
Unfortunately, endemicity in itself doesn’t give us actionable information on how we decide how to defeat the virus. We might also have the myth that endemicity means the future with the virus may be better than we’ve had so far. It means we are more or less tempted to bet on the fact that the virus might play nice in the coming years, but we know that may not be the case.”- Dr. Ayebare
3. When We Assess Endemicity, It’s Important To Take Global Disparities Into Account
“…Globally, as cases go towards endemicity or even once we get there…we [are likely to observe] widening disparities in the global fight against COVID with those who have access to tools like vaccines moving on to participating in the global economy and those without having to endure long nights through the thick of the pandemic. Also, [there is a tendency to assume that] once we say ‘endemicity is here’ and we use [it] as an excuse not to care. [In such a situation,] we risk being called flat footed…” – Dr. Ayebare
4. There’s Always Potential For Future Variants And We Shouldn’t Take Our Eyes Off The Ball.
“…Predicting exactly what a variant is going to do and how it’s going to behave is very difficult and I don’t even want to get engaged in it, other than to point out …what has become something as a catch phrase for me: I never bet against natural selection. We can certainly expect that if a variant arises which is better able to transmit under the current context than those that we currently have, it will take over. By taking our eye off the ball, we are losing our ability to respond appropriately to it. We are effectively gambling that the properties of that variant are going to be relatively benign. – Dr. Hanage
5. Investing In Air Filtration and Paid Sick & Family Leave Policies Could Make A Big Difference In Reducing Infections
“I think it’s going to be exceedingly difficult…to prevent all infections. There are some measures that we still haven’t taken to scale to reduce infection. That includes improving indoor air quality through enhanced ventilation and air filtration–that can really make a difference. And that’s one that does not require individual action or compliance…Another is providing people with paid sick and family medical leave, so that they don’t have to go to work or school when they’re sick and contagious to others. Those two interventions alone could make a huge difference here.” -Dr. Gounder
6. Good Data Should Be At the Core Of Efforts To Ensure Health Equity
“Efforts to ensure health equity have to start with data. If you don’t have good data, you can’t even see those health inequities. It’s very difficult to assess the why–the what to do about it–without good data. I think one of the challenges we have is right now data that we have on race and ethnicity in particular is really incomplete. It depends on who is collecting that data on the ground and feeding that up through the system that eventually gets reported to places like the CDC. But, we often say in epidemiology and other statistics: ‘garbage in is garbage out.’ So, if you’re not really getting complete data and accurate data, you’re not going to be able to assess what those inequities are.” -Dr. Gounder
7. There’s No Shame In Erring On The Side Of Caution And Amending Our Approach As We Gain More Information
“…The other take-home lesson that I’ve taken with me from this pandemic is that there is no shame in erring on the side of caution. I think where evidence is not solid or resources may not permit, the pragmatic approach of taking the highest level of protection for the known threat–I would recommend that. And then we can scale down once the new information regarding the transmission dynamics or PPE recommendations becomes available. – Dr. Ayebare
8. Endemic Doesn’t Mean We Should Stop Trying To Make Things Better.
If I were to say to you ‘breast cancer is endemic’ ‘colon cancer is endemic’ would that mean that we would just throw up our hands, we would stop trying to diagnose, we would stop mammograms and colonoscopies, that we would stop doing everything we could to improve treatment outcomes? No, of course not. And I think we have to think about COVID in that same way. Just because it’s endemic, doesn’t mean you give up on actually mitigating the impact and reducing disease and death.” -Dr. Gounder
“Who told us that endemic means you don’t do anything? That’s not what endemic means, I can guarantee you that. We should continue to be thinking about what we need to do. There are lots of things we can do … being prepared to roll with the punches, do pandemic management, remember that you can always get better at it, and we should hopefully get better at it by thinking about it all the time and by working to be better at it… – Dr. Hanage
9. It’s Important To Have Low-Cost, Community-Based Risk Reduction Measures In Place For Whatever Lies Ahead
“I think for a real resourced setting approach, it’s regrettable the number of lives that have been lost to COVID, but I believe the impact on livelihood is what is likely to have a more significant impact even way after the pandemic has abated or become endemic. So, because we have to live, I think it’s important that people should be encouraged to participate in the economy or try to get back to their lives. However, risk reduction measures [must be] built into how we [participate in the new normal, especially] in schools, grocery stores, and public transport… Therefore, we have to think local and think low-cost…. The Motivation to save livelihoods [is encouraging enough to ensure the sustenance of these approaches for society to continue to function.] Also, people should be prepared–we don’t know what COVID is going to throw at us in the next few weeks or months.” -Dr. Ayebare
10. By Getting Vaccinated & Making Other Sacrifices, We’ve Saved A Lot Of Lives. We Can Continue To Do So.
“..we have correctly talked about how many people have lost their lives and how many people have had their future lives blighted by Long COVID. However, we have also saved many. We may well never know exactly how many, but all of the sacrifices people have endured for the last two years should not be considered to be in vain. They have taken a bad situation and stopped it being even worse. So I think that the point that as we move into a stage where we are treating the virus as endemic, we should recognize that there are things we can continue to do in order to help. And if people want to help, they can.” – Dr. Hanage
Erica Augustine
Communications & Outreach Associate
Boston University Center for Emerging Infectious Diseases Policy & Research (CEID)
