The Omicron surge has largely dissipated, the number of COVID-19 cases and related hospitalizations and deaths have fallen rapidly and there are no new variants of concern on the horizon. Moreover, research tells us that due to the number of Omicron infections, plus vaccines being administered, more than 80% of people in Oregon have some level of immunity against infection of COVID-19 for at least the next few months.
Does that mean COVID-19 is now endemic in Oregon or the U.S.?
Not quite yet.
The word “endemic” refers to a disease that is usually present in a community, is fairly predictable and doesn’t cause large-scale disruption to society. Malaria, for example, is endemic to certain countries, but not in the United States. The seasonal flu is endemic in the U.S. and around the world because public health experts can generally predict its behavior (which is why we have “flu season”), and the illness doesn’t usually overwhelm our lives, society and health care system.
Endemicity and COVID-19
With widely available and highly effective COVID-19 vaccines, better understanding of how the virus spreads and treatments that are becoming more available, it will become possible to live our lives without strict policies like indoor mask mandates. However, some major hurdles get in the way of endemicity, such as low vaccination rates and higher case counts in certain geographic pockets.
We also don’t fully understand COVID-19’s patterns year-to-year, like we do with the flu. Generally, respiratory diseases spread more easily in colder seasons because people gather indoors and spend more time closer together.
“We watch how the flu behaves in the southern hemisphere so we know what the new strains are, and we can make new vaccines every year,” said Dean Sidelinger, MD, MSEd, Oregon Health Authority health officer and state epidemiologist.
But COVID-19 hasn’t necessarily followed that pattern. The Delta surge, for instance, peaked in Oregon in August 2021. For now, it will take more research to determine whether COVID-19 follows any kind of seasonality.
Additionally, endemicity does not mean no new variants. A state or country with endemic COVID-19 would be a place where “new variants might arise but they are not spreading so quickly and causing so much illness that it overwhelms the health care and economic systems,” Sidelinger said.
But a more manageable disease, Sidelinger emphasized, also doesn’t necessarily mean a milder one. COVID-19, even as an endemic disease, could still cause severe illness in some people. The flu, for example, kills between 12,000 and 52,000 people every year. Additionally, a flu strain can sometimes cause a pandemic, like H1N1 or swine flu in 2009, but it is rare.
To stay prepared for a possible new COVID-19 variant or surge, Oregon monitors positive COVID-19 test samples as well as wastewater samples from around the state. If a new variant emerges or a new surge is incoming, we’ll know and be able to respond quickly.
Reaching endemic COVID-19
Our actions drive COVID-19 towards endemicity: we’re getting vaccinated and boosted, wearing masks where appropriate and changing our behavior when surges occur. And as society’s immunity level increases (from vaccinations, infections or both), so does society’s protection from large surges.
“The best protection against COVID-19 is making sure you’re up to date on all recommended vaccines,” Sidelinger said. That means completing a primary series plus getting a booster, if eligible. If you’re not sure about your vaccination status and eligibility, check out the Center for Disease Control and Prevention’s website.
And although most indoor mask requirements have lifted across Oregon, everyone is encouraged to wear a mask if they feel safer doing so, including in crowded settings, if someone has a condition that makes them vulnerable to severe disease or lives with someone at high risk or is unvaccinated. Oregon still requires masks be worn in health care settings, and some businesses and schools may choose to require masks as well. The federal government still requires masks on all forms of public transportation, as well as in airport and on planes, requirements that are scheduled to end April 18.