People say they want COVID-19 to become 'endemic.' But what does that really mean?

As Canadians grow increasingly weary after two years of COVID-19, many people are tossing around the term "endemic" as an expression of hope that we're moving into a stage where we pull back public health restrictions and live with the virus.   

"The word 'endemic' has become one of the most misused of the pandemic. And many of the errant assumptions made encourage a misplaced complacency," Aris Katzourakis, a professor of evolution and genomics at the University of Oxford in the United Kingdom, wrote in an article published in the journal Nature earlier this week. 

"Thinking that endemicity is both mild and inevitable is more than wrong, it is dangerous: it sets humanity up for many more years of disease, including unpredictable waves of outbreaks."

It also falsely suggests the pandemic is nearing an end in Canada and other wealthy countries, infectious disease specialists and epidemiologists say — but this is a stage when public health measures remain critical. 

"Here's what [endemic] doesn't mean: It doesn't mean where we're at right now," said Dr. Isaac Bogoch, an infectious diseases specialist with Toronto General Hospital. 

"We're seeing health-care systems stretched and society significantly impacted by the virus. That's not endemic. That's still pandemic."

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"Endemic" means a virus is present in a region at a stable level, without the rising and falling waves of infection that we've seen so far throughout the coronavirus pandemic, experts say. 

Endemicity occurs when "the natural replication of a virus is balanced out by the built-up immunity in the population, resulting in an overall stasis — a constant number of cases in the community," Katzourakis said in an interview with CBC News. 

That immunity is achieved through vaccination and recovery after natural infection.

In an endemic state, the reproduction number of the virus — a measure of how contagious it is —hovers around one, "so it's not declining and it's not increasing," said Dr. Raywat Deonandan, an epidemiologist at the University of Ottawa. 

Endemicity says nothing about how badly the disease affects people, he said. 

For example, malaria is endemic in many parts of the world and is one of the most deadly diseases for young children, according to UNICEF.   

"Politically, the word [endemic] seems to be being conflated with: 'We're done with this and let's move on,'" Deonandan said.