The holidays are finally here and almost one thousand days have passed since COVID-19 blanketed the planet and was declared a worldwide pandemic by The World Health Organization. Current public health messaging is claiming that COVID-19 has reached some version of endemic status and equating it with success. The advertising campaign implies that the end of the pandemic is near and we have reached an acceptable level of safety. This is far off the mark. In reality, COVID-19 will eventually transition into an endemic, however, it’s going to be a brutal ending to the pandemic. Endemicity is not a guarantee of safety, it’s an assurance to be constantly on guard. 

The ongoing trend in public health messaging would have you believe that it’s measured by the total number of positive cases, number of hospitalizations or some ill-defined vague “predictable pattern.” However, whether or not a disease has reached an endemic status has a precise measurable mathematical meaning. Mathematically speaking, infectious diseases in endemic equilibrium have an effective reproduction number (usually denoted Re) stably at one. This means that the average number of secondary cases per primary case is around one for a sustained period of time. As a result, the disease is persisting at the population level but the amount of secondary cases is fluctuating within an envelope centered around one. Thus, we were unable to eliminate the disease and it’s around to stay forever. The ultimate goal of any infectious disease control strategy is to eliminate the disease and reach disease-free equilibrium, where there is essentially no disease present in the population. Unfortunately, this is mathematically impossible for COVID-19, so endemic status is the best we can achieve. 

Some of the most recognizable endemic infectious diseases are the flu, chickenpox and malaria in certain regions. Regarding COVID-19, we are not in endemic status yet, but it’s approaching and mathematical modeling suggests it’s likely a few years away. However, this is not the desired ending for any pandemic, especially this one. Unlike other infectious diseases which have reached endemic status, COVID-19 has many sinister disease characteristics, some of which are just now being realized. The disease dynamics of COVID-19 are proving to be far more dangerous and unpredictable than the flu, for example, and come with a dramatically higher long-term cost.

Alarming Factors of Hyperendemic COVID-19

COVID-19 contains a nearly perfectly balanced combination of ingredients which cooperate to make it much more dangerous and difficult to control than other viruses. It’s highly contagious, airborne, and fueled by a significant proportion of infectious asymptomatic hosts. Due to this, we are most likely looking at a hyperendemic. This is a situation in which there are persistently high levels of disease spread within populations forever. 

  • Infections carry an enormous risk of massive chronic illness potential. It is becoming increasingly known throughout the scientific community that mild or asymptomatic infections may result in chronic life-threatening conditions. We are finally beginning to understand what COVID-19 recovery looks like and in a vast majority of cases, it’s life-altering and results in disability. 
  • It’s a key that unlocks dormant infections. Evidence is surfacing that mild or even asymptomatic COVID-19 infections activate underlying pre-existing conditions resulting in lasting neurological symptoms. A vast majority of them being vector-borne, such as Lyme or Bartonella, and are thought to be a crucial factor in complications that lead to Long COVID. Presently, many long haulers are chronically ill with an extremely low quality of life and are struggling to find effective treatment for their complex multifactorial situations. 

All these disease characteristics effectively differentiate endemic COVID-19 from other well known infectious diseases and will result in the next global health crisis. In fact, it is already here in its infancy stage and we currently call it long COVID

What Will the Endemic COVID-19 World Look Like? 

Once we have officially reached an endemic equilibrium, then we will be in a post-pandemic world. In this new world, we will be facing decades of chronic illness and disability resulting from COVID-19 infections. COVID-19 will permanently be in a hyperendemic status and as a result, there will be a constant presence of  high levels of COVID-19 disease occurrence throughout populations.

The levels of disease spread may take on a sporadic nature where COVID-19  occurs infrequently and erratically in some geographical areas, with predictable relatively high levels in others. The irony is that this bleak future caused by these extremely complex and seemingly unsolvable problems has some partial solutions. The most promising one is to focus mitigation efforts on the dominant airborne route of transmission.

However, due to inaccurate and inconsistent public health messaging, society is behaving like it’s reached disease-free equilibrium. The harsh reality is that we are still in the grasp of a global COVID-19 pandemic and the ending is going to be brutal.

The vaccines have proven to reduce disease severity and as a result have a positive impact on hospital capacity, but they are not transmission blocking. Due to this major shortcoming, mutations will continue to occur making infection outcomes less predictable in terms of complications that lead to chronic disorders resulting from multi-organ damage. Herd immunity is unachievable and life is forever changed. We are currently living in a different world and our only choice is to adapt. 

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Dr. Jacob B. Aguilar

Dr. Aguilar currently holds the academic rank of Assistant Professor in the Department of Mathematics in the School of Computing, Artificial Intelligence, Robotics, and Data Science and is the Associate...

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1 Comment

  1. Dear Dr Aguilar,

    Thank you for your article.

    Please clarify what is meant by ‘vast majority’ in the last sentence of your first bullet: ‘We are finally beginning to understand what COVID-19 recovery looks like and in a vast majority of cases, it’s life-altering and results in disability. ‘

    Do you mean vast majority of all cases of covid infections, or vast majority of cases of long covid? The former does not appear plausible and so if this is not what you meant, I wonder whether you might be willing to clarify that sentence (or better yet, revise for clarity in the article). I am trying to have conversations with friends and colleagues about what is happening, and this article could be helpful towards that end.

    With best wishes,
    Laura

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