What It Means to Be in the Endemic vs. Pandemic Phase of COVID

Over two years after the initial coronavirus outbreak, as life begins to look more like "normal," people are starting to wonder: is the pandemic over? The answer to that question seems closer to "yes" than ever, especially after the latest news from Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases.

In an April 26 interview on "PBS News Hour," Dr. Fauci said that the US is "out of the pandemic phase" of COVID-19, which sounds promising — but doesn't mean the pandemic is completely over. Based on lower hospitalization and death numbers, Dr. Fauci believes the US is now in a "transitional phase" between pandemic and endemic, he explained in a follow-up interview with The Washington Post. "Right now we're at a low enough level that I believe that we're transitioning into endemicity," Dr. Fauci explains. "We're not in the full-blown explosive pandemic phase. That does not mean that the pandemic is over."

But what does "endemic" mean, and how does it compare to "pandemic"? And what does this mean about the overall outlook going forward, and for the end of COVID? Here's the scoop.

Not quite. Rather, Dr. Fauci is saying that the US, specifically, appears to be out of the "full-blown" pandemic phase of COVID. That phase was typified by what we experienced in 2020, when we were "having 900,000 cases a day, tens of thousands of hospitalizations, 3,000 deaths a day," Dr. Fauci explained on PBS. Right now, the country is experiencing a "low level" of COVID-19, Dr. Fauci says — and the ultimate hope is to keep it that way.

"We're not going to eradicate this virus," he explains. But if we can maintain this low level and "intermittently vaccinate people," COVID-19 could stay at a manageable place that allows for the resumption of "normal" life. Dr. Fauci adds he's not sure how often COVID vaccines and boosters might have to be administered (whether on a yearly basis or longer) to reach that point of equilibrium.

Building upon his PBS comments, Dr. Fauci told the Washington Post that the US is "transitioning into more of a controlled endemicity." But what's the difference between endemic and pandemic? A disease reaches the endemic phase when it's constantly present in the population but is controlled by treatments and vaccines, according to the Centers For Disease Control and Prevention. That level stands in contrast to a pandemic, which Dr. Fauci defines as "widespread infection throughout the world."

Dr. Fauci notes in both interviews that the global state of COVID-19 is quite different than that of the US. "The world is still in a pandemic. There's no doubt about that. Don't anybody get any misinterpretation of that," he says.

His comments come as COVID outbreaks continue in Europe and Asia, a wave that the US appears to have missed the brunt of due to widespread immunity from the vaccine and the prevalence of the initial omicron variant. COVID is still infecting Americans, but symptoms generally appear to be milder, and although case counts are creeping up, they're not as high as they were in the initial months of the pandemic. (Dr. Fauci notes that this is at least partially due to the prevalence of at-home tests, which aren't recorded in official case counts.) Hospitalizations are rising slightly as well, but deaths remain relatively low.

As for COVID-related restrictions? Those imposed by state and federal governments are all but gone. Most recently, a court struck down the federal requirement to wear a face mask on airplanes and public transit, prompting cheers and applause from passengers who received the news midflight. In an echo of Dr. Fauci's comments, states like California have already begun transitioning to "endemic plans," focused on prevention and rapid outbreak response rather than restrictions, to address the newest phase of the COVID crisis.

At this point, Dr. Fauci says we will not fully eradicate COVID-19, but managing it at a low level appears feasible. To get to that stage, though, it remains crucial that Americans get vaccinated, stay up to date with their booster shots, and give themselves the best chance at avoiding or mitigating the effects of this virus.