Since it began over two years ago, the COVID-19 pandemic has infected more than 500 million people and impacted daily life around the globe — from lockdowns and travel restrictions to mask mandates and virtual learning. Here in Massachusetts, more than 1.7 million people have been infected with COVID-19 and more than 23,000 have died.

With COVID vaccines widely available in the U.S., and mask mandates being dropped, many are hopeful for a return to normal.

While COVID-19 vaccines became widely available to most Americans in 2021 and resistance to the virus has improved, people are wondering when the pandemic will finally end. Despite there being moments when it felt like that was near, a new variant would emerge and another wave of infections would begin.

Drs. Chanu Rhee and Meghan Baker, assistant professors of population medicine at Harvard Medical School and the Harvard Pilgrim Health Care Institute, infectious disease physicians, and associate hospital epidemiologists at Brigham and Women’s Hospital, are cautiously optimistic.

“It’s hard to predict definitively when the COVID-19 pandemic will end,” says Baker. The best-case scenario, Rhee explains, is that we reach endemic status. However, he adds, “I’m reluctant to say whether or not COVID-19 will become endemic in the near future. We could be heading there now as Omicron continues to fade. But, as the last two years have taught us, COVID-19 might have more surprises in store for us.”

Phases and stages

With so much coverage and information on COVID-19 swirling around, chances are you’ve heard the terms endemic, epidemic, and pandemic mentioned at various times. 

COVID-19 began as an epidemic, which Rhee explains is “when there is an unexpected increase in disease cases that impacts a large number of people in a specific geographical area.” Once COVID-19 spread around the world, it was declared a pandemic by the World Health Organization (WHO) in March 2020. “Pandemics are essentially when an epidemic occurs on a global scale,” he says.

According to Rhee, COVID-19 will hopefully become endemic, which refers to “diseases that are permanently prevalent within a certain region,” he says. “The common cold and influenza are examples of endemic viral infections which wax and wane predictably over the course of a year. They will never go away completely, but they also aren’t typically causing major disruptions to society and the healthcare system like what we see with a pandemic.”

Managing endemic diseases

It’s widely accepted that COVID-19 will likely never become fully eradicated. Looking at how we manage other endemic diseases can give us a glimpse into what it might be like to live with COVID-19 in the future.

The seasonal flu is one example of an already endemic disease.

The most prominent example of managing an endemic is influenza, more commonly known as the flu, which causes millions of people to get sick every year. While the flu is endemic, the viruses frequently change and mutate into new strains each year. Many people will experience mild symptoms as a result of the flu and can recover at home within a few days or weeks. However, some individuals are at higher risk of developing serious flu-related complications and must take extra precautions. The most effective way to manage the flu is a yearly vaccination to protect against new strains of the virus and reduce the likelihood of severe illness. Many health insurers, like Harvard Pilgrim Health Care and Tufts Health Plan, cover flu vaccines, so be sure to check your coverage before booking an appointment.

Robert Klugman, associate vice president and medical director of employee health and occupational medicine at UMass Memorial Health, referenced the H1N1 influenza (swine flu) pandemic back in 2009. “We saw that most people had good resistance from prior exposure to other flu variants and vaccines. While H1N1 was less contagious than what we’re seeing from COVID-19, several vaccines became available to help control the spread. Even though the H1N1 influenza pandemic ended in 2010, these strains are still prevalent today. Similarly, COVID-19 is going to be a lot like this, where the virus behaves like its predecessors and still circulates among the population.” 

Malaria is another example of a global endemic that generally impacts warmer regions that are closer to the Equator. Transmission rates in the U.S. are low, but in malaria-endemic areas — including certain parts of Africa, Asia, and South America — there is an increased risk of getting the virus. Rapid and accurate diagnosis of malaria is critical to determining the appropriate treatment of the disease and lessening community spread. Unlike the common cold or flu, malaria is not contagious; the disease is transmitted via a parasite carried by infected mosquitoes and cannot spread from direct person-to-person contact.

The key to COVID-19 becoming endemic is controlling its spread around the world — not just here in the U.S. “If [endemic status] is not reached elsewhere in the world, the virus will continue to mutate in those countries and might spread to others,” says Klugman. “While we have prior experience dealing with other COVID variants, such as Delta and Omicron, new versions of the virus can create increased challenges and cause people to be less resistant to existing immunity and vaccines.”

A gradual process

Currently, Omicron cases are on the downswing in many states. Because Omicron has a high infection rate and vaccination efforts are continuing across the globe, it is likely that more people have gained some form of immunity to the virus. This will play a critical role in future waves as new variants are discovered. However, it’s important to understand that endemic does not mean that the virus isn’t still harmful. “Unlike smallpox where we were able to eradicate it from the world, COVID-19 will be sticking around,” says Klugman. 

Klugman advises that people continue to take precautions, especially in the event of future spikes in COVID cases.

The COVID-19 pandemic has equipped us to better handle future public health emergencies, continued Rhee. From gaining increased knowledge into respiratory disease transmission to rapidly conducting clinical trials and implementing contact-tracing initiatives, “We’ve come a long way since the early days of the pandemic,” says Rhee. Even today, health care experts are still learning more about COVID-19, and questions remain on whether we’ll continue to need additional booster shots. 

Baker notes that it’s too soon to say if or when the next booster shot would be recommended, and that there’s a possibility of a yearly vaccine, similar to how the flu is prevented. “There is also great interest in developing a universal coronavirus vaccine that could offer protection against SARS-CoV-2 as well as other coronaviruses.”  

While it is still too early to tell when COVID-19 will end, Klugman advises that, “people should continue to take precautions and use good judgment for the foreseeable future.” Keeping an eye out for new variants and vaccinating individuals who are eligible but haven’t received the vaccine are important factors that will help ensure that the world heads in the right direction. 

“In certain settings, we expect that mask requirements will continue to end and masking will be an individual decision,” says Baker. “However, it is possible that there will be surges in the future, even if COVID-19 is no longer considered a pandemic. While we won’t have to wear masks forever, we should be prepared to put masks back in some situations if case counts start to rise again.”

For additional information on COVID-19 vaccines, testing, and other resources, visit Harvard Pilgrim and Tufts Health Plan.