The new meaning of endemic that’s arisen during the COVID pandemic isn’t based in disease dynamics. Public health professionals, medical providers, journalists, and government officials are increasingly using the word endemic to mean some version of “getting back to normal”.
When people ask, “When will we get to endemic?”, what they really mean is, “When can we reopen?”, “When can the masks come off?”, “When will COVID be less disruptive?”, and maybe, “What amount of disease and death is acceptable to us?”
If we get to a point where COVID continues to devastate elders, immunocompromised people, and chronically ill and disabled people, will that mean it’s “endemic”?
If we get to a point where COVID is like HIV, where your privilege determines whether you get to ignore it, will that mean the pandemic is over?
What if we find a way to keep our healthcare system teetering just on the edge of collapse without quite falling over so that everyone who isn’t a healthcare worker can pretend the system is working fine, will that mean we entered the "endemic phase"?
What we need to be asking is, what is the “normal” that we’re trying to get back to? Whose deaths are acceptable to us? What level of disease are we willing to accept as normal or inevitable?
If we get to a point where we don't have an exponential increase in cases, that's great, but that doesn't mean exponential growth can't return - R-numbers are not fixed properties of infections. It doesn't mean people won't stop dying or that COVID is mild.
If individual cities like San Francisco think they're "getting to endemic", they should also remember that cities are connected to the rest of the world - this crisis won't be over until it's over everywhere.
And endemic does not mean we get to go back to normal. Normal is how we got here, and normal will continue to bring us new crises until we collectively decide to stop accepting it.Berkeley Free Clinic Outreach @BFCoutreach Jan 31
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