Is California in an ‘endemic’ and what do next COVID steps mean for daily life?
After more than two years of the coronavirus shaking the world’s public health landscape and societal norms, the end to the pandemic isn’t here yet.
As health experts and public officials begin to use the term “endemic,” many are asking what that means — generally, but in terms of daily life, too. Gov. Gavin Newsom plans to reveal California’s new plan to approach the “next phase” of COVID Thursday afternoon.
In a call with reporters, Secretary of Health and Human Services Dr. Mark Ghaly said “we’re not out of the woods yet.”
Throughout the span of the pandemic, news of new variants, everchanging mask guidelines and vaccine recommendations have permeated government policies and everyday conversations. That’s not going away.
Before Thursday’s announcements, The Bee reached out to several health experts, to ask how any endemic plan may affect the daily lives of Californians. Here’s what they said:
‘Nail Jell-o to the wall’
It’s hard to know what will happen in the future in regards to COVID-19, public policy and health guidance, said Todd Davenport, a professor and vice chair of physical therapy at the University of the Pacific.
“It’s a little bit like trying to nail Jell-o to the wall,” said Davenport who works with patients who are experiencing long COVID.
With cases going from new lows to record highs, the development of the coronavirus and its effect on people is unpredictable.
“I think it’s really important that we not just talk about endemic phase,” Ghaly said. “But how do we continue to live with a virus that changes and kind of throws curve balls at different times.”
Ghaly added, “I think for California and our future, it is about being ready and being prepared.”
Are we in an ‘endemic’?
While some officials are tossing around the concept as they plan for next steps, no one has officially classified COVID-19 as an endemic.
What we know now is, “the virus will remain with us for some time, if not forever,” a state press release said. So we’re planning ahead.
Carol Mansyur, assistant professor of public health at Sacramento State, said epidemiologists classify the ways diseases spread in three ways: pandemic, epidemic and endemic.
Pandemics are diseases that spread rapidly across the world, she said, as we’ve seen with COVID-19.
Once the cases drop and there’s a certain number of cases expected each year from a disease, the virus is considered endemic, Mansyur said.
“That simply means that a disease or condition is present among the population or time, so it exists permanently in a particular region,” she said, adding that it’s similar to the flu and most people will have developed some form of immunity from it.
An epidemic, according to the Centers for Disease Control and Prevention, is when cases of a disease increase suddenly in a geographical area.
Mansyur said it’s “entirely possible” for COVID-19 to go into an endemic phase because a lot of people, especially those who contracted the omicron variant, have developed some level of immunity to the virus.
“No epidemiologist can predict for certain because it is all new to us,” she said. “And we don’t know how many variants it also has down the road that could be even worse.”
Davenport of the University of the Pacific said he thinks it’ll be a while before COVID is endemic because community transmission rates are still high and it’s not geographically confined yet.
Even if we reach an endemic state, that doesn’t mean COVID will be less harmful.
“There are still very severe diseases that are considered to be endemic,” said Davenport.
He cited polio, which has been reduced to certain parts of the world, such as Nigeria and Pakistan, where it’s hard to help people gain immunity via vaccinations.
“That doesn’t make the polio less concerning. It doesn’t make it less troublesome. It doesn’t make the chronic effects less severe for people to call it pandemic versus endemic,” Davenport said.
Daily life in a COVID-19 endemic
How a coronavirus endemic will affect daily life, in terms of required masking, booster shots and other regulations, is hard to predict, the professors said.
Mansyur said it depends on what public health authorities decide and recommend.
The Newsom administration has said that it’s important that local public health officers and elected leaders work together to set requirements and recommendations that align with the cultures and concerns unique to their respective communities.
Fenyong Liu, professor of infectious diseases at the University of California, Berkeley, said preventing disease rests on individuals as well.
Liu said if you don’t want to be infected, you should still take safety measures to protect yourself, whether it’s using face masks or social distancing.
Ghaly, in the Thursday call, said the new plan urges people to keep up immunity, wear masks when required or recommended and stay up to date with the latest state information on cases and hospitalizations.
California’s SMARTER plan for COVID-19
In the Thursday afternoon call, Ghaly announced a seven-factor framework on how to manage the virus.
“Each domain is anchored around being smarter and protecting our citizens with equity as our guide, while keeping our culture and commerce constantly moving forward,” Ghaly said.
It follows the seven letters in the word “smarter” with ‘s’ signifying shots, ‘m’ for masks, ‘a’ for awareness, ‘r’ for readiness, ‘t’ for testing, ‘e’ for education and ‘r’ for Rx treatment.
“We’re gliding into normal. We’re not announcing the normal,” Ghaly said. “The virus will drive what we do. “We’re going to shift with the virus so we can keep the state as safe as possible.”
With the SMARTER plan, California will use knowledge from the last two years and adaption measures to meet the evolving challenges of the virus.
Possibility of new variants in an endemic
New variants will continue to emerge because viruses continue to mutate and evolve, Liu said.
“That’s why we have to have a shot every year,” Mansyur said, referring to the flu shot.
Some virus variants may be more severe than others, she said, and it can potentially lead to an epidemic or pandemic.
Liu said a way to prevent new variants is to make sure people don’t get infected so that the virus won’t have a chance to replicate and mutate.
What about long COVID?
Davenport said, even if the virus is circulating within a geographic area or specific populations at lower levels than today, you’ll still see a number of people have long haul COVID symptoms.
“Because long COVID ultimately depends on you becoming infected with COVID to begin with,” he said.
What an endemic could mean for marginalized communities and kids
Health disparities have been around for a long time, and it’s something that has come to light with the COVID-19 pandemic, said Mansyur whose research interests include health inequities.
Davenport said this can be seen with how the virus has affected people of color and frontline workers.
According to the CDC, some communities have faced difficulties due to lack of health insurance, access to child care and the inability to skip work.
“There will always be susceptible populations and typically, these are populations of lower socioeconomic status because they don’t have as many resources to tackle diseases as people [of] higher socioeconomic statuses,” Mansyur said.
As the virus begins to circulate at smaller levels in an endemic, life may look “normal” to some people, Davenport said.
“And so we have to be very careful to maintain a health equity focus on ensuring that vulnerable people, vulnerable populations remain protected,” he said.
Davenport said this means undertaking data collection and acting decisively to ensure public health guidance are equitably distributed.
This story was originally published February 17, 2022 at 2:00 PM.