What’s an Endemic Disease (Which COVID-19 Will Be): Differences Between Endemic, Epidemic & Pandemic

It’s highly ironic that you can’t spell “endemic” without “end”, but there is literally no end in sight to this virus.

Wait…what?

Yep, that’s right.

You probably clicked on this article, hoping for a good piece of news that the COVID-19 pandemic will be over, but the truth is, the virus will not be disappearing.

However, it is likely that COVID-19 will become an endemic disease in the near future. If you’re still confused by what that means, read on to find out more!

If you prefer to watch a video instead, here’s our pretty host explaining everything in simple English:

What’s an Endemic Disease

Of course, the first thing you probably want to know is “what is endemic?” and “how does it differ from pandemics and epidemics?”

If you look at the dictionary, the word “endemic” is defined as a characteristic belonging to a particular group of people or country.

It comes from a combination of Greek words: “en” meaning “in” and “demos” meaning “people”! Together, it simply means within the population.

Oh, so this is why the “end” in “endemic” does not apply.

An endemic is therefore a disease outbreak that is consistently present but limited to a particular region, where rates and spread of the disease is predictable.

From this definition, you can already tell that an endemic is very different from a pandemic because, well, the spread of COVID-19 was not predictable at all.

As we watched in horror, COVID-19 grew at an exponential rate and infected many people around the world, with over 173 million cases today.

What about epidemics then? The US Center for Disease and Control Prevention (CDC) defines an epidemic as an unexpected increase in the number of disease cases in a specific geographical area.

The key difference between an epidemic and an endemic is that an endemic disease is always present in the area while an epidemic outbreak is a surge of cases.

Examples of Endemics

Now that we’re up to speed on what an endemic is, let’s talk about some of these diseases.

The most well-known endemic disease is probably malaria, which is prevalent in parts of Africa, South America, the Middle East and Asia. In 2019, there were an estimated 229 million cases of malaria and 409,000 deaths worldwide that year, as reported by the World Health Organisation (WHO).

However, it is not considered a pandemic because the weather in temperate regions is unable to support the breeding of the Anopheles mosquito, preventing transmission.

For instance, the US CDC notes that at temperatures below 20°C, the malaria parasite cannot complete its growth cycle in the mosquito and thus cannot be transmitted. In addition, the economic development and public health measures in Western Europe and the US have succeeded in eliminating malaria.

Similar to sub-Saharan Africa, Singapore has its fair share of an endemic disease related to mosquitos, and one we always hear about in the news.

That’s right, it’s the dreaded dengue.

In fact, it’s so serious in the region that Asia represents nearly 70% of the global burden of the disease. The most affected regions are the Americas, the Western Pacific and of course, South-East Asia.

Singapore has seen over 2,700 cases since January this year and there are still over 20 active clusters.

Other diseases endemic to Singapore include influenza, hand foot mouth disease, tuberculosis, as well as hepatitis A, B, C and E.

Many of us probably remember the H1N1 outbreak in 2009 as the first influenza pandemic of the 21st century. Influenza is endemic to Singapore today, with yearly vaccinations recommended to all residents to protect themselves from the virus.

Are Endemics Dangerous?

Given that COVID-19 has killed millions worldwide, you might be wondering whether an endemic would be just as dangerous as a pandemic.

While most individuals infected with COVID-19 only experienced mild symptoms, the elderly population in Singapore is a serious concern if the virus were to become endemic.

But just like dengue, we will be able to successfully protect ourselves with appropriate public health measures and personal.

Maybe one day, a new law might be put in place to allow every person to only have 4 friends. Kids might even grow up to never experience karaoke. Oh, the horror!

(But somehow many people would be happy…no?)

How Will COVID-19 Become Endemic

Associate Professor Alex Cook at the National University of Singapore’s Saw Swee Hock School of Public Health said that the pandemic will end at some point, but it would not be due to the virus disappearing.

“Rather, enough people will have been infected or vaccinated such that the virus spreads slower and affects fewer people.”

For Singapore to achieve such immunity, 70 to 90% of our population has to be vaccinated, experts noted. This marks the beginning of our endemic living.

As for when the COVID-19 pandemic is “officially” dubbed as an endemic, we don’t really know. Professor Paul Tambyah, president of the Asia-Pacific Society of Clinical Microbiology and Infection, estimates that it might take anywhere from three to four years for a post-pandemic era to emerge.

According to The Straits Times, WHO officials have also warned that any change to COVID-19’s status as a pandemic would be premature.

“A lot of different things could happen…This dynamic state might take quite a long time to settle down into a less dynamic state,” added the director of the WHO’s department of health emergency information and risk assessment.

Professor Tambyah explained that the most likely scenario leading up to such a declaration would be when the number of serious illnesses and hospitalisations decline, prompting WHO to declare the pandemic over.

This was done back in 2010 for H1N1.

Living With An Endemic Disease

Experts have noted that living with endemic COVID-19 is not going to be easy, but it is definitely doable.

“Apart from vaccinations, masks must persist too. Data clearly shows they reduce transmission but people must give up frivolous cosmetic masks and replace them with certified masks known to be effective,” wrote Dr Leong Hoe Nam, infectious disease specialist at the Rophi Clinic at Mount Elizabeth Hospital who is on TV more times than Fann Wong in the last 16 months.

He added that rapid antigen testing will have to continue and it can be expected that such tests will be conducted in the comfort of your own home in the future.

These tests can help detect the virus in individuals in the first five days of illness when infectiousness is highest.

The Ministerial Task Force (MTF) has also begun planning for when the virus becomes endemic, developing strategies to cope with the new situation.

Finance Minister Lawrence Wong, who co-chairs the task force, has said, “We will take more aggressive localised actions, and we will try our very best to avoid having to impose general nationwide restrictions like another circuit breaker. We think that is the way to live with the virus while enabling most activities to resume.”

Firstly, achieving a high vaccination rate goes without being said. But in the future, receiving booster shots might become the new normal.

Mr Wong also mentioned that better treatments for COVID-19 may become available in the future, giving the authorities greater assurance in the cases where infections occur despite vaccination or when a serious illness arises.

Finally, while border restrictions might be eased, more risk-based and targeted precautions will need to be in place to monitor the overall situation in other countries.

We’ll just have to wait and see how the future plays out.

Featured Image: kandl stock / Shutterstock.com (Image is for illustration purposes only)