Thread by @steerewilliams

We've reached a new phase of the COVID-19 pandemic (a really long thread). So many (even safe, rational) folks are leaning on a new motto- one I'm calling 'endemic fatalism'. "We're all going to get it," is what I keep hearing. No doubt that Omicron has shifted the narrative

The CDC recently reported that the Omicron variant has 53% less risk of hospitalization and 91% less risk of death when compared to Delta. This has led many people to think that Omicron is spreading so rapidly around the world, hitting both the vaccinated and the unvaccinated

that we will reach collective herd immunity in short order. Seeing COVID-19 as endemic, in other words, might mean an end to the pandemic. Spain’s Prime Minister Pedro Sanchez, for example, publicly asserted this week that the European Union should reduce surveillance and testing

People are once again comparing COVID-19 to the seasonal flu, a notion experts (like me and others) warned against in the first year of the pandemic.

But reframing COVID-19 as an endemic disease right now is a premature notion at best, representing more of what we want COVID-19 to become than the epidemiological reality we face today.

The truth is that hospitals around the world are near capacity, percentage-wise with more children under five years old than we have seen throughout the pandemic.

Healthcare workers, parents, and those individuals immunocompromised are strained beyond measure after two years of physical and mental hardship. It makes sense that we want to see COVID-19 become a milder disease like the seasonal flu: seasonal; predictable; less virulent.

But the evolutionary trajectory of COVID-19 does not at this time suggest a clear path towards endemicity, and epidemiologists and evolutionary biologists warn against impulsively applying this notion to the disease.

A historical dive into the term endemic, though, may help us to see the faults of reframing COVID-19 as endemic right now. Although the term was occasionally used in the 18th century, by the mid 19th century

endemic was frequently employed when thinking about infectious disease. Derived from the Greek words “in” and “people,” epidemiologists by the 1850s used endemic to mean diseases that regularly occurred in particular locations.

the term endemic in mid 19th c. was tied to terrestrial and soil-based notions of disease. Intimately linked to the term endemic was its counterweight, epidemic, which meant an imported, and often it was believed, contagious disease.

Epidemic and Endemic were connected terms, not oppositional ones, and a disease like cholera was considered both endemic and epidemic at the same time.

Distinguishing endemic from epidemic was a way to explain the geographical distribution of disease around the world, no doubt, but it was also fueled by 19th century colonialism

Framing cholera as endemic to India, for ex. was a way to scapegoat the origin of the disease to a far-away land and people- “them” not “us.” Malaria and yellow fever were seen to be “endemic” to the tropics, plague to Southeast and East Asia.

Built into the idea of an endemic disease in this era was also a way to explain the rise, distribution, and spread of epidemic disease.

Framing a disease as either endemic or epidemic has always been about fitting a political and cultural agenda.

As John Macpherson, Inspector-General of Hospitals in Bengal, India, noted in 1867, “no question in medicine is more interesting than that of an endemic disease taking on the character of an epidemic, and of the behaviour of an endemic, when its own epidemic form reaches it.”

Around 1900 the notion of an endemic disease began to subtly change to mean a disease present in a location through human-to-human or animal-to-human reservoirs, but one that could for either human, animal, or environmental reasons erupt into an epidemic or even a pandemic.

Cholera, plague, and typhoid served as models for this new type of thinking. All three had begun to decline in Europe and North America and in the process were labelled as endemic to what we now call the Global South. And the culture wars still raged.

The question that came to dominant epidemiologists, ecologists, and evolutionary biologists in the twentieth century were the reasons why an endemic disease might suddenly erupt into an epidemic one.

Already by the late 19th century some experts suggested environmental, evolutionary, and human-animal zoonotic reasons, though even today this question still dominates research into infectious disease.

What is clear from even a cursory historical examination of the concept of endemicity is that there are cultural and political, and not always scientific reasons for labelling a disease endemic.

By the mid 20th c. the term endemic became more oppositional to the term epidemic, and experts in the Global North considered cholera, typhoid, and plague to be diseases endemic to the Global South- out of sight, out of worry. But these diseases, continue to ravage human pops

Western notions of endemicity have enabled those in the Global North to neatly shelf diseases as problems of econ development. A similar phenomenon happened in the 1990s with HIV/AIDS

at best welcoming COVID endemicity is a neoliberal apology for the failure of most gov's ability to properly handle COVID-19 for the past two years. At its worst this view is a neodarwinian fatalism. We need to stand against both. This history matters.