What Will an ‘Endemic’ Approach to COVID Look Like Nationwide?

On February 17, Gov. Gavin Newsom announced that California will be adopting an “endemic approach” to the COVID-19 pandemic, making it the first state to do so. They intend to practice public health strategies that would allow health officials to identify and respond to a surge in cases—while relaxing some measures in the meantime. 

Now, other states are barreling toward a return to normalcy by making moves to lift mask and vaccine mandates, too.

California's plan is to stay on top of the disease as people learn to live with the virus, since there may not be a defined end to the spread of COVID-19. Here’s what the endemic approach will entail.

What Does Endemic Mean?

Endemic means that the disease is constantly present in a population or within a given geographic area. 

“Epidemics occur when the rate of disease increases quickly,” Leslie M. Kantor, PhD, MPH, professor and chair of the Department of Urban-Global Public Health at the Rutgers School of Public Health, told Verywell. “Pandemics are when epidemics occur in several countries. Endemic refers to an ongoing or sporadic level of disease that exists in the population.”

Endemicity does not mean that the disease is considered harmless. Some examples of endemics are the common cold, seasonal flu, malaria, or poliomyelitis.

“In truth, the rate of transmission of COVID-19 in the United States remains high in many areas of the country,” Kantor said. “However, we are clearly on the other side of the Omicron peak and there is a combination of political pressure and fatigue with pandemic reduction measures that is motivating leaders to come up with a new approach.”

California’s new endemic approach assumes that COVID-19 will not go away completely. Therefore, the state is adjusting its public health strategies to respond quickly to increases in transmission instead.

“I personally do not favor the word ‘endemic’ as it suggests that we won't see any other future waves—and we probably will,” David Dowdy, MD, PhD, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, told Verywell. “But I do think that there's value in setting benchmarks for when COVID-19 is no longer considered a pandemic emergency.”

How Different Will Policies Look With An Endemic Approach?

Endemic COVID-19 policies will have subtle shifts from the public health strategies we’ve come to know, but the disease will still be taken seriously.

“I think the difference is that we wouldn't be doing things for COVID-19 that we don't do for other diseases like the flu,” Dowdy said. “So, for example, vaccination would still be promoted, but we might not have measures like mask mandates in place.”

On February 15, California lifted its state-wide indoor mask mandate for vaccinated individuals because infection rates decreased significantly since the Omicron peak and hospitalizations have begun to stabilize.

Their new approach can be summarized with the acronym SMARTER, which means:

• Shots: Administering hundreds of thousands of vaccines per day to reduce hospitalizations
• Masks: Stockpiling millions of high-quality masks to distribute them as needed
• Awareness: Provide updated information about COVID-19 from health officials
• Readiness: Performing wastewater surveillance to prepare for surges
• Testing: Increasing laboratory testing capacity to measure infection levels
• Education: Ensuring a safe shift to in-person instruction in schools 
• Rx: Making COVID-19 treatments available and accessible

The SMARTER plan focuses on preventing COVID-19 outbreaks and responding quickly in case they occur. Health officials will be monitoring trends throughout the state to adjust guidance if necessary.

“Because California participates in wastewater surveillance, that state will be able to quickly mobilize a response if increases in COVID-19 are detected,” Kantor said.

Wastewater surveillance serves as an early indicator of the spread of COVID-19 because it helps detect the presence of the virus in both asymptomatic and symptomatic individuals.

Will Other States Follow Suit?

It’s possible that California’s shift will encourage other states to follow suit, especially if their infection rates have gone down. However, it must be done with careful thought. 

“The California approach is a rigorous public health approach which is designed to ensure that there isn’t unfettered spread of disease,” Kantor said. “From a public health perspective, this approach is much more robust than most of what happened across the country during Omicron. To the extent that all available scientific tools and prevention measures are utilized based on data, I’d be delighted to see this approach move forward quickly.” 

The decision to shift to an endemic COVID-19 approach would largely depend on local levels of transmission, Dowdy said. 

“Importantly, when we're talking about policies on a national level, it's important that COVID-19 be below this ‘pandemic’ or ‘emergency’ level in most—if not all—states before enacting them,” he added. “Otherwise, we risk fueling new waves in the country. But on a local level, I think it's very reasonable to consider scaling down restrictions that are currently in place.”

Even if more states remove restrictions and adopt endemic policies, they should still be prepared for a COVID-19 surge at any given moment.

“We need to make sure we remain prepared in case of a new wave,” Dowdy said. “We will see another wave of COVID-19 at some point in time, and we need to be as ready as possible when that wave does happen.”

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