Endemic does not mean constant as SARS-CoV-2 continues to evolve
Open accessAbstract
COVID-19 has become endemic, with dynamics that reflect the waning of immunity and re-exposure, by contrast to the epidemic phase driven by exposure in immunologically naïve populations. Endemic does not, however, mean constant. Further evolution of SARS-CoV-2, as well as changes in behavior and public health policy, continue to play a major role in the endemic load of disease and mortality. In this article, we analyze evolutionary models to explore the impact that a newly arising variant can have on the short-term and longer-term endemic load, characterizing how these impacts depend on the transmission and immunological properties of the variants. We describe how evolutionary changes in the virus will increase the endemic load most for a persistently immune-escape variant, by an intermediate amount for a more transmissible variant, and least for a transiently immune-escape variant. Balancing the tendency for evolution to favor variants that increase the endemic load, we explore the impact of vaccination strategies and non-pharmaceutical interventions that can counter these increases in the impact of disease. We end with some open questions about the future of COVID-19 as an endemic disease.
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COVID-19's impact on mortality could be comparable to other individual lower respiratory infections in future years, and health-care systems should prepare for and expect future COVID-19 seasons to be endemic.
“This suggests that COVID-19's impact on mortality could be comparable to other individual lower respiratory infections in future years, and that health-care systems should prepare for and expect future COVID-19 seasons to be endemic.34”
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- Authors
- Otto, S. P., MacPherson, A., & Colijn, C.
- Affiliations
- University of British Columbia (CA)
- Simon Fraser University (CA)
- Corresponding author
- Otto, Sarah P
- Venue
- Evolution
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-03-09
- Volume
- 78
- Issue
- 6
- Pages
- 1092-1108
- ISSN
- 0014-3820 (ISSN-L)
- 1558-5646
- OpenAlex
- W4392630588
- Cited by
- 31
- References
- 48
- Citations by year
- 2026: 12 · 2025: 14 · 2024: 5
- FWCI
- 10.74
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Evolution (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Zenodo (CERN European Organization for Nuclear Research) (cc-by)
- Funders
- Natural Sciences and Engineering Research Council of Canada (RGPIN-2022-03726, RGPIN-2022-03113, RGPIN-2019-06624)
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Mathematical and Theoretical Epidemiology and Ecology Models
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- SARS-CoV-2, COVID-19 pandemic, endemicity, viral evolution, immune evasion, vaccination strategies, non-pharmaceutical interventions, transmission dynamics, waning immunity
- MeSH terms
- COVID-19, SARS-CoV-2, Humans, Evolution, Molecular, Endemic Diseases
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