Some European countries, including Spain, are working on tentative plans for when to start treating COVID-19 as an “endemic” disease, but the World Health Organization and other officials have warned the world is far from declaring a pandemic. See what endemic disease means and the implications for the future.

What does it mean for a disease to be endemic compared to an epidemic?

Diseases are endemic when they occur regularly in certain regions according to established patterns, whereas a pandemic refers to a global outbreak that causes unpredictable waves of disease.

Catherine Smallwood, an infectious disease expert at the World Health Organization’s European headquarters in Copenhagen, Denmark, said the World Health Organization has said that redefining the coronavirus as an endemic disease remains “a long way to go”. “We still have a lot of uncertainty and the virus is developing rapidly,” she said earlier this month.

For many countries, designating a disease as endemic means fewer resources are available to fight it, as it may no longer be considered a public health emergency.

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Who will decide when the COVID-19 epidemic occurs?

Most wealthy countries are likely to make their own decisions, depending on how the virus spreads within their borders and the likelihood of new cases causing large outbreaks. Widespread use of COVID-19 vaccines, drugs and other measures in wealthy countries could help them contain the outbreak long before the virus is contained globally.

Technically, the World Health Organization has not declared a pandemic. Its highest alert level is a global health emergency, and since January 2020, COVID-19 has demonstrated the distinction. Since then, the UN health agency has convened a committee of experts every three months to reassess the situation.

The pandemic may end when experts from the World Health Organization declare COVID-19 no longer qualified as a global emergency, but the criteria for that decision are not clearly defined.

Dr Michael Ryan, WHO’s head of emergencies, said: “It’s somewhat subjective because it’s not just about the number of cases. It’s about the severity and impact.”

Others point out that the designation of COVID-19 as endemic is arguably a political rather than a scientific one, and it speaks to how much disease and death national authorities and their citizens are willing to tolerate.

read more: How will the pandemic end? Omicron cloud predictions for endgame

What is Spain’s proposal?

Spanish Prime Minister Pedro Sanchez said last week that the drop in the death rate from COVID-19 suggested it was time European officials began to consider whether the disease should be considered endemic. That means Spanish officials will no longer need to record every COVID-19 infection, and people with symptoms won’t necessarily be tested, but if they get sick, they will continue to be treated. The proposal has been discussed with some EU officials, but no decision has been made.

In October, the European Centre for Disease Prevention and Control published recommendations on how countries can transition to more routine COVID-19 surveillance after the acute phase of the pandemic. In its recommendations, the agency said countries should integrate their surveillance of the coronavirus with other diseases such as the flu, and test a representative sample of COVID-19 cases, rather than trying to test every symptomatic person.

Does locality mean the problem is over?

Will not. Many serious diseases, including tuberculosis and HIV, are considered endemic in parts of the world and continue to kill hundreds of thousands of people each year. Malaria, for example, is considered endemic in many regions of sub-Saharan Africa and is estimated to cause more than 200 million cases each year, with about 600,000 deaths.

“Endemic by itself doesn’t mean good,” Ryan said. “Endemic just means it’s here forever.”

Health officials have warned that even after COVID-19 becomes an established respiratory virus like the seasonal flu, the virus will continue to be deadly to some people.

Even after the pandemic is over, “COVID will still be with us,” said Dr. Chris Woods, an infectious disease expert at Duke University. “The difference is that people won’t die indiscriminately because of it, and it will become so routine that we will be able to better and more equitably provide vaccines, treatments and diagnostics to all.”