Rosy assumptions endanger public health — policymakers must act now to shape the years to come.
The word ‘endemic’ has become one of the most misused of the pandemic. And many of the errant assumptions made encourage a misplaced complacency. It doesn’t mean that COVID-19 will come to a natural end.
In other words, a disease can be endemic and both widespread and deadly. Malaria killed more than 600,000 people in 2020. Ten million fell ill with tuberculosis that same year and 1.5 million died. Endemic certainly does not mean that evolution has somehow tamed a pathogen so that life simply returns to ‘normal’.As an evolutionary virologist, it frustrates me when policymakers invoke the word endemic as an excuse to do little or nothing.
Soon after the Alpha variant emerged and spread in late 2020, I argued that, unless infections were suppressed, viral evolution would be fast and unpredictable, with the emergence of more variants with different and potentially more-dangerous biological characteristics.
COVID-19 is, of course, not the world’s first pandemic. The fact that immune systems have evolved to cope with constant infections, and the traces of viral genetic material embedded in our own genomes from ancient viral infections, are testament to such evolutionary battles. It is likely that some viruses went ‘extinct’ on their own and still caused high rates of mortality on the way out.There is a widespread, rosy misconception that viruses evolve over time to become more benign.
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