Moving from a pandemic to an endemic.

We will officially reach an endemic when infection rates are predictable and fluctuations have a minimal effect on medical, behavioral and economic responses. We have seen this 'normalization' with other viruses, such as influenza. That virus has similarities with SARS-CoV-2 (the coronavirus that causes COVID-19) and now we must learn to live with both.

I am delighted to say that the short to medium term threat forecast from SARS-CoV-2 is relatively positive, certainly in the best state since we first encountered COVID-19. That being said, there are a number of uncertainties we need to stay aware of, such as duration of immunity (natural and vaccine-induced), medical advances and the potential of variants.

The main risk in moving from a pandemic to an endemic is the emergence of a variant that replaces Omicron as the dominant strain. While greater infectiousness is possible, a variant would have to be able to evade prior immunity in order to become globally dominant. Alpha, Delta, and Omicron met successfully this standard; Beta and Gamma much less so.

What we do know is that SARS-CoV-2 will continue to mutate (we cannot stop that), and that we struggle to predict when a variant with an evolutionary advantage will arrive. This means that it would be fruitless to discuss 'if' a variant will arrive (that's fairly certain), and far more productive to talk of 'when' we will see the next effective variant of SARS-CoV-2.

In summary, every day that passes without a new variant is a gift. Considering we have seen four strains become globally dominant in just over two years, it is unlikely that we will have to wait too long. We must use this 'quiet' time to create individual, organisational, regional, national and global response systems that can scale quickly if we see a threat on the horizon.