Four years after SARS-CoV2 triggered a devastating global pandemic, US health officials now consider covid-19 an endemic disease.

“At this point, covid-19 can be described as endemic worldwide,” says Aaron Hallthe deputy director of science at the CDC’s division of coronaviruses and other respiratory viruses, told NPR in an interview.

This essentially means that COVID is here to stay in predictable ways.

The classification does not change any official recommendations or guidelines for how people should react to the virus. But the categorization recognizes that the SARS-CoV2 virus that causes COVID will continue to circulate and cause disease indefinitely, underscoring the importance of people getting vaccinated and taking other measures to reduce their risk for the foreseeable future.

“It’s still a very significant problem, but one that can now be managed against the backdrop of many public health threats and not as a sort of one-off pandemic threat,” says Hall. “And how we approach covid-19 is very similar to how we approach other endemic diseases.”

Ever since the coronavirus exploded around the world, officials have referred to COVID as a “pandemic,” which occurs when a dangerous new disease spreads widely in different countries.

The definition of “endemic” is fuzzier, but generally refers to a disease that has become entrenched in places, such as malaria found in many parts of Central and South America and sub-Saharan Africa, forcing people to learn to live with it.

And although covid is still spreading a lot, everyday life has returned to normal for most, even during the summer’s wave of infections. On Wednesday, Noah Lyles competed in his Olympic race despite a symptomatic covid infection and won a bronze medal. President Biden worked from home during his recent COVID infection.

COVID seems to be becoming a normal part of life. So NPR reached out to the CDC and other experts to find out if they think it’s time to start referring to covid as endemic.

“Yes, I think in the way that most people think of the term endemic — something that we have to deal with on an ongoing basis — yes, absolutely, COVID is endemic in that way,” said Dr. Ashish Jha. Jha is the dean of the Brown University School of Public Health, who served as the White House’s COVID-19 response coordinator for President Biden.

But not everyone agrees. Some epidemiologists say that COVID may be on the verge of becoming endemic, but the virus is still too unpredictable to reach that conclusion yet. The summer rise, for example, started surprisingly early and turns out to be significantly greater than expected.

The latest data from the CDC shows high or very high levels of viruses in wastewater in almost every state.

“There is still a lot of unpredictability with this virus,” says Katelyn Jetelinaan epidemiologist who writes the popular newsletter: Your Local Epidemiologist. “And many scientists including myself think it will take at least a decade for SARS-CoV2 to really find this really predictable pattern. I hope that over time it will fade into the background. But we’re just not there yet.”

Hall and Jha agree that covid remains somewhat unpredictable, but argue that it has become predictable enough to be considered endemic.

“The best way to describe COVID right now is as endemic but with these periodic epidemics,” Hall says. “And these epidemics can vary in terms of their timing and magnitude. And that’s exactly why ongoing vigilance and surveillance is critical.”

And even though covid is endemic, that doesn’t mean it’s no longer a problem.

“Endemic does not necessarily mean good,” William Hanagean epidemiologist at the Harvard TH Chan School of Public Health. “Tuberculosis is endemic in some parts of the world. And malaria is endemic in some parts of the world. And neither of those are good.”

COVID still kills hundreds of people every week, mainly older people and those with other health problems. According to a new CDC reportCOVID is no longer the third leading cause of death, but the disease still ranks as the 10th leading cause of death. Covid is expected to kill close to 50,000 people each year, according to the new report.

“I think we have to be very careful about just writing this off and saying, ‘Well, it’s just a mild infection.’ It is not,” says Michael Osterholmwho runs the Center for Infectious Disease Research and Policy at the University of Minnesota. “It’s especially a significant risk for those who are older and those with underlying conditions. The good news is for most younger people, otherwise healthier people will be like having a flu-like infection.”

But even if someone doesn’t get terminally ill, covid can still make people pretty miserable, knocking them out of work or school. And then there is covid for a long time.

“I really hope this is not our new normal for covid,” says Samuel Scarpinowho studies infectious diseases at Northeastern University in Boston. “I had it a few weeks ago, and almost everyone I know has had it. It would be a real bummer if we’re in this situation where we have covid (in the summer), and then we come into the fall with RSV, and then we have the flu and then there is basically a risk of respiratory infections all year round.

So whether or not covid can officially be considered endemic, people will still need to think about protecting themselves by getting vaccinated once or twice a year and consider masking in risky situations and around high-risk people.

Better treatments and new vaccines that can prevent the spread of the virus would also help, as would better ventilation, many infectious disease experts say.

“We still need to do more, I think, to get this virus under control,” says Jha. “This is a virus that we have to deal with. We can’t just ignore it. We can do better and we should do better.”

It remains important to continue monitoring the spread of the virus and its evolution, especially to try to detect the emergence of new, more dangerous variants, Jha and other experts said.

“We will have to continue to live with covid,” says Caitlin Riversan epidemiologist at the Johns Hopkins Center for Health Security. “It’s one more thing that people have to deal with. It’s another reason why your kids might miss school or you might miss work or something else to think about when planning gatherings. We’re stuck with that.”

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