Return to life before SARS-CoV-2. Brandie in the spring of 2020, just a few weeks following the first death on French territory, on February 14, this promise fizzled. One wave following another, people have become accustomed to the idea that Covid-19 will take hold in their lives. From now on, governments and international bodies are aiming for a common horizon, that of a pandemic that would turn into an endemic. In May 2020, this word weighed like a threat: “This virus might become endemic in our communities, it may never go away,” then warned Michael Ryan, director of health emergencies at the World Health Organization (WHO). Today, the same word shines like the hope of a disease that would kill less, making it possible to lift the restrictions that restrict the daily lives of billions of people.
But what is an endemic? “For an epidemiologist, an infection is endemic when the rates of new infections remain stable”, explains Aris Katzourakis, professor of genomics and evolutionary science at the University of Oxford (United Kingdom) in the journal Nature of January 24. A disease may be endemic in some regions and not in others, such as malaria, or cause waves in certain seasons, such as the flu in winter.
The concept, however, is confusing. “The word “endemic” is one of the most overused of this pandemic, regret Aris Katzourakis. It does not mean that Covid-19 will end naturally. » Becoming endemic does not mean disappearing. On the contrary: “An endemic disease is permanently raging in a region”, explains Albert Ko, professor of epidemiology and medicine at the Yale Institute for Global Health (Connecticut). The pathogenic microbe takes root there thanks to the animal or human hosts that harbor it.
Another disappointment: an endemic disease is not necessarily benign. The endemic condition “does not tell us if this disease is serious or not”, warns Stuart Ray, professor of medicine at Johns-Hopkins University (Maryland). “A popular belief is that viruses evolve to become more benign over time. This is not the case. A disease can be endemic, widespread and deadly,” adds Aris Katzourakis. This is evidenced by three endemic scourges: HIV, tuberculosis and malaria. In 2020, tuberculosis killed 1.5 million people; HIV, 680,000; and malaria, more than 600,000. Added to this devastating trio are hepatitis B and C, or even, in certain tropical regions, dengue fever, bilharziasis, etc. The only example of an eradicated human endemic: smallpox, in 1980, thanks to vaccines.
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