Three years after the World Health Organization ended the COVID-19 public health emergency, infectious disease specialists still disagree about whether the pandemic is over. The disagreement is not mainly about the data. It is about the absence of a definition.
There is no case count, transmission rate, or death threshold that marks the boundary between pandemic and endemic. Epidemiologists have said for years that the transition is usually identified in hindsight rather than in real time.
Which is why the practical answer for individuals is the less satisfying one: the label does not change anyone's personal risk, and the risk itself varies enormously by age and health status in ways the word obscures.
The Terms Do Not Carry the Meanings Most People Assume
A pandemic is generally defined as a widespread disease outbreak causing disruption on a global scale. Endemic means the constant presence of a disease rather than a disruptive outbreak.
Neither definition includes a number, and endemic is not a synonym for mild. William Hanage of the Harvard T.H. Chan School of Public Health has made the point bluntly, noting that endemic does not necessarily mean good and that tuberculosis and malaria are endemic in parts of the world.
Michael Osterholm, director of the University of Minnesota's Center for Infectious Disease Research and Policy, told CIDRAP News there is no magic answer to the question of what defines a pandemic, and that the modern examples all involve respiratory viruses because the transmission dynamics make them worldwide threats.
Asked directly whether the pandemic is still going on, Osterholm said it is not, describing a country now adjusting into a more routine cycle of infection. He attributed that to preexisting population immunity and to the relative genetic stability of the virus compared with the first four years, when the ancestral strain gave way to Alpha, Beta, Delta, Gamma and Omicron in rapid succession. Past flu pandemics, he noted, faded into background endemic disease in much the same way.
The Case for Calling It Endemic
Officials at the CDC have described COVID as endemic, characterizing it as a significant problem that can be managed alongside other public health threats rather than as a singular emergency.
The supporting evidence is the pattern. Waves have become more predictable, severe outcomes have declined substantially relative to the first years, and the virus has not produced a variant that escapes population immunity the way earlier ones did.
Caitlin Rivers, an epidemiologist at the Johns Hopkins Center for Health Security, has framed the endemic state in practical terms rather than triumphal ones, saying that COVID is one more thing people have to deal with, another reason a child might miss school or an adult might miss work.
The shift from pandemic to endemic is typically identified by looking backward and reassessing, not by observing a threshold being crossed in the moment. Under that view, arguing about the present label may be less useful than tracking whether the pattern holds through another respiratory season.
The Case for Holding the Label
The counterargument rests on what the vocabulary licenses. Osterholm, who says the pandemic phase has passed, has been equally direct that the illness should not be written off as merely a mild infection.
The mortality picture supports that caution. COVID has continued to kill thousands of Americans each year, concentrated among older people and those with other health conditions, and it remains among the leading causes of death nationally, well below its peak but not trivial. Deaths are also frequently recorded under nonspecific causes such as pneumonia or respiratory failure, the same pattern long seen with influenza, which is why the CDC uses modeling to estimate the true toll.
There is also the separate question of preparedness for the next event, which the current debate tends to crowd out. Osterholm has argued in commentary that the more consequential question is not what to call the current phase but how the United States would be better prepared for another pandemic, which he treats as a matter of when rather than if.
The Risk That Actually Varies
For most healthy adults under 65 with updated immunity, a COVID infection now resembles other respiratory infections in course and severity. That is a genuine change from 2020, and it is fair to say so.
The people for whom it has changed least are adults over 65, very young children, people who are immunocompromised, people with chronic lung, heart or kidney disease, and pregnant people. For these groups, the calculation around vaccination, testing, and early antiviral treatment remains meaningfully different, and a debate about vocabulary should not be read as reassurance.
Antiviral treatment works best when started early, generally within five days of symptom onset, which makes testing decisions time-sensitive for anyone in a higher risk category. People who are unsure whether they qualify should ask a clinician in advance rather than during an illness.
Cost and access have shifted. Free testing programs have largely ended, and coverage for vaccines and antivirals now depends on insurance status and current recommendations, which have been in flux. Checking plan documents before the fall respiratory season is more useful than assuming last year's arrangement holds.
Signals That Would Settle the Question
Nothing on a fixed schedule. Public health bodies are unlikely to issue a formal declaration, because the transition is a gradual biological process rather than an administrative event.
What would move the needle is several consecutive years of seasonal, predictable waves without a substantially immune-evasive variant. Surveillance systems that would detect a departure from that pattern include wastewater monitoring, emergency department visit data, and variant sequencing, all of which remain in operation and are tracked continuously.
Readers who want a signal to watch should track those systems rather than the terminology. The word will follow the data, and it will probably be applied in retrospect.
Frequently Asked Questions
Is COVID still a pandemic? Experts disagree. CDC officials have described it as endemic, and some prominent epidemiologists say the pandemic phase has passed, while others emphasize continued unpredictability.
Is there an official definition? No numeric threshold separates the two. Pandemic means global-scale disruption; endemic means constant presence. Both are judgment calls.
Does endemic mean mild? No. Tuberculosis and malaria are endemic in parts of the world. The term describes persistence, not severity.
Does the label change my risk? No. Individual risk depends on age, immune status, chronic conditions and vaccination history, not on terminology.
Who still faces elevated risk? Adults over 65, very young children, immunocompromised people, those with chronic lung, heart or kidney disease, and pregnant people.
When should I get tested? Early, if you are in a higher risk group, because antiviral treatment works best when started within about five days of symptom onset.
What should I watch to know if things change? Wastewater surveillance, emergency department visit data, and variant sequencing, rather than shifts in vocabulary.
