By Elaine Rassel
We have seen COVID-19 and what it has done to millions of people. Now people are asking if COVID-19 could be classified as endemic? There are four terms that could apply to a disease. Let’s take a look at these four terms.
Pandemics is a disease affecting a large number of people in multiple countries or regions around the world according to WHO (World Health Organization) or in other words_a global outbreak that causes unpredictable waves of illness. Epidemics is a disease affecting people in a country or region. Outbreaks is a sudden occurrence of an infections disease. Endemic is when diseases occur regularly in certain areas according to established patterns. (For many countries, designating a disease as endemic means that fewer resources will be available to combat it, since it will likely no longer be considered a public health emergency.)
These four names have plagued us throughout history. In the past century, we’ve survived a few. How did those end? Is there a chance we can get ourselves out of the one we are in now?
The Spanish flu probably did not start in Spain. It was a particularly deadly strain of H1N1 influenza and the U.S. first saw it in Kansas. The disease killed so many young people and it was not the ordinary influenza by another name. If it hit a town, a young person could wake up in the morning feeling fine and 24 hours later be dead. Half the people who died on this flu in 1918 were in their 20’s and 30’s.
As a species, did we beat the Spanish flu? No, but we did survive it. A third of the world’s population was believed to have contracted the Spanish flu during that pandemic, and it had a case-fatality rate of as high as 10-20% globally and 2.5% in the U.S. It is thought that 675,000 people in America died out of a population of 103.2 million, a number recently surpassed by COVID-19 victims of a 2020 U.S. population of 329.5 million. Flu vaccines wouldn’t be developed until the 1930’s and wouldn’t become widely available for another decade.
The virus went through a process called attenuation. Basically, it got less bad. We still have descendant strains of the Spanish flu floating around today. It’s endemic, NOT a pandemic.
The normal seasonal flu usually kills less than 0.1% of people who contract it. Deaths have been between 12,000 and 52,000 people in the U.S. annually for the past decade. The regular seasonal flu is both less contagious and less deadly than COVID-19. People were washing hands, working from home and socially distancing in the winter 2020 flu season likely contributed to the fact that it was a comparably light flu season.
The Spanish flu ended as an ENDEMIC.
Let’s move on to Polio. The first documented polio epidemic in the U.S. was in 1894. Outbreaks occurred throughout the first half of the 20th century, primarily killing children and leaving many more paralyzed.
Polio reached pandemic levels by the 1940’s. There were more than 600,000 cases of polio in the U.S. in the 20th century, and nearly 60,000 deaths_a case fatality rate of 9.8%. In 1952, there were 57,628 reported cases of polio resulting in 3,145 deaths.
Polio was everyone’s nightmare. People were afraid to death of polio. It was highly contagious. In a household with an infected adult or child, 90% to 100% of susceptible people would develop evidence in their blood of also having been infected. Polio is NOT spread through the air_transmission occurs from oral-oral infection like sharing a drinking glass, or by what is called hand-fecal. (In other words, people don’t wash their hands after going to the bathroom and then make you a sandwich.)
Polio, like COVID-19 could have devastating long-term effects even if you survived the initial infection. President Franklin Roosevelt was among the thousands of people who lived with permanent paralysis from polio. Others spent weeks, years, or the rest of their lives in iron lungs. From our community, Chuck Beaton came down with polio and it paralyzed his legs. Marian Ricker was studying to be a nurse in a Sioux City hospital when she contacted it. She ended up in an iron lung for years.
Precautions were taken during the polio pandemic. Schools and public pools were closed. Then in 1955, a vaccine proved to be 90% effective similar to the effectiveness of our current COVID-19 vaccines. Vaccine technology was still relatively new, and the polio vaccine was not without side effects. A small number of people who got that vaccine got polio from it. Another subset of recipients developed Guillain-Barre syndrome, a noncontagious autoimmune disorder that can cause paralysis or nerve damage. A botched batch killed some of the people who received it.
The polio vaccine campaign became a moment of national unity as Jonas Salk and the folks that solved the polio problem were national heroes. By 1979, polio was eradicated in the United States. It ended as Vaccination.
HIV/AIDS came to our attention in 1981 when the CDC announced the first cases of what we would later call “AIDS”. Do you remember the teenager, Ryan White, who had contacted AIDS from a blood transfusion and was refused to go to school in 1986? A judge threw out a temporary injunction barring him from classes at Western Middle School near Kokomo, Indiana.
About half of Americans who contracted HIV in the early 1980’s died of an HIV//AIDS-related condition within two years. Deaths from HIV peaked in the 1990’s when 50,000 dying and have decreased steadily since then. As of 2019, about 1.2 million Americans are HIV-positive with 5,044 deaths attributed to HIV that year.
Unlike COVID-19, that was quickly identified as a respiratory disease, HIV spread for years before scientists knew exactly how it was transmitted. Today, we now know how to prevent the spread of HIV, and treatments for it have progressed where early intervention can make the virus completely undetectable.
Around 700,000 people in the U.S. have died of HIV-related illnesses in the 40 years since the disease made its appearance. It ended as an Endemic.
Smallpox is something we don’t hear about anymore but at one time it was devastating. This disease had been observed in the Eastern Hemisphere back as early as 1157 B.C, with the first colonizers bringing it to North America in the early 1500’s. Up to this time, there had been no smallpox known. Globally, smallpox is estimated to have killed more that 300 million people in the 1900’s. The case fatality rate of variola major, which caused the majority of small pox infections, is around 30%.
Outbreaks were in North America through the centuries long after it arrived here. In order to get some control of smallpox, people were infected with a weakened version of it long before vaccines even existed.
Onesimus, an enslaved man, is believed to have introduced smallpox inoculation to North America in 1721 when he told slave owner, Cotton Mather, that he had had smallpox in West Africa before coming to America. Mather tried to convince doctors to consider inoculating residents during that outbreak, to limited success. A doctor who inoculated 287 patients reported that only 2% of them died of smallpox, compared with a 14.8% death rate among the general population.
Even George Washington was involved in inoculations for smallpox. In 1777, he ordered troops who had not already had smallpox, to undergo a version of inoculation in which pus from a smallpox sore was introduced into an open wound. People, at this time, who were inoculated developed a mild case of smallpox, then developed natural immunity. Some did die, but at a lower rate compared with other ways of contracting smallpox.
In England in 1796, Edward Jenner first demonstrated the effectiveness of his newly created smallpox vaccine. Vaccination spread throughout the world after that.
Early vaccines reduced smallpox’s power, smallpox still did exist. In 1947, there was an outbreak in New York City. This outbreak let people know that vaccines were not 100% effective in everyone forever. Eugene Le Bar, a 47 year old male, was the first fatality following vaccination. He had a smallpox vaccine scar to prove his vaccination. New York City health commissioner, held a news conference urging all New Yorkers to get vaccinated against smallpox, no matter if it was the first time or what we now call a “booster shot.”
New York City’s mayor and President Harry Truman went on camera to get vaccinated. New Yorkers numbered 6.35 million out of a city of 7.8 million were vaccinated. The final toll of the New York outbreak was 12 cases of smallpox that resulted in 2 people dying. The final outbreak of smallpox in our country was in Rio Grande Valley in 149 with eight people being affected.
WHO announced a plan in 1959 to eradicated smallpox globally with vaccinations. Small pox was declared eradicated in 1980. Smallpox ended with Vaccination.
SARS first appeared in China in 2002 before it made way to the U.S. and 28 other countries. Just what the do initials, SARS, mean? Severe Acute Respiratory Syndrome, too many words, was shortened to SARS when results of it was spoken of. It was caused by a coronavirus named SARS-CoV, or SARS_an associated coronavirus. COVID-19 is caused by a virus so similar that it’s called SARS-CoV-2.
Continued in next weeks Marcus News

More than 8,000 people globally contracted SARS during the outbreak and 916 died of it.  There were 115 cases of SARS suspected in the U.S.; only 8 people had laboratory-confirmed cases of this disease and none of them died.  Like COVID-19, fatality rates from SARS were very low for young people_with less than 1% for people under age 25_but for people over age 65, more than 50% of them contacted SARS.  The fatality rate at this time was 11%.  Public anxiety was widespread, even in those areas that were unaffected.
SARS and COVID-19 have a lot in common, even though the diseases weren’t exactly the same.  Unlike COVID-19 response, the response to SARS was fast and immediate.  The WHO (World Health Organization) issued a global alert about this unknown and severe form of pneumonia in Asia on March 12, 2003.  The CDC activated 

its Emergency Operations Center two days later (March 14), and issued an alert for travelers entering the U.S. from Hong Kong and parts of China. Pandemic planning and guidance went into effect by the end of the month of March.
The disease, SARS, stopped spreading before a vaccine or cure could be created. It ended: Died out after being controlled by public health measures.
SWINE FLU was caused by the same type of virus that the Spanish flu had_influenza A H1N1. There were about 60.8 million cases of swine flu in the U.S. from April 2009 to April 2010. During that time period, there were 274,304 hospitalizations and 12,469 people died. There were millions more cases of swine flu that there were of COVID-19 in the same period, but a fraction of the fatalities. 80% of swine flu deaths were in people younger than age 65.
Swine flu was first detected in California on April 15, 2009 and the CDC and Obama administration declared public health emergencies before the end of that month. In the same month cases were first detected, the CDC started identifying the virus strain for a potential vaccine. People received flu shots with H1N1 protections in October of 2009. WHO declared the swine flu pandemic over in August of 2010. Like the Spanish flu, swine flu never went away completely. It ended as Endemic.
EBOLA was first heard of in 2014. From 2014 to 2016, there were 28,616 people in West Africa that had Ebola and out of this number, 11,310 people died. This was a fatality rate of 39.5%. Even though people were worried that it would reach to the U.S., there were only two people that contracted Ebola on U.S. soil, and neither one of these people died.
How did people in the U.S. escape Ebola? While COVID-19 is transmitted in the air, Ebola isn’t transmitted in the air so there is no spread that way. Ebola is spread through the bodily fluids of people actively experiencing symptoms, either directly or through bedding and other objects that they touched. People not within three feet of a person with Ebola, has almost no risk of getting it.
You might say that part of the problem of Ebola came from Africa. After a person dies, families wash their bodies of the deceased, thereby exposing themselves to infected fluids. The disease could be controlled once there was adequate equipment delivered to those areas affected and precautions were taken by health care workers and families of the victims.
Even though this particular outbreak ended in 2016, it is possible we will see another Ebola event in the future. The FDA approved an Ebola vaccine in 2019.
Ebola subsided after being controlled by public health measures.
COVID-19_will this ever end? It has been said that COVID-19 is here to stay with most people thinking it will be endemic for a while.
COVID-19 has a lot going for it, as far as viruses go. Unlike Ebola and SARS, it can be spread by people who don’t realize they have it. Unlike smallpox, it can jump species, infecting animals and then animals potentially reinfecting us. Unlike Polio, one person can spread it to a room full of people, and not enough people are willing to get vaccinated at once to stop it.
In some populations, enough people will get vaccinated to achieve what has been called “herd immunity.” In other others, it will burn through the population until everyone’s had it, and achieves naturally gained immunity (which confers less long-term protection that vaccination) or dies. People still die from influenza and HIV in the United States; a disease becoming endemic isn’t exactly a happy ending.
How will COVID-19 end? It will end with a combination of vaccine, a naturally gained immunity attenuation, availability of rapid testing, and improvements in treatment for active cases could turn it into what “those people not sure of treatment” called it to begin with_a bad cold or flu.
Getting people to get vaccinated for COVID-19 could be compared to leading a horse to water, that doesn’t want to drink.
Most wealthy countries will probably make the decision of when COVID-19 is endemic depending on how the virus is circulating within their borders and on the potential for new cases to cause big out-breaks. The COVID-19 vaccines, medicines and other measures widely available in rich countries will likely help them curb outbreaks long before the virus is brought under control globally.
It’s likely the pandemic will be over when the WHO’s experts declare that COVID-19 no longer qualifies as a global emergency, but the criteria for that decision are not precisely defined. It’s not just about the number of cases but rather about severity and it’s about impact.
Some have said that designating COVID-19 as endemic is arguably a political question rather than a scientific one, and it speaks to how much disease and death national authorities and their citizens are willing to tolerate.
The country of Spain has considered the falling death rates for COVID-19 could suggest that it’s time for European officials to start considering whether the disease should be considered endemic. What does this mean? It means that Spanish officials wouldn’t need to record every COVID-19 infection and that people with symptoms would not necessarily be tested, but they would continue to be treated if they are sick.
Back in October, the European Centre for Disease Prevention and Control had some advice on how countries might transition to more routine surveillance of COVID-19 after the acute phase of the pandemic. Among its recommendations, the agency said countries should integrate their monitoring of the coronavirus with other diseases like flu, and test a representative sample of COVID-19 cases, rather than attempting to test every person with symptoms.
Does endemic mean the problem is over? Not really. There are many serious diseases, including tuberculosis and HIV, that are considered endemic in parts of the world and continue to kill hundreds of thousands of people every year.
Endemic in itself does not mean good. It just means it’s here forever. Health officials warn that even after COVID-19 becomes an established respiratory virus like seasonal flu, the virus will continue to be fatal for some.
“Even after the pandemic ends, COVID-19 will still be with us. The difference is people won’t be dying indiscriminately because of it, and it will be so routine that we will have much better and fairer access to vaccines, therapeutics and diagnostics for all,” Dr. Chris Woods, an infectious disease expert at Duke University states.
Now there is another virus called Omicron that has similar symptoms like COVID-19, but is a virus of all its own but has been called COVID-19. When this outbreak of Omicron happens, people are all worried that COVID-19 is back again and don’t want to see Omicron as another virus.
Once you have had chicken pox, you are prone to get “shingles”. If a few people come down with shingles, is it right to put out the alarm that CHICKEN POX is back again when it is actually shingles? We, who have had chicken pox, can be thankful that there was finally a vaccination for it. There is help for shingles, also. Finding a cure or help for these childhood diseases didn’t come overnight.