Talk:Endemic COVID-19/Archive 2

True endemic definition
This article: https://www.science.org/content/article/it-time-live-covid-19-some-scientists-warn-endemic-delusion from last year mentions an attempt at defining a "true endemic phase" ("daily case rates below 30 per 100,000, ICUs below 80% of capacity, vaccination rates of at least 75%, and fewer than 100 COVID-19 deaths a day nationwide" [in the US]).

I wonder how many COVID-specific definitions have been proposed.

(Incidentally, wrt the Steere-Williams quotation, this source also mentions that the decision to reduce restrictions is because politicians in the US "face political and economic pressures. States’ moves may be driven largely by the public’s impatience with restrictions", which suggests that we should consider whether Steere-Williams' viewpoint should be singled out as if it were only his own viewpoint, and not one that is widely spread.) WhatamIdoing (talk) 05:06, 14 May 2023 (UTC)


 * from last June covers possible non-endemic paths, and then concludes that the transition to endemic status is "inevitable". It also does a good outline of research that should be done now, to better understand endemic COVID, which would be useful for a ==Research directions== section (suggested in Manual of Style/Medicine-related articles). WhatamIdoing (talk) 05:15, 14 May 2023 (UTC)
 * The latter paper is modelling possible futures. I'm not certain it's that useful. Bondegezou (talk) 13:56, 14 May 2023 (UTC)
 * I think what may be most useful is this sentence: We distinguish between 4 possible paths of an emerging pathogen, including “sporadic spread,” “local or regional spread,” “pandemicity,” and “endemicity.”
 * In particular, there are versions of Living with COVID that are not Endemic COVID-19. The Singapore source that @SmolBrane linked below is just as relevant for non-endemic local/regional spread as it is for actual endemicity.  (It's less relevant for sporadic spread, which tends to die out on its own, and thus doesn't need much in the way of testing, wastewater surveillance, etc.)  I think that making that distinction would help readers understand that endemicity is not the only possible outcome, or even the only possible outcome that results in basically functioning societies.  Endemicity is the most likely outcome, but (a) there are other outcomes and (b) if you got to pick, then sporadic spread would probably be better. WhatamIdoing (talk) 19:40, 14 May 2023 (UTC)
 * I'm not sure what "true endemic" is, but it's worth mentioning that Singapore utilized a multi-ministry task force which included the Minister for Trade and Industry, and the Ministry for Finance, as well as the Minister for Health.  They published their endemic comments in a news article, not in a medical journal.  So we have to be careful not to choose content on the behalf of our sources, instead of the other way around. SmolBrane (talk) 18:02, 14 May 2023 (UTC)
 * I think it might be helpful to contrast the Singapore source that you link with this one.
 * Singapore: "Covid-19 may never go away....Covid-19 will very likely become endemic....Covid-19 will be endemic...."
 * US proposal: [We'll know it's become endemic when we see] "daily case rates below 30 per 100,000, ICUs below 80% of capacity, vaccination rates of at least 75%, and fewer than 100 COVID-19 deaths a day nationwide."
 * The Singapore source says nothing concrete about what endemic Covid actually is, or how you would know if the situation in Singapore actually constitutes endemicity. It just talks about a vague possibility at some point in the future, with some soothing but basically irrelevant noises about "new normal" and "living with" disease and some optimistic hopes that it will be "less threatening" and that "treatments will improve" after people's "acceptance" of the risk of morbidity and mortality.
 * The US source provides objective measurements. You collect the data, compare it against the numbers, and say either "Yup, it meets our definition of endemic" or "Nope, it's not endemic".
 * These are really not the same things. WhatamIdoing (talk) 19:27, 14 May 2023 (UTC)
 * (Thank you firstly for your civil and collaborative tone, it's well-welcomed on this article!) I agree they are not the same and I agree that objective measurements would be desirable here. But those objective standards are not universally utilized(as far as I am aware) so we can't assume them to be universally relevant.  There are some differences (and certainly some similarities) between endemic COVID and "living with", "new normal", but I will again say that we have to be careful not to insert our own research and synthesis here.  If a national WP:MEDORG states that COVID is endemic, we need good reason to exclude it here.  The S'pore situation is nuanced and complex.  Regards, SmolBrane (talk) 14:26, 15 May 2023 (UTC)
 * As they say, the nice thing about standards is that you have so many to choose from. I expect that we'll find multiple standards, and there will probably even be multiple standards proposed just for the US.  (You might expect wealthy countries to have different metrics than poorer countries, but I think we'll see even more than that.)  Ultimately, I expect endemicity to be clearly visible only in hindsight, but we'll just have to be careful not to overstate things in between now and then.
 * A reputable MEDORG willing to cleanly state that COVID has already become endemic, without any weaseling around, would be an excellent source. We'd probably need to present it as a claim ("The Medical Organization said that COVID-19 became endemic in Country in 2022") rather than as an indisputable fact, but if we ever get such a source, I think we should include it, even if it has to be followed up with "and these other 16 equally good organizations say they're wrong". WhatamIdoing (talk) 21:17, 15 May 2023 (UTC)
 * I agree with this, but sadly such statements get purged from the article . Crossroads -talk- 02:11, 16 May 2023 (UTC)
 * A great illustration of the problem. A news report making great play of how vaccination has led to reduced health risk, being spun into something about endemicity somehow seeming responsible, while ever-so-plainly failing to mention vaccination. Bon courage (talk) 09:23, 16 May 2023 (UTC)
 * Looking at one of the sources through machine translation, which was a clarification of some previous remarks, I think that these are the key sentences:
 * "THL's Mika Salminen stated on Wednesday that the Pandemic has turned into a corona epidemic . What does endemic disease really mean?"
 * "According to Mika Salminen, the term he used was practically 'a jingle of words', but the purpose of the message is to emphasize that Korona is now permanently among us."
 * It sounds like the point was to say that SARS-CoV-2 can't be eradicated, which is not the same thing as it being endemic. An infectious disease can be ineradicable and not endemic (e.g., if the spread is too great, in which case it is a pandemic, or too variable, in which case it is not endemic).
 * I would therefore put that in the failed verification category if it were claiming that it (already/definitely) is endemic in that country, and possibly even for a claim that they might be transitioning to a non-sporadic, non-regional spread model, as that does not appear to be what the official says he intended to communicate.  WhatamIdoing (talk) 18:55, 16 May 2023 (UTC)
 * A reputable MEDORG willing to cleanly state that COVID has already become endemic, without any weaseling around, would be an excellent source. See the New Zealand and South Korea sections on this talk page.  COVID-19 pandemic in Finland and COVID-19 pandemic in South Korea are both POV forks with this article currently, since those summaries were removed from this article. SmolBrane (talk) 14:18, 16 May 2023 (UTC)
 * That not what a POVFORK is. Bon courage (talk) 14:31, 16 May 2023 (UTC)
 * If we add that specific proposal to define endemicity then it should be from the paper that proposes it rather than this article from their news section. But I'll note that such a proposal contradicts those who claim (during Covid anyway; have sources really said this before?) that actually something can be endemic with very high spread and severity.
 * The news articles notes that many other countries besides the US also lifted restrictions at roughly the same time or even sooner, as well as noting many (not all of course) scientists who either agreed it was time to do so, or nearly so. And indeed, since then we've reached a point where very few restrictions exist anywhere. I don't see any reason to change the coverage of the Steere-Williams quote.
 * I do agree that this source is good and should be used. Thank you for finding it. Crossroads -talk- 21:58, 14 May 2023 (UTC)
 * Endemic has pretty much always meant it's a predictable amount. The specific word hyperendemic can be used to describe predictably high levels.  WhatamIdoing (talk) 23:29, 14 May 2023 (UTC)
 * Regarding endemicity and high transmission, I did find this paper a little while back "Higher Viral Transmission Paradoxically Reduces Severe COVID-19 During Endemic Transition" . My brain is out of juice right now so I have no suggestions at the moment. SmolBrane (talk) 14:32, 15 May 2023 (UTC)
 * Perhaps related "Immunological characteristics govern the transition of COVID-19 to endemicity" . SmolBrane (talk) 14:37, 15 May 2023 (UTC)
 * Unfortunately, they're both primary sources, and the January 2021 paper is probably outdated. We have twice as much information now as we did when that was written. WhatamIdoing (talk) 21:22, 15 May 2023 (UTC)
 * The Steere-Williams article is also a primary source; similarly the Katzourakis article is a "world view" piece, and the Tracey McDonald source is an editorial. If we're going to include things like that, then to be consistent and NPOV it's fine to include this to a small extent. As WP:MEDDATE notes, in some areas few reviews are published. And the diagrams at WP:MEDASSESS ranks editorials and expert opinions near the bottom of the pyramid of evidence quality.
 * The current emphasis in the article is not consistent with the breadth of the scientific literature, rather it is unduly like certain social media narratives in which Covid becoming "like the common cold", and lifting NPIs possibly being a good thing, is anathema; itself an Americentric perspective of how Covid, and especially measures to combat it, was and is politicized. Crossroads -talk- 01:37, 16 May 2023 (UTC) clar. Crossroads -talk- 03:24, 16 May 2023 (UTC)
 * As you say, this is all new and I can't find any reviews to include, so in that context, if people want an article on endemic COVID, then editorials and expert opinions in the peer-reviewed academic literature is better than nothing, and better than just citing newspapers.
 * COVID-19 was politicised all over -- that's not an Americentric perspective! The peer-reviewed academic literature we have explicitly comments on how endemicity is politicised. As per WP:NPOV, I think it's good we surface that. Bondegezou (talk) 09:01, 16 May 2023 (UTC)
 * I'm not talking about mentioning the politicization as such in the article, rather what I mean is that it suffers from the bias in which saying that NPIs can end and that it will become like the common cold was (and in some corners of social media still is) stigmatized as right-wing anti-science especially by Americans even though it isn't 2020 anymore and these are now common perspectives among experts.
 * As for citing newspapers, that really needs to be unpacked. If that means some newspaper or journalist giving their opinion, then yes, that is even worse. However, if they are simply relaying the statements of MEDORGs or health ministers, then those are perfectly usable sources to relay that. It remains the case that editorials and expert opinions are worse than primary sources, yet the article relies excessively on the former. Crossroads -talk- 00:38, 18 May 2023 (UTC)
 * Relevantly for this article, "NPIs can end and that it will become like the common cold" is not the same as "endemic".
 * (Also, I doubt that NPIs will completely end. Certain individual requirements have or will end, but there are no reasons to rip the improved air filtering out of buildings and airplanes, and schools and employers are likely to be sympathetic to sick people not coming in to work to infect everyone else for years to come.  Those are NPIs, too.) WhatamIdoing (talk) 03:34, 19 May 2023 (UTC)
 * , your view that it suffers from the bias... etc. is your opinion. Fair enough, but that's WP:OR. Do you have sources supporting that view? Bondegezou (talk) 08:31, 19 May 2023 (UTC)
 * I'm not aware of any sources about this Wikipedia article. :) My complaint is that some of us are allowing in low-quality sources emphasizing high risk etc., while purging other higher-quality sources that connect endemicity to lifting measures or low risk. That's pretty classic POV issues with the article from where I stand. Crossroads -talk- 01:23, 20 May 2023 (UTC)
 * If you have higher-quality sources that should be covered, please suggest them. Bondegezou (talk) 14:31, 21 May 2023 (UTC)
 * Quite. WP:PRIMARYNEWS sources are poor, especially for a technical health topic. More scholarly sources would be great however! Bon courage (talk) 15:17, 21 May 2023 (UTC)

Background or main subject
I'd like to pick up on something @Bon courage said recently: "This is meant to be an article giving the knowledge of what endemic COVID is".

Looking at the article, I see basically two sections:


 * ==Background==, and
 * a list of what has been said about a handful of countries

The ==Background== section appears to be partially background information and partially a description of what endemic COVID is (and isn't). If that's the main subject, then this section heading should be changed. But if the main subject of this page is not really what-endemic-COVID-is, and is more of a living-with-COVID-new-normal-finally-not-an-emergency-any-longer subject, then that section is properly background information...but maybe in that case, we should change the article title.

I would like to hear what y'all think, but first I want to remind you: There is no single correct answer here. There are no sources or policies saying that the English Wikipedia must/mustn't have an article titled _____, or must have exactly one/two/three articles related to this, or anything else. Please think it through and use your best editorial judgement. I look forward to hearing what you think. WhatamIdoing (talk) 21:34, 15 May 2023 (UTC)
 * "Background" could be renamed to "Overview" or something else. I'd rather keep the topic as "endemicity" because anything else sounds too broad and likely to become an unfocused mess and a dumping ground for axe-grinding (on both sides). Regarding the matter of things related to returning to normal or lifting restrictions, much of that was during a pandemic phase but because the situation had improved, and some of it is of unclear connection to endemicity. That material belongs in other articles. Something I and some others believe is that when relevant authorities do connect such actions to endemicity it should be included here, but such things keep getting sporadically purged and reverted by others on the grounds that they're too primary, which I find disruptive and (whether intended or not) POV. Crossroads -talk- 01:49, 16 May 2023 (UTC)
 * I think the trouble is in that word "connect" in that editors take it to mean "word is used in same statement or news report". The idea that it is endemicity in and of itself which allows health restrictions to be relaxed is exceptionally odd. It is the threat posed to public health. If something was highly lethal and endemic no health authority would relax; if something was completely harmless and a raging epidemic health authorities would not impose draconian restrictions. Playing fast and loose with this "connection" courts the very wrong use of the concept of "endemic" that our scholarly sources warn against. Bon courage (talk) 03:42, 16 May 2023 (UTC)
 * I'm not too interested in the details of COVID endemicity unless the source provides it. We have an article on endemic (epidemiology) already.  It's not our job to interpret to this degree.  If a national MEDORG classifies COVID as endemic in a national region and it's published in a conventional news source, what are your sourced grounds for opposing inclusion?
 * To Crossroads' point, endemicity is the best way to constrain this type of article since it's much more clear than "living with COVID" or "new normal" or whatever. SmolBrane (talk) 14:26, 16 May 2023 (UTC)
 * I don't think that we need "sourced grounds" for opposing inclusion of material that we believe is off topic. See Article titles and scopes if you want a longer explanation, but basically, Wikipedia editors have to decide what the subject of the article is, because there are no reliable sources that say what the scope of a particular page on Wikipedia ought to be.  We can use sources to help us make good decisions, but we must make the decisions ourselves.
 * For example, we could decide that the subject of this particular page is SARS-CoV-2 infection using the narrowest, most technical possible definition of endemic, and that if a national MEDORG classifies COVID as endemic in a national region and it's published in a conventional news source, then that belongs in a List of places where someone claimed COVID-19 was endemic. I wouldn't necessarily recommend splitting the subjects so starkly, but doing so would be 100% within the bounds of our written policies and guidelines (e.g., WP:N's "Editors may use their discretion"; the entire Consensus policy). WhatamIdoing (talk) 23:04, 16 May 2023 (UTC)
 * This article used to be named "Endemic phase of COVID-19", I outlined the collection of sources that demonstrated the accuracy of this over on the COVID-19 pandemic talk page back in November . The DUEness of the shift from pandemic to endemic is great, that's why this article should be maintained correspondingly, despite issues with what this article is actually about.  A bunch of that material has been removed unfortunately, to the detriment of our readers.  If we are going to arbitrate who is using the word endemic correctly, we should be able to navigate DUEness as well. SmolBrane (talk) 15:14, 17 May 2023 (UTC)
 * Would like to invite your thoughts on the New Zealand section above, and my thoughts on it SmolBrane (talk) 15:18, 17 May 2023 (UTC)
 * Editor discretion must be within the bounds of WP:NPOV; if the topic of the article has been decided to be "endemic Covid", then no, editors are not at liberty to exclude material because they personally think a MEDORG made a mistake. That's pretty blatantly putting editor opinion ahead of experts. If article content is a popularity contest of internet denizen opinions then just dispense with sourcing altogether and make it a Twitter slapfest. Crossroads -talk- 00:43, 18 May 2023 (UTC)
 * I usually give the definition of Cure as the example for this problem. So, being English speakers, we all think we know what it means for a disease to be cured (in an individual), right?  Only... most of us are wrong.  The "real" (medical) definition involves plotting disease-free survival curves and figuring out when the slope goes flat.  For some kinds of breast cancer, you're cured if you're disease-free for three years.  For some kinds of lung cancer, it's 15 years.  So this means that if you have breast cancer and have no detectable disease three years later, then you're cured.  And if breast cancer is detected in subsequent years, it's a new primary, not a recurrence of the old one.
 * But non-stats folks don't think that way. They don't feel that way.  They'll say that they were cured when they started to feel better.  When active treatment ended.  When the first test gave good news.  When a troublesome side effect wore off.  When a personally significant milestone passed (e.g., a birthday).  Or that they're still not cured, even though their doctors say they are, because they just don't feel it.
 * I think we have a similar challenge here. There's a technical, mathematical definition of endemicity.  Covid might be endemic now, and it might not.  (We can only calculate the beginning of endemicity well afterwards.)  That definition has nothing to do with policy measures like whether it's a good idea to wear a mask on an airplane or who should pay for screening tests or even whether we should collect the information that's necessary for calculating whether we've truly entered into an endemic stage.
 * And back here at Wikipedia, editors are at liberty to decide that the scope of the article is (for example) "COVID as an endemic disease, as indicated through the usual mathematical standards for infectious diseases", in which case we actually would have to exclude statements that merely say that COVID won't be eradicated (because non-eradication alone is not the usual mathematical standard for endemicity) or that a government is changing a policy (the change might be sensible, but it still doesn't tell you whether it's endemic) or that a politician said something.
 * The scope of the article is a decision that we make. My question is:  Do we want to follow the narrow scientific definition, or do we want to talk about a broader subject like "maybe things will be kind of normal again, which is a state that politicians mistakenly describe as endemic"? WhatamIdoing (talk) 04:16, 19 May 2023 (UTC)
 * That does seem like it may turn out to be an apt comparison, but as for now my position is that we should stick to the more specific topic of endemic Covid. Sometimes "back to normal" moves will be related to this, and oftentimes not. Especially the latter since it does so far seem like we might end up hearing about "endemic" mostly in hindsight whereas lifting restrictions was usually based on more immediate circumstances. But when it is named as a factor, we should mention it. Crossroads -talk- 01:17, 20 May 2023 (UTC)
 * How would you mention it?
 * Using the cure definition, imagine that we have (a) a definition saying that you're cured of breast cancer if no disease is detectable after three years and (b) Cindy Celebrity tells the magazine that she's cured, even though it's only been six months. How would you mention the celebrity's situation?  Remember that the claim might well be true (a large percentage of women with Stage 1 or 2a breast cancer are cured immediately, by surgery alone – the problem is that you don't know which ones are and which ones aren't), but it cannot be known or proven at this point in time.
 * Would you write "Cindy Celebrity claims to be cured"? "Cindy Celebrity is cured"?  "Cindy Celebrity talked about becoming cured"? WhatamIdoing (talk) 17:17, 20 May 2023 (UTC)
 * @Crossroads, I really hope you can answer this question. I am trying to understand how to reconcile your desire for "the more specific topic" but also to include the less-specific topic (i.e., any political appointee who "connects" political decisions about public health to the possibility that Covid will become endemic).  These feel like contradictory answers to me. WhatamIdoing (talk) 00:09, 24 May 2023 (UTC)
 * Something that was "completely harmless" would never be described as a "raging epidemic" in the first place. I do not find it "exceptionally odd" at all that endemicity can be the reason for lifting restrictions. If infection is inevitable, prior immunity from vaccination and (sub-optimally) previous infection is near-universal thus decreasing severity, and there are no longer expected to be surges that could overwhelm the health system, then I can easily see that, combined, described as "endemic" and given as the reason to lift restrictions. I'm not claiming here that that is the case everywhere now, nor that this is why restrictions have usually been lifted in the past, but it is not implausible.
 * But we do need expert sources to make that connection to add it, not a mere newspaper article going out on a limb and overinterpreting something. My main point is that when experts do give it as the reason then it should be mentioned. Crossroads -talk- 00:48, 18 May 2023 (UTC)
 * So where is your MEDRS source saying endemicity is "the reason" to lift public health measures? All I can see is scholarly sources saying this is a misconception. Bon courage (talk) 06:00, 18 May 2023 (UTC)
 * Here's an example of such, a MEDORG, which you nonetheless removed: One guy writing what's basically an op-ed in an academic journal is not a scholarly MEDRS nor does it override everyone else. Many sources do not agree that one can completely separate 'much-reduced severity' from 'become endemic' for this virus, or that one can have the latter without the former. Crossroads -talk- 18:25, 18 May 2023 (UTC)
 * A press release is not MEDRS's ideal, and a press release that claims they are "moving towards" endemicity is not evidence that it is so, especially since the author's next public communication was to disclaimed his sloppy use of the term endemic, calling it a jingle, as in something that sounds good but doesn't necessarily have any facts behind it.
 * It is true that reduced severity and endemicity are conflated in many people's minds. That's probably because the disproven century-old law of declining virulence feels like a good idea (optimal virulence is more complicated than that, especially since humans aren't the only possible host), and because people don't really like thinking about the possibility of a virus wiping out humanity, and might even hope that since it hasn't happened yet, then it never will because it is somehow impossible. WhatamIdoing (talk) 04:34, 19 May 2023 (UTC)
 * On keeping the topic as "endemicity": What should we do when we have a source (e.g., a newspaper article) that uses the word endemic, but then says that they didn't strictly mean endemicity; they meant that it won't be eradicated, and so their statement applies equally to an epidemic situation as well as to an endemic situation?  Are you comfortable saying that this isn't really about endemicity? WhatamIdoing (talk) 23:07, 16 May 2023 (UTC)
 * If it's just a newspaper article that said it of their own accord, then exclude. My concern is MEDORGs that are local CDC-equivalent bodies, and health ministers, being excluded, when they should be included. Crossroads -talk- 00:40, 18 May 2023 (UTC)
 * The Finnish official that you cited used the word endemic, and then explicitly disclaimed that afterwards. Do you still think that a word he disavowed should be reported here as if he meant it?  That seems misleading to me. WhatamIdoing (talk) 04:36, 19 May 2023 (UTC)
 * I didn't read that as a disavowal (the translation was admittedly odd and unclear). It's still up on their website, so I don't see any reason to think they don't stand behind it. Crossroads -talk- 01:12, 20 May 2023 (UTC)
 * It's obviously misleading, and part of the whole POV problem this article's had for a while. Anyway, I've solved it by removing all these country-by-country factoids since they're the locus of the consensus breakdown. I suggest any fans of this "shopping list" start an RfC or something if they want to establish consensus that this stuff has any merit being here. Bon courage (talk) 02:39, 20 May 2023 (UTC)
 * If someone says something one day, and the next day, they say that it was just "a jingle of words" (Jingle like advertising? Jingle like a pleasant sound?) and they actually meant non-eradicated, then we really should believe them about the "what I actually meant" part. WhatamIdoing (talk) 17:19, 20 May 2023 (UTC)

Possibility of becoming a hyperendemic COVID-19
It was like that in HIV and Dengue endemics. But why? 49.147.228.233 (talk) 09:58, 22 May 2023 (UTC)
 * Are you proposing an edit or just hoping to discuss the topic? The latter is discouraged on wikipedia, see: WP:NOTAFORUM — Shibboleth ink  (♔ ♕) 15:16, 22 May 2023 (UTC)
 * An expert in Canada claims in the news that it's currently hyperendemic there: Which means that it's around, it's not necessarily spreading very rapidly, but it's in very high numbers," he said.  Although an official government report or a proper scientific paper would be a better source, that use is probably consistent with the epidemiological definition of hyperendemic COVID-19. WhatamIdoing (talk) 03:10, 24 May 2023 (UTC)

Providing context
I had previously added this information, citing a source already being used in the article:

Not all infectious diseases become endemic. Common infectious disease patterns include:


 * Disease eradication – an unlikely outcome for COVID-19
 * Sporadic spread – unpredictable outbreaks that tend to die out relatively quickly
 * Local or regional spread – unpredictable outbreaks, or epidemics, that are sustained for a significant period of time in local or regional areas, without global spread
 * Pandemic – global outbreaks
 * Endemic – steady, predictable infection levels, including seasonal patterns.

I think, if you want people to understand what an endemic disease is, it is important to understand what it's not. This is not unusual in medicine-related articles. For example, the second sentence of Cancer provides information on what cancer is not.

Crossroads has removed it, saying "This is way beyond what that source says, and even if not, it is excessive use of a lower quality "world view" article. It's also undue emphasis on outcomes that do not apply to Covid, the topic of this article."

Taking the concerns in order:


 * I don't think it goes beyond what the source says (at all, much less "way beyond"). Did you get access to the source again?  I was actually a little concerned when I was writing this that I was getting too close to the line for Plagiarism.  Perhaps more importantly, this is basic information in epidemiology.  These definitions can be found in textbooks such as this one, this one, this one, chapter 4 in this one, with little variation beyond whether the author prefers to call unpredictable outbreak below the global level local/regional spread or an epidemic, with both labels being understood to mean the same thing.  The advantage to the cited source is (a) it's already used in the article and (b) it explicitly connects these basic definitions to COVID-19.  The first book I link in this paragraph also explicitly connects these concepts to COVID-19.  Perhaps you'd prefer that one?  Or if you want something more accessible to the average person, Bill Gates' book about COVID-19, says in its early pages that "A good rule of thumb is that an outbreak is when a disease spikes in a local area, an epidemic is when an outbreak spreads more broadly within a country or region, and a pandemic is when an epidemic goes global, affecting more than one continent. And some diseases don’t come and go, but stay consistently in a specific location—those are known as endemic diseases. Malaria, for instance, is endemic to many equatorial regions."
 * If you are concerned about these undisputed facts being followed by a "lower quality" source, then I've just provided multiple textbooks that contain the same basic information, so that problem is easily solved.
 * I wonder why you believe that these are "outcomes that do not apply to Covid". We actually don't know whether COVID-19 will become endemic (=steady rate) or a series of epidemics (=variable rate) or something else.  Obviously, the "pandemic" item applies, because that's either what we have now or what we hopefully have finally stopped having.  It is unlikely to be eradicated or sporadic (though this source says that New Zealand and Thailand achieved the enviable state of sporadic transmission in the early days), but I think the main point is that knowing what endemic is not helps people understand what it actually is.  You can't really understand endemic (=like malaria) if you don't understand sporadic (=like gastroenteritis) and epidemic (=like measles).  It is, consequently, appropriate to include information about contrasting disease prevalence states, because that helps people understand the contours of the main subject here.  Or, to put it another way, how can you know what "endemic COVID-19" is, if you don't know what both "endemic" and "COVID-19" are?  You don't actually know what endemic COVID-19 is unless you also know that it's different from pandemic COVID-19, different from epidemic COVID-19, etc.  Therefore we need to provide enough information about what endemicity is, that we can comply with the rule that "Each article on Wikipedia must be able to stand alone as a self-contained unit".  Readers should not have to go to a different article to find out what this one is actually about.  Also, lots of sources (here's another book and another) provide this kind of compare-and-contrast information, so it's a normal way for sources to present this information.

I therefore suggest that this information be returned to the article, perhaps with additional sources. WhatamIdoing (talk) 01:15, 24 May 2023 (UTC)


 * Here's another source, (review from a year ago), saying We distinguish between 4 possible paths of an emerging pathogen, including “sporadic spread,” “local or regional spread,” “pandemicity,” and “endemicity.”   They predict endemicity:  We contend that endemicity is the most plausible route for SARS-CoV-2 in the foreseeable future, with SARS-CoV-2 poised to eventually become the fifth endemic seasonal coronavirus (HCoV) along with HKU1, NL63, OC43, and 229E and suggest that age distribution is a good way to detect when COVID-19 has transitioned from pandemic to endemic.  (They decline to predict how long this will take, but they most of the timespans they give as examples are a couple of years.) WhatamIdoing (talk) 03:08, 24 May 2023 (UTC)
 * Well, I liked it. More scholarly sourcing for this article is what is needed. Bon courage (talk) 03:16, 24 May 2023 (UTC)
 * I'm happy for you to add something from e.g. PMID 35771775, and I think using it to explain possible paths and their predictions are a good use of it, but I stand by my edit summary earlier for that particular material. Nobody thinks sporadic-spread is going to happen again for Covid, it only happened in a few places with strict border controls and on-and-off lockdowns as part of a now-defunct "zero COVID" policy and prior to the rise of more transmissible variants. Mentioning such possibilities in the article as though they are still plausible can be misleading. I also don't think "like malaria" is at all a helpful comparison for this particular virus; it's not a comparison we see expert sources really making, rather they make comparisons to other respiratory viruses like the flu and the other four endemic coronaviruses. That said, bottom line is that I think we should move on from trying to bleed dry that one particular "world view" article, and that we will benefit from using better sources as mentioned, and including what is actually predicted for Covid specifically. Crossroads -talk- 23:11, 24 May 2023 (UTC)
 * I wrote "Common infectious disease patterns include:" which is not at all like "maybe sporadic-spread could happen again for Covid".
 * The particular diseases given for comparison depends on which part of the world the speaker comes from, and also whether the speaker prefers an especially strict definition of endemicity. There's a POV in the field that says the common cold and influenza is too variable to be endemic.  Also, even if you believe influenza is endemic, it is at best only sometimes endemic.  Pandemic and epidemic flu are real, too. WhatamIdoing (talk) 04:23, 25 May 2023 (UTC)

Long Covid
The Lancet talked about "a pandemic of Long COVID", but this is a metaphorical use of the term pandemic, and I think that is unnecessarily confusing for this article. Consequently, I've removed it. WhatamIdoing (talk) 15:20, 5 July 2023 (UTC)
 * I support this. Crossroads -talk- 18:30, 5 July 2023 (UTC)

Navbox
The sidebar navbox lists endemic COVID as a type of "international response", which is kind of silly. (Endemicity is a situation that either happens or doesn't.) I'm not sure that there's a good section for it, though. Maybe "variants"? (A mutation could push us into endemicity, or out of it.) Or at the top? Or something else? WhatamIdoing (talk) 09:47, 8 July 2023 (UTC)

Over time
So... we have a section that amounts to a chronological proseline of changing expert opinions: "A March 2022 review declared... A June 2022 review predicted that... In October 2022, a report [...] assessed that... As of March 2023, it was not possible to predict..."

It previously began with a rather bland introductory statement, "The view of experts developed over time, as more information became available." @Crossroads removed it, saying that it was unsourced and probably something made up by Wikipedia editors for which we could not expect to find any published reliable source. For myself, I consider it amply verified by the sentences that follow it – the equivalent of "COVID-19 has a variety of symptoms" followed by a list of a variety of symptoms. I also assume Crossroads didn't attempt to find a source.

This section needs an introductory statement so that readers know what to expect in this section. Dumping an unlabeled list of events on readers with no explanation is both bad writing style and unencyclopedic. What can we add to this paragraph that will tell readers what to expect from this section? WhatamIdoing (talk) 14:38, 20 July 2023 (UTC)

Deleting or changing the article entire structure
This article was written in a time when endemic management of COVID-19 was a future idea. Now all countries, bar a fraction tiny dependencies and pacific island countries, around the world manage Covid in an endemic way. That is different country to country but politicians and health officials all refer to their current management as 'living with Covid' or 'endemic management.' The drafts of this article I have as a past/present tense instead of a future tense feel silly. I believe the best course of action is either deleting this article or re-writing it entirely as a historic article, talking about early failed attempts to 'live with Covid', and how countries manage Covid nowdays. Pending discussion I've tried to update the article. AndrewRG10 (talk) 01:22, 29 July 2023 (UTC)


 * @AndrewRG10, I wonder if you could explain your ideas about what difference (if any) there is between saying "Covid is endemic" vs "Covid is being managed as if it were endemic". WhatamIdoing (talk) 02:15, 29 July 2023 (UTC)
 * Government managing a disease like an endemic doesn't mean the disease is endemic. Managing a disease as if it were endemic can be seen with diseases like common cold and influenza that are universally recognised as endemic. Their management is no more than just government guidelines and promotion, free vaccinations for at risk people and educating on good hand hygiene. But lets say in first half of 2021, it's universally acknowledged Covid was still a pandemic but some countries tried to manage the disease in the same way as their endemic diseases. AndrewRG10 (talk) 02:35, 29 July 2023 (UTC)
 * Okay, @AndrewRG10, it sounds like we are agreed that a disease being endemic is not the same thing as that disease being treated like it's endemic.
 * Do you think this article is supposed to be about what endemic Covid is, or about how governments are managing Covid? WhatamIdoing (talk) 03:19, 29 July 2023 (UTC)
 * Well that's my confusion because I swear there was a page called endemic management of Covid but this is the only one I can find in regards.
 * I feel this article can have far more content talking about the past attempts at endemic management of Covid and also the current management. Seeing there is no article on endemic influenza (or any disease from my quick search of wiki) it doesn't make sense to have one about the state of endemicity of Covid.
 * But I'm still not convinced myself how to update and future proof this article to fit the modern reality and am therefore keen for other editors to pitch in with editing and discussion. AndrewRG10 (talk) 04:18, 29 July 2023 (UTC)
 * There have been several semantic issues with this article and its progenitor Living with COVID-19 which was eventually merged back into this article. I am not sure of the fate of this article for the reasons you mention.  I think this will be affected by the outcome of the consensus #18 conversation you're involved in over at Talk:COVID-19 pandemic, although I haven't bothered to open that can of worms over there.  IMO better to just wait and see how this all shakes out with collaboration and consensus building.
 * The weather is too nice for me to be editing much these days so I can't say I'm not part of the problem. I encourage more efforts in this direction, that's all I can say.  I have considered creating Endemic COVID-19 by country and re-adding the list-style material that used to be included here.  Maybe that would be productive.  Many countries have 'endemic phase' sections that I likely created, and they are currently forking with this article. SmolBrane (talk) 15:46, 30 July 2023 (UTC)
 * We don't do that for other diseases. I would strongly suggest you instead put that country-by-country content in the respective "COVID-19 pandemic in X country" articles, many of which are sorely out of date because most people lost interest in the topic in 2022. We need closure in those articles, stating when restrictions were lifted and so forth. Crossroads -talk- 22:47, 30 July 2023 (UTC)
 * I had mostly already done that, and yes many articles need updating. It still seems appropriate to have a list of regions where covid is endemic, possibly in a section instead. SmolBrane (talk) 23:16, 30 July 2023 (UTC)
 * a list of regions where covid is endemic – I think you mean "a list of regions where Covid is being treated as if it were endemic, regardless of whether or not it actually is?
 * It might make more sense to have a list of all countries, with a short description of how that country is currently handling it. Maybe we could write a summary as short as "Lockdowns March 2020–Oct 2020; vaccines widely available June 2020; restrictions eased Oct 2020–May 2022; all restrictions removed June 2022". WhatamIdoing (talk) 00:19, 31 July 2023 (UTC)
 * We've had this discussion before; little reason to have it again. SmolBrane (talk) 01:07, 31 July 2023 (UTC)
 * Addendum--The sources aren't making this easy either. The WHO ended the PHEIC but never said anything about endemic.  Similarly with most countries' policies now--did they actually use the word?  Are we SYNTHing to presume that 'new normal', 'living with' are practically differentiated from the technical specification of endemicity?  We could be waiting a while for that rubber stamp, and this may be affected by the 'post-pandemic' section suggested on the COVID-19 talk page. SmolBrane (talk) 15:51, 30 July 2023 (UTC)
 * We may sometimes have come close to SYNTH, though I don't think editors have added anything that couldn't have been be found in some source, if we've really been determined to. The bigger challenge is that some sources used the word endemic to mean something other than Endemicity.  They've used it to mean something more like "schools are open, businesses are open, hospitals aren't overwhelmed, and I can go places just for fun again".  This problem is not unique; we have been dealing with sources writing "pseudoscience" when they mean "fraud" or "bad science" for years. WhatamIdoing (talk) 01:04, 31 July 2023 (UTC)
 * I've come around, and suggest that this article be merged into COVID-19 pandemic, and that the title redirect specifically to the heading COVID-19 pandemic, assuming it persists. Most of the remaining content here is either already there, or could easily fit there. Overly detailed content about the technical definition of pandemic, or about outcomes like sporadic spread that nobody thinks are actually plausible at this point, can simply be dropped. Crossroads -talk- 22:07, 30 July 2023 (UTC)
 * The post pandemic section on the Covid-19 pandemic article is probably already large enough to be split into its own article. Might be best to hold off on a merge since it would be better to merge this article with a post pandemic one. SmolBrane (talk) 23:12, 30 July 2023 (UTC)
 * I agree with holding off on anything drastic like merging but short term I think merging it into COVID-19 pandemic is best. Having an entire page which just talks about the few months and years after the pandemic doesn't make much sense. My proposal of making this article more about how countries manage COVID-19 like an endemic disease, while interesting, can really be slimmed down into one paragraph with links to mentioned countries individual page. AndrewRG10 (talk) 07:50, 31 July 2023 (UTC)
 * I don't think about this article as being about a particular point in time. I think of it as being a phase.  Influenza switches between endemic and pandemic phases; COVID could, too.  Therefore we should have an article of the "Endemic COVID is..." variety, not an article of the "At one point in time, some governments made some choices..." variety. WhatamIdoing (talk) 15:04, 31 July 2023 (UTC)
 * It appears there are ~three different angles on what this article is about lol.  Integrating to a post-pandemic article would offer a lot more flexibility.  The COVID-19 pandemic article is already 381kB, the post pandemic section you made added five and this article merging would add 5-10 more it looks like. I won't oppose merging this to the pandemic article for the purpose of collaboration, but I would highly suggest waiting until a post pandemic article is created.  Both post-pandemic and endemic COVID-19 are likely to expand with time, so the sooner we allocate that to a new article, the sooner we can condense the pandemic article and correctly structure this one(probably as sections on the post pandemic article). SmolBrane (talk) 15:30, 31 July 2023 (UTC)
 * You could boldly create an article entitled Post-pandemic of COVID-19 or COVID-19 post-pandemic, that's what I did with this article and it was never substantively opposed. There is a dearth of editors in this space so I appreciate your efforts. SmolBrane (talk) 15:34, 31 July 2023 (UTC)
 * I think that would be a bad idea. I'd like to see some heavyweight sources first, rather than create an article and then try to find sources to fit. As WAID said COVID may be pandemic and/or returning to pandemic status forever, so implying it was a "point in time" now passed would seem odd, and reprise the underly fallacy that has plagued this article. A framing might be "post-emergency phase COVID", but that seems an odd way of coming at it. Bon courage (talk) 15:53, 31 July 2023 (UTC)
 * Your objections will be well directed at COVID-19_pandemic. I support expanding/transferring that section into a new article. SmolBrane (talk) 16:00, 31 July 2023 (UTC)
 * A badly-titled section is not a good reason to create a bad-titled article. Bon courage (talk) 16:27, 31 July 2023 (UTC)
 * You are welcome to try removing the section. SmolBrane (talk) 16:34, 31 July 2023 (UTC)
 * If the COVID-19 pandemic article is going to remain in present tense than I no longer support a merge. As it is the section I supported redirecting to no longer exists as such. Also, there are persistent efforts to bring back poor sources like old opinion articles by individual academics, which shouldn't even be here, let alone in a merged article. Crossroads -talk- 18:51, 31 July 2023 (UTC)
 * @Bon courage I agree having a post-emergency phase won't work because that's a very country by country thing, some ended their 'emergency' in 2021, well before the pandemic ended. It also is trying to push this idea that pandemics have end dates. They don't. They're a smooth transition that you don't realise has happened till months later. COVID-19 has been the perfect example. There was never an end date to the pandemic, there was a smooth transition throughout late 2022 into 2023 and people only in the past couple months have realised and medical and media sources have now reported on that.
 * We just have to accept that there was never an end date to the COVID-19 pandemic, just a general time of early-mid 2023 that the majority, or the weight of sources referred to it as over. AndrewRG10 (talk) 21:13, 31 July 2023 (UTC)
 * Don't agree. The best sources are saying the pandemic is ongoing, albeit with a possible end in sight. Some of the lay press and public have "moved on", but the lay press on medical topics is useless. Bon courage (talk) 21:24, 31 July 2023 (UTC)
 * WP:Due Weight states we asses what the majority of sources are saying. Unfortunately you have this idea the minority of sources, the ones that agree with your pre-conceived ideas seem to have more weight over the majority of sources. They don't. Your evidence that the Weight of sources refer to the pandemic as ongoing needs to be show that the majority of sources refer to is as ongoing. And you cannot bring reliable sources down by calling it the 'lay press.' AndrewRG10 (talk) 21:30, 31 July 2023 (UTC)
 * That's just an essay, no has no policy weight, but even so says "In general, a topic should use the most reliable sources that are available to its editors". NPOV is at stake here, and that is core policy. "Lay press" is not reliable for biomedical content; see WP:MEDRS, and the question of whether of not a disease is a pandemic is biomedical. Your attempt to "go personal" is not appreciated. Bon courage (talk) 21:36, 31 July 2023 (UTC)
 * NPOV is not at risk because some editors disagree with you. NPOV would be more at risk because of your insistence on not using reliable unbiased reputable media because they disagree with your opinion and are no more than just 'lay mans media.' Except of course in this cases where the regular media agrees with you and therefore holds more weight.
 * The WHO is not the authoritive source or even an authoritative source. If you want to stay neutral you have to take the weight of everything. Yes the WHO holds more weight than a news article but if every single 'lay man' media refers to it over, you no longer have enough weight to keep calling it a pandemic. It goes both ways. AndrewRG10 (talk) 20:48, 1 August 2023 (UTC)
 * Basic misunderstanding of policy. We need reliable sources, and for WP:BMI those are MEDRS. To say the WHO is not even an authoritative source is basically a POV-pushing manifesto statement. Bon courage (talk) 20:56, 1 August 2023 (UTC)
 * The WHO is not an authoritative source when it comes to declaring pandemics. They've spent quite a bit of time trying to tell people they aren't as they cannot declare beginning and ends of pandemics under the current treaty (may change soon). Regardless that was settled months ago that the WHO will be a strong and weighty source but ultimately it would be counter balanced eventually. You need to now provide proof that most sources refer to it as ongoing and not put more weight on the ones you agree with and chuck aside any that doesn't by calling it lay man media. AndrewRG10 (talk) 21:20, 1 August 2023 (UTC)
 * Yes, because such a "declaration" is a legal thing thy are not empowered to do (nobody is, globally). They can and so however make a scientific determination and have done so on multiple occasions, You have now reversed the burden of evidence, and continue to personalize this (which shows you have no good argument): Wikipedia follows reliable sources. If you have others strong ones (CDC, NICE, etc.) then produce them: but no reliable source addressing the question is saying the pandemic is "over"; rather the WHO is inviting a parallel with the current cholera epidemic, which has now run for over 60 years. To repeat, lay sources on this precise question are useless to us (also they often use "pandemic" to mean the-whole-COVID-thing, rather than using the term in the scholarly sense). Bon courage (talk) 03:12, 2 August 2023 (UTC)
 * Where is the evidence that a few WHO officials occasionally using the word "pandemic" post-PHEIC counts as any sort of "scientific determination"? It's not a study or any kind of rigorous research or detailed report. As for CDC and NICE, neither of them refer to it as a pandemic. They obviously have no reason to outright say "endemic" or "no longer a pandemic", they just describe the disease and advice as they do for the flu. In fact, this NICE page (admittedly a news page, but it is a statement by a NICE official) refers to the pandemic in past tense. Crossroads -talk- 00:04, 5 August 2023 (UTC)
 * Discussion of whether COVID-19 is, present tense, a pandemic seems more useful on the COVID-19 pandemic article. If you want to talk about endemic COVID-19, we need WP:MEDRS-compliant sources using the word "endemic". Articles that don't use either the term "pandemic" or "endemic" aren't that useful here. Bondegezou (talk) 16:58, 5 August 2023 (UTC)
 * The claim that Now all countries, bar a fraction tiny dependencies and pacific island countries, around the world manage Covid in an endemic way. is a misunderstanding of what “endemic” means. That some media use “endemic” to mean “less serious” does not mean that this article should deviate from what the most reliable sources, as per WP:RS and WP:MEDRS, say.
 * Coverage of how responses to COVID-19 have changed over time can be covered best on individual country’s COVID pages. Bondegezou (talk) 10:12, 2 August 2023 (UTC)