No Urgency To Label COVID ‘Endemic,' Epidemiologist Says

By Austin Fisher, Source New Mexico

April 7, 2023

Later this month, the four major hospital systems in New Mexico will no longer require patients, visitors, or health care workers to wear masks indoors.

"The COVID pandemic is coming to a close and has become an 'endemic' disease," according to public health officers in New Mexico.

When the hospitals announced the end of mask requirements last Friday, Dr. Steve McLaughlin, chief medical officer for the University of New Mexico Hospital, said in a news conference the changes are “a sign of the forward progress we’re making as we move toward the end of the pandemic.”

Abby Cartus has thought a lot about whether COVID is endemic, and she said she doesn’t know.

The more interesting question is why there is a desire to designate COVID as endemic, said Cartus, an epidemiologist and co-host of Death Panel, a podcast about the political economy of health.

That desire, she said, seems not based on public health considerations but rather “is really borne out of a desire to just move on, to not have to spend money, to not have to continue with all these special programs, and to not have to feel like this is still happening.”

“I don’t think that there’s any urgency — from a public health perspective — to declare COVID endemic at this point,” Cartus said.

Her view is different from public health officers in New Mexico. Former acting New Mexico health secretary David Scrase said last August he believes “we’ve been endemic with COVID since the summer of 2020 — or technically spring.”

New Mexico Hospital Association CEO Troy Clark said in an interview Monday the changes are happening now because, “We’re addressing — shifting from pandemic to endemic.”

Asked to explain this shift, Clark said it doesn’t mean COVID has gone away, but it is no longer affecting all of society.

“You’re going from a virus that is having a massive impact on a society — and the size of that community could be state national, this happened to be worldwide — and endemic meaning it’s becoming something that is not as critical of nature, but is becoming more normalized in the process,” Clark said.

"This distinction between pandemic and endemic is often deployed in a rhetorical way to make COVID seem like it’s something we don’t need to do anything about," Cartus said.

"Saying COVID is 'endemic' doesn’t really imply it’s no longer a big deal," she said.

“When something is endemic, that means you are committed to doing something about it in perpetuity,” she said.

"An epidemic is typically something causing a massive outbreak in one area, and a pandemic is something causing a massive outbreak in many areas at once, all over the world," Cartus said.

“There seems to just be an idea that if we can just make the signifiers of COVID disappear, then COVID has disappeared,” she said. “That seems like a very irresponsible way to deal with something that still is a pretty big public health problem.”

UNMH mask requirements likely never returning for COVID

The day before the public announcement, UNM officials sent an email to all of their employees saying they will determine any future changes on masking based on a color-coded system created by McLaughlin and the UNM Hospital epidemiologist.

The system has three levels: “extreme risk,” where masking would be required in UNM Hospital buildings; “seasonal/surge,” where masking would be “strongly” encouraged in clinical buildings; and “endemic,” where masking is optional.

McLaughlin described the system as “a flexible framework” to decide recommendations around masking. He said it’s meant to support providers, patients, families and staff if “they choose to wear a mask to work all the time.”

Cartus reviewed a copy of the email, and the first thing she noticed about this system is that “mask requirements are never coming back for COVID.”

Under the system, a surge in COVID cases would not trigger a mask mandate, Cartus points out. The only example would be if there was an outbreak of a new virus for which there are no vaccines or treatments, according to the email.

“That doesn’t seem particularly consonant with the approach to infection control in hospitals that is taken for other types of communicable diseases,” Cartus said.

UNM spokesperson Christopher Ramirez said Thursday there are more viruses out there than just COVID that are highly transmissible, and that UNM officials want to reserve the right to bring masks in the hospital back in the future.

“We want to make sure that as we think about good community health, we’re thinking beyond COVID,” Ramirez said. “The policy could change depending on what’s going on in our community, and it’s obviously our intention to make sure that we have good policies in the hospital to make sure everybody’s safe.”

McLaughlin said UNM officials expect their measurements to “evolve over time” from changes in testing, and he thinks we will have improved ways of tracking viral activity.

Cartus does not have a lot of confidence that health systems can accurately assess the level of community transmission, since the testing and data infrastructure have been scaled back since earlier in the pandemic.

“Even if they could, I’m very skeptical that they would even turn this masking requirement back on,” Cartus said.

Cartus said in many places, testing for COVID is at the lowest point since the beginning of the pandemic and a lot of the monitoring infrastructure for COVID has been dismantled.

New Mexico ended its free PCR testing program at the end of 2022 and after April 11 will publish its epidemiological reports on COVID less often. The reports are currently published every two weeks, but will slow to once per month.

“The way it usually goes is this type of thing is a one-way ratchet,” Cartus said. “I’ve never seen a government or a health system take an off-ramp and then turn it back on.”

Source New Mexico, an independent, nonprofit news organization, delivers original reporting and stories that center the lived experiences and expertise of the people of New Mexico, alongside insightful opinion and analysis. Source New Mexico is part of States Newsroom, a national 501(c)(3) nonprofit supported by grants and a coalition of donors and readers.