That whole thing pissed me off so much I went through all of those articles myself.
COVID is not “endemic,” and these papers do not prove that it is.
Most of the papers people cite to claim COVID is endemic are not actually demonstrating that. They are assuming it, using it as background framing, or borrowing a policy/administrative label and treating it like epidemiological proof.
That is a much weaker claim
In epidemiology, “endemic” doesn’t mean “it’s still around” or “we’re used to it now.” It means a disease has reached a stable, predictable baseline level in a population. Predictability is the entire point. If transmission is still producing irregular surges, shifting baselines, and ongoing large-scale impact, that is not endemic equilibrium—it’s instability.
Also, quick clarification: the issue is not that COVID has zero seasonality. It’s that it does not have clean, stable, flu-like seasonality. SARS-CoV-2 circulates year-round, often with both summer and winter waves, instead of settling into a single predictable season. That alone undermines the idea that it has reached a steady endemic pattern.
What these papers actually do
There are three main ways “COVID is endemic” gets smuggled into research:
Assumption framing: “In the endemic phase…” (no proof provided)
Policy framing: “After reclassification to endemic…” (government decisions ≠ epidemiology)
Modeling shorthand: “Under endemic conditions…” (a scenario, not a conclusion)
None of these are evidence that COVID has actually stabilized.
1. MDPI (Germany insurance data study)
This paper literally defines 2022–2023 as the “first year of endemicity.” That’s not something they prove—it’s something they decide in advance.
And then their own data shows:
hundreds of thousands of cases
multiple peaks (October and March)
thousands of hospitalizations
significant mortality in severe/critical cases
That is not a stable baseline. That is ongoing wave behavior.
So even within their own “endemic phase,” COVID is still spiking and causing substantial harm.
2. ScienceDirect (South Korea social contact study)
This paper is about who people interact with, not whether COVID has stabilized.
“Endemic phase” appears in the title and intro, but:
• there is no analysis of transmission stability
•no demonstration of a predictable baseline
•no test of endemic criteria at all
The word “endemic” is just scene-setting language.
This is like saying “in the modern era” before studying traffic patterns. It tells you nothing about whether the disease itself has reached equilibrium.
3. ScienceDirect (clinical / infectious disease paper)
This paper uses “endemic phase” language—but again, it’s not proving anything about transmission stability.
•a clinical/infectious disease analysis
•focused on patient outcomes and disease burden
no demonstration of a stable baseline
no evidence of predictable transmission patterns
no test of endemic criteria
Instead, it still describes:
continued clinical burden
So what you have is a paper about a disease that is still actively affecting patients—
written during a time the authors are calling “endemic.”
That’s not proof. That’s labeling.
4. American Journal of Epidemiology (excess mortality letter
Even this paper—while using the phrase “endemic COVID era”—doesn’t actually support the claim.
It explicitly notes that excess mortality may still reflect:
indirect consequences of infection
In other words, the system is still dealing with ongoing downstream impacts, not a neatly stabilized disease state.
5. MDPI (anticoagulant prescribing trends)
This paper is about medication use over time, not COVID transmission dynamics.
“Endemic era” is just a time label, not a conclusion supported by the data.
It does not demonstrate endemicity at all.
6. JAMA Network Open (vaccination cost-effectiveness model)
This is a model, not observational evidence.
It assumes an endemic scenario and then simulates outcomes. That’s a hypothetical framework, not proof that the real-world system has stabilized.
Even within that model, COVID still produces:
So even the assumption of endemicity still includes substantial disruption.
7. Environment International (wastewater + hospital cases, Japan)
This paper defines “endemic” based on a government reclassification date.
That is a policy decision—not an epidemiological transition.
What the study actually finds:
wastewater continues to track COVID cases strongly
transmission remains widespread
surveillance became more difficult after policy changes
This is measuring before vs. after a policy shift, not proving that the disease became stable.
What endemic would actually look like
If COVID were truly endemic in the strict epidemiological sense, you would expect:
a consistent baseline level of transmission
predictable seasonal patterns
limited, stable variation over time
What we actually see instead:
multiple unpredictable waves
shifting or rising baselines
continued hospital burden and mortality
reliance on wastewater and emergency-style surveillance
That is not a system in equilibrium.
Across all of these sources, “endemic” is never demonstrated through stable transmission data—it’s declared, and then everything else is analyzed inside that declaration.
Calling COVID “endemic” right now is not a neutral scientific conclusion. It’s a framing choice.
And when you actually read the papers people cite, they are not showing a virus that has quietly settled into the background. They are describing one that is still persistent, unstable, and actively shaping public health outcomes.
That’s just something people have decided to call endemic.
