Selling Fish in the Evening Market

An Endemic Pandemic Mixed with Public Health Puffery

Are we bored yet? Many signs make it evident that the public attention span for COVID-19 is running short. Governments all over the world are looking to reasons to say that the pandemic has become endemic and we’re moving on. Mask requirements are beginning to fade. Denmark has lifted all of its pandemic restrictions.

But what does it really mean – if anything – to say that a disease, condition, or virus has become endemic? And why is public health so insistent on calling obesity an epidemic or a pandemic but not an endemic condition?

The Warm and Fuzzy Endemic Narrative

Somehow the popular narrative around endemic COVID has it that we’re stuck with this virus, so we’re learning to live with it. The deadly, global 1918 flu pandemic faded into endemicity and we learned to live with the flu season. So a common presumption is that where we’re heading in a similar direction with COVID-19.

Writing in the Atlantic, Jacob Stern and Katherine Wu tell us this is a false narrative:

“Endemicity promises exactly none of this. Really, the term to which we’ve pinned our post-pandemic hopes has so many definitions that it means almost nothing at all. What lies ahead is, still, a big uncertain mess, which the word endemic does far more to obscure than to clarify. ‘This distinction between pandemic and endemic has been put forward as the checkered flag,’ a clear line where restrictions disappear overnight, COVID-related anxieties are put to rest, and we are ‘done’ with this crisis, Yonatan Grad, an infectious-disease expert at Harvard, told us. That’s not the case. And there are zero guarantees on how or when we’ll reach endemicity, or whether we’ll reach it at all.”

Endemic Obesity?

An endemic condition is one that regularly exists in a population. It persists and follows a predictable pattern – like seasonal influenza.

For four decades now, obesity has been growing steadily. The trendline has been stunningly steady. Despite public health and policy pundits saying we can “end it in a generation,” this condition has always been with us and it always will be.

And yet, it’s rare to find anyone in public health acknowledge the simple fact that obesity is endemic. Especially in the U.S., it’s here and we need to learn to cope better with it.

Crisis Fatigue Undermines Trust

The only explanation we can think of for avoiding this obvious truth is that catastrophizing obesity is seen as a good way to garner attention and funding for pet projects.

In truth, though, it may be that decades of chicken-little rhetoric about obesity has brought us fatigue with the subject. Nearly half of U.S. adults are living with it. It’s not the end of the world. Rather, it’s something that chips away at health and quality of life.

When public health experts insist on making something into a crisis, they risk making themselves irrelevant. Especially if they don’t offer effective and pragmatic guidance. In this regard, we see striking parallels between obesity, and COVID-19.

Public health guidance is useless if the public rejects it.

Click here for more about COVID endemic talk and here for a thoughtful commentary about epidemic and endemic descriptors for obesity.

Selling Fish in the Evening Market, painting by Petrus van Schendel / WikiArt

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February 13, 2022

4 Responses to “An Endemic Pandemic Mixed with Public Health Puffery”

  1. February 13, 2022 at 9:01 am, John DiTraglia said:

    Great points. Can I use this idea with citation of you in my weekly article for the Portsmouth Daily Times and my Substack?

    • February 13, 2022 at 11:55 am, Ted said:

      Of course you can.

  2. February 13, 2022 at 3:29 pm, Allen Browne said:

    Interesting that Flegal’s comment from 16 years ago seems appropo today:

    “These observations have proved difficult to explain. Clearly some kind of change in energy balance has occurred, but we have surprisingly little ability to explain exactly why this has happened. Why was body mass index relatively stable and why did it begin to increase fairly suddenly? Why is the distribution becoming more skewed? Despite the intense attention paid to obesity and the numerous hypotheses that have been put forward, we still lack explanations supported by data and we lack understanding of the mechanisms driving these changes.”


    • February 14, 2022 at 2:54 am, Ted said:

      I had the same reaction, Allen.