California’s new plan for shifting from “pandemic” to “endemic” COVID-19

COVID-19 will be with us for a long time to come.

On Thursday, the state’s top health official unveiled a strategy to track and tame the stealthy virus as California moves from a “pandemic” to “endemic” phase, charting a more purposeful path as we learn to live with the pathogen.

“We aren’t out of the woods,” said Dr. Mark Ghaly, California’s secretary of Health and Human Services, at a press briefing. “We’re just more familiar with the woods and don’t need to live fully afraid of what’s behind the next tree.”

The plan promises more reliable supplies of essential tools, so California is less dependent on unstable global supply chains. It will stockpile thousands of ventilators, 75 million masks and 30 million over-the-counter tests.

It also aims to build a more reliable system of healthcare workers, maintaining a registry and employment contracts so that it can boost staffing by 3,000 people within two to three weeks.

And it is updating old quarantine and contact tracing protocols so that they better fit the circulating variant and vaccination rates. Ghaly did not provide specifics on how those protocols might change.

These changes will be triggered by metrics that Ghaly called “on ramps and off ramps,” based on changes in virus. If the virus becomes more virulent, the state will look to infection rates to dial up its response. If it becomes more transmissible, the state will watch hospitalization rates.

The state will continue to strive for improved vaccination rates, he said. But the focus will shift to children who have not yet gotten two doses and the elderly, disabled and immunocompromised who have not yet gotten boosters.

It also aims to improve monitoring through ongoing testing and sequencing of viruses, he said.

The state will continue to buy and distribute testing supplies until the private sector takes over, he said.

“We will work to test even more effectively than we have,” Ghaly said. “Surveillance is going to be key to understanding when and where we see signals of transmission occurring.”

Later this afternoon in San Bernardino County, Governor Gavin Newsom will further outline the next phase of the state’s comprehensive pandemic response.

“Endemic” doesn’t mean that the virus is completely and utterly gone. Rather, it means we’ll reach a kind of equilibrium, where Californians and SARS-CoV-2 coexist in a milder and more benign way.

Experts say that COVID-19 will soon join a handful of other viruses that cause routine respiratory disease, mainly in the winter, when conditions favor their transmission. Instead of causing tsunamis of devastating illness, the virus will trigger small surges of milder illness.

One example is the West Nile virus, which emerged in New York City in 1999 and within five years spread across all of North America. Influenza is also endemic – always circulating at a low level and constantly acquiring new mutations.

Experts commended the state’s approach, which follows a pattern of success, they said. If the entire US had the death rate of California, nearly 270,000 Americans would still be alive.

“California’s thoughtful approach to the pandemic has led to the lowest per-capita death rate of any large American state,” said Dr. Robert Wachter, professor and chair of the Department of Medicine at UC San Francisco.

“Coming out of the Omicron surge, we have to apply all the lessons we’ve learned in the past two years, to be sure that we’re taking the smartest possible approach to this rapidly evolving threat. I was impressed by the plan, which does just that.”