Are we there yet? A guide to achieving endemic status for COVID-19 and variants

To clarify factors that support a policy change from pandemic to endemic status and to examine options for non-medical responses to reduce COVID-19 transmission.

Critical factors to be considered in pandemic response decisions are not limited to medical options or public health orders, although these are important.

All evidence drawn from publicly available sources is presented through the lens of the authors' nursing, management, education, policy and research experience.

As COVID-19 variants cause infections to surge nurses and other health practitioners, who are the de facto implementers of public and health policy, need to consider the evidence supporting a pandemic policy change to endemic status. Non-medical options for reducing transmission and variant mutations are needed to enable at-risk populations to avoid infection.

Public policy that shifts infection risks onto the general population requires close scrutiny of the evidence base for such decisions and warrants open debate and review. If people are to manage risks arising from policy decisions, they need access to non-medical virus detection options as well as access to effective medicines and treatment.

Nurses have an extension to their advocacy role when policy changes about infectious disease status are declared. Evaluation of policy in terms of validity, equity and scientific basis is part of nursing's public responsibility. Policies that fail to reflect what is happening at the patient care level need to be questioned and modified where necessary. Only policies deemed 'good' policy by nurses should be implemented without challenge. Access to devices for environmental detection of the virus would enable real-time estimation of infection risks and inform individual decisions about the real risk of participating in work or other activities.

Policy decisions to transition from pandemic to endemic status must be evidence based. Clear messaging about risks and options assists policy implementation. Terminologies describing stages of infectious disease spread from 'outbreak, epidemic, endemic and pandemic' are not interchangeable, although they will expand and contract across the range in response to interventions such as public health safety measures (PHSM), quarantine, vaccinations, antivirals and fatalities that alter the case count in defined locations for those who avoid or survive an infection.