COVID-19 is not going away. The virus continues to circulate worldwide and will for the foreseeable future. But the nature of the threat has changed dramatically since 2020. Hospitalization rates during the October 2023 through April 2024 season were the lowest recorded since surveillance began in 2020, and most people now carry some level of immune protection from previous infections, vaccinations, or both. COVID is settling into a pattern more like seasonal flu: always present, occasionally surging, and most dangerous to older adults and people with weakened immune systems.
Why COVID Cannot Be Eradicated
Only two human diseases have ever been fully eradicated (smallpox) or nearly so (polio), and both required conditions that COVID simply doesn’t meet. Eradication demands three things: a vaccine that stops transmission, reliable diagnostic tools, and no animal reservoir where the virus can hide and re-emerge. COVID fails on all three counts.
Current vaccines reduce severe illness but don’t reliably block infection or transmission. The virus also circulates in animals, including minks, cats, dogs, and tigers, creating a cycle of spillover from humans to animals and spillback of potentially new strains into humans. Even if every person on Earth were vaccinated tomorrow, the virus would persist in animal populations and eventually find its way back. The intensive early-pandemic measures of mass testing, contact tracing, and quarantine proved effective but were, as researchers have noted, “extremely time-consuming, costly, and socially fragile.” No country could sustain them indefinitely.
What “Endemic” Actually Means
The World Health Organization ended the COVID public health emergency in May 2023 and has since shifted its guidance from emergency response to “sustained, long-term, and integrated management.” In late 2025, the WHO released a unified plan covering not just COVID but all coronavirus threats, including MERS and potential future outbreaks. The framing is telling: COVID is now treated as a permanent fixture that health systems must manage alongside other respiratory diseases, not a crisis to be resolved.
Endemic doesn’t mean harmless. It means the virus circulates at relatively predictable levels, with periodic surges. Seasonal flu is endemic, and it still kills tens of thousands of people in the U.S. each year. COVID is following a similar trajectory, with winter waves driven by new variants and waning immunity.
How the Virus Is Still Evolving
SARS-CoV-2 mutates more slowly than influenza. Lab studies show influenza’s key surface proteins evolve roughly 30 to 39 times faster than the spike protein on the COVID virus. This is because SARS-CoV-2 has a built-in proofreading mechanism that catches and corrects copying errors during replication, something influenza lacks. Overall, influenza’s evolutionary rate is about five times higher than COVID’s.
That slower mutation rate is a mixed blessing. It means COVID variants tend to emerge less frequently than new flu strains, but the virus still produces enough change to partially dodge existing immunity. Each new variant can trigger a wave of reinfections, particularly among people whose last vaccine or infection was months ago. The pattern resembles what happens with flu seasons, just on a slightly different timeline.
Who Is Still at Serious Risk
COVID’s burden falls overwhelmingly on older adults. During the 2023 to 2024 season, adults 75 and older were hospitalized at a rate approaching one per 100 people, and their peak weekly hospitalization rate was nearly 25 times higher than for adults aged 18 to 49. While those numbers represent the lowest hospitalization rates since the pandemic began, they still reflect a significant toll on the oldest and most vulnerable.
Long COVID remains a concern as well. A large meta-analysis covering 144 studies found a global pooled prevalence of 36%, meaning roughly one in three people who contract COVID experience symptoms lasting beyond the acute infection. Not all of these cases are severe or permanent, but the sheer volume of infections means millions of people are dealing with lingering fatigue, brain fog, shortness of breath, or other symptoms months after their initial illness.
What Protection Looks Like Now
The CDC recommends an annual COVID vaccine for everyone six months and older, with the decision framed as individual choice rather than a blanket mandate. The emphasis is strongest for people 65 and older, those at high risk for severe disease, pregnant individuals, residents of long-term care facilities, and anyone who has never received a COVID vaccine. The agency also notes that vaccination can lower the risk of developing long COVID, which adds a reason to stay current even for younger, healthier people.
People with moderately or severely compromised immune systems follow a separate, more intensive vaccination schedule. For everyone else, the approach mirrors the annual flu shot: get an updated dose before respiratory virus season, and your protection against severe outcomes will be strongest during the months when circulation peaks.
Next-Generation Vaccines in Development
The current vaccines target the spike protein and need regular updates as the virus changes. A $5 billion U.S. government initiative called Project NextGen is funding the development of vaccines designed to do more. The goal is broader protection that holds up against multiple variants, longer-lasting immunity, and the ability to actually block infection and transmission rather than just preventing severe illness.
One of the most promising approaches involves nasal or inhaled vaccines that build immune defenses directly in the respiratory tract, the place where the virus first takes hold. These mucosal vaccines could, in theory, stop the virus before it replicates enough to spread to others. Other candidates target multiple parts of the virus beyond just the spike protein, which could make them harder for new variants to evade. The initiative is evaluating roughly 10 candidates in early-stage trials, with five to six moving into larger studies. More than $1.4 billion in funding was announced in 2023 alone.
None of these will make COVID disappear. But a vaccine that cuts transmission, not just severe disease, would be a fundamental shift in how the virus moves through populations and could reduce the frequency and size of seasonal waves.
The Practical Outlook
COVID is becoming a managed, seasonal respiratory illness. You will likely encounter it repeatedly over your lifetime, much as you encounter flu and common colds. The key differences from 2020 are substantial: population-wide immunity is high, treatments exist for high-risk patients, hospitals are no longer overwhelmed, and updated vaccines are available annually. The virus hasn’t gone away, but the emergency has. For most people, the practical reality is an annual vaccine decision and the occasional bout of illness that, while unpleasant, resolves without serious complications. For older adults and immunocompromised individuals, COVID remains a meaningful health threat that warrants more aggressive prevention.