Managing COVID-19 as an Endemic Virus

English | Español


The term “endemic” refers to a disease that is circulating in a community at an expected or normal level, minus an occasional outbreak (for example, the flu). South Carolina, along with other states and the federal government, has begun treating COVID-19 as an endemic virus due to declining case and hospitalization rates as well as the increased availability of vaccines, treatments, and rapid testing. Through these resources along with preventive strategies like wearing masks when indicated, we can keep severe cases to a minimum and live our daily lives with an acceptable level of COVID-19 in the community.

DHEC’s endemic approach was discussed in more detail during our March 2 COVID-19 Media Briefing. We are taking a layered approach to decrease community spread and reduce the strain on our healthcare systems.

Follow COVID-19 Community Levels

Recommendations for masking are currently based on COVID-19 Community Levels. That said, individuals can still choose to wear a mask at any time to better protect themselves and their loved ones against virus spread.

DHEC has adopted CDC’s guidance on masking, which is based on the COVID-19 Community Level for each county. In part, the guidance states:

  • For low levels of COVID-19 in a community, masking is “not needed in most settings,” but remains optional for individuals.
  • In communities with medium levels of COVID-19, individuals who are at higher risk of contracting COVID-19 as well as those who are regularly around immunocompromised individuals are encouraged to mask up, while it is optional for others.
  • In communities with high levels of COVID-19, masking is recommended in indoor settings, including schools and workplaces.

When masking, wear a mask with the best fit, protection, and comfort for you. Others things to consider when masking include:

  • Make sure that the nose and mouth are covered and that it fits well with no gaps. 
  • An N-95 or KN-95 mask is the best one to use if available and well-fitting  
  • If using a cloth mask, it should have at least two layers of breathable, washable material.

People with symptoms, a positive test, or exposure to someone with COVID-19 should wear a mask around others. Guidance calls for close contacts to wear a mask for 10 days after exposure, and for those who test positive to wear a mask through day 10 after symptoms began if they meet the criteria to be released from isolation before then. CDC's Isolation and Exposure Calculator is easy to use and tells you what to do if you have tested positive for COVID-19, are experiencing symptoms, or are a close contact.

Additional masking information from CDC is available here.

Vaccination is another tool needed to successfully transition to an endemic status for COVID-19 and remain there. COVID-19 vaccines are safe, effective, and are the best way to protect individuals and their loved ones against severe cases of COVID-19. Vaccines are proven to be effective against severe disease due to the original SARS-CoV-2 strain as well as its variants and subvariants. Individuals ages five years and older are strongly encouraged to get their COVID-19 vaccinations.

  • COVID-19 booster shots  are recommended for fully vaccinated people aged 5 years and up once they are due, based on when they received their last dose. Like an annual flu shot, a booster shot for COVID-19 is strongly encouraged because it increases protection over time, as the initial vaccination becomes less effective. To be clear, an initial COVID-19 vaccination series is still highly effective against the virus, especially severe disease due to it. As with any medicine, the initial vaccination wears off over time, so a booster is recommended to maintain a high level of protection.
  • A single bivalent booster is recommended for those 5 and up who and should come at least two months after completion of the primary monovalent vaccination series or receipt of a monovalent booster vaccine. Those 18 and up who have received two doses of the Janssen (an initial vaccination and booster) receive a single bivalent booster of an mRNA vaccine (Pfizer or Moderna) at least two months after their Janssen booster dose.
  • DHEC’s “You Make the Call” initiative encourages parents to talk to pediatricians and other trusted health professionals about getting their children vaccinated. The goal is for parents to gather all the accurate facts so they can make the best decision for their children.

Debunking the Myths

  • Since vaccines have become readily available, there have been many false claims about their efficacy, side effects, composition, etc. More than 215 million Americans are fully vaccinated against COVID-19, and the most recent studies are still proving these vaccines to be incredibly safe and effective.
  • For peer-reviewed, factual information on the vaccines and other COVID-related topics, visit DHEC and CDC’s pages about the disease.

Testing is incredibly important to reducing the spread of COVID-19. When you know your COVID-19 status, you can isolate if needed and keep your close contacts informed so those individuals can get tested and make the best decisions for their families.

Polymerase chain reaction (PCR) testing, sometimes also referred to as nucleic acid amplification testing (NAAT) or molecular testing, detects the genetic material of the SARS-CoV-2 virus (the virus which causes COVID-19), while antigen testing detects spike proteins on the surface of the virus. Antigen and molecular tests are the preferred methods to detect a current infection as opposed to blood tests for antibodies which should not be used to diagnose a current infection. Rapid antigen tests are now the most effective testing tool to reduce the spread of COVID due to their speed, accuracy, and widespread availability, which allow individuals to test anytime and immediately isolate if sick.

Free at-home COVID-19 rapid antigen tests

  • At-home COVID-19 rapid antigen tests are available for free at most DHEC public health departments. DHEC’s testing locator is updated in real time to reflect which locations have them in stock.

Who should be tested

You should get tested if you are:

If you did not use a rapid test and have to wait longer to learn your status, you should isolate as if you tested positive until you get your results. If you test positive, follow guidelines for isolation and for telling close contacts. If you were are a close contact of someone who tested positive, follow COVID-19 exposure guidance.

DHEC recognizes that while vaccinations remain the best way for individuals to protect themselves against COVID-19, vaccinated and unvaccinated individuals may need treatment if they contract the virus. Several outpatient treatment options are available for those who contract COVID-19, including monoclonal antibody infusions and anti-viral pills.

Tracking and understanding relevant COVID-19 data are also useful during endemic status. Many data points that were critical during the pandemic are not as important as the virus becomes endemic, while others are more significant than before.

  • DHEC’s updated data plan includes a switch from daily reporting to weekly reporting to best track the virus’ impact by monitoring trends.
  • Reported data also will show a shift to more of a focus on severe COVID-19 cases. For an endemic disease, data on severe cases that result in hospitalization and death are a better indicator of how COVID-19 is impacting communities.