COVID-19 Becoming Endemic In India: Is The Virus Here To Stay?

An endemic disease means that COVID-19 will become like the flu wherein it will only be found in particular areas and will be in control in remaining parts of the country

World Health Organisation Chief Scientist, Dr. Soumya Swaminathan stated that COVID-19 may be moving into the endemic stage from the pandemic stage in India as there is low or moderate level of transmission of SARS-CoV-2 within the country.

In an interview with Karan Thapar from the Wire, Dr. Swaminathan also added that even though the virus is transmitting in the population, the absence of exponential peaks strengthens her belief that India is now moving into the endemic stage.

The question that now arises is whether this endemicity will allow people to live as they used to in 2019 or will people have to now live with the virus, making this the new normal. BOOM spoke to Dr. Giridhar Babu, Professor and Head- Life Course Epidemiology, Public Health Foundation of India and Dr Rajib Dasgupta, Professor and Chairperson, Centre of Social Medicine and Community Health, JNU to understand the same.

What Is The Meaning Of An Endemic?

A disease is considered as endemic when its prevalence is restricted to a specific geography, or a population. Diseases like malaria, HIV are considered to be endemic to a certain region or sect of people.

With India showing variation in the number of cases across the country; Kerala and Maharashtra still reporting a higher number of daily cases as compared to the rest of the country, Dr. Swaminathan said that this trend highlighted that the disease was now being constrained to particular locations. She also added that the heterogeneity in the population in India is why the country is witnessing such a difference in COVID-19 case numbers.

"By endemicity we refer to a basal level of transmission that is seen for a long stretch of time and does not have any untoward surprises. The new cases reported daily are within a range," Dr. Babu explained.

How Is An Endemic Different From Pandemic And Epidemic?

The WHO declared COVID-19 as a pandemic on March 11, 2020 after several countries reported a surge in cases. The apex health body classifies the progression of a disease into separate stages on the basis of the spread of the disease.

A disease can originally be endemic or transform into an endemic after being declared as a pandemic. To be declared as a pandemic, the disease is first classified as an epidemic. An epidemic is when a certain disease rapidly spreads within a confined geography or population. It turns into a pandemic if the proportion of cases exponentially increases and the disease is no longer limited to only that population.

In the case of COVID-19, as the transmission rate of SARS-CoV-2 decreases, and the vaccination rate increases across countries, scientists believe that the virus could become seasonal like the flu. Countries like the United States have a flu immunisation schedule where residents take a flu shot every year. These vaccines are to protect people from being infected by the different strains of the influenza virus still circulating within the region.

A survey conducted by Nature magazine in February 2021, has many epidemiologists and infectious disease experts sharing that the chances of eradicating SARS-CoV-2 in the manner that small pox and polio were eradicated are low.

These public health experts also said that people will have to learn to live with the virus, eventually.

How Will COVID-19 Become Endemic In A Population?

On August 11, Harvard TH Chan School of Public Health published an interview with Yonatan Grad, Melvin J. and Geraldine L. Glimcher Associate Professor of Immunology and Infectious Diseases to understand how COVID-19 will transition into an endemic disease.

Prof. Grad shared that endemicity refers to scientists optimistically presuming that enough people will have immunity either from vaccination or from natural infection which will lead to reduction in the transmission and even COVID-19-related hospitalization and death, while the virus continues to circulate.

However, with the virus mutating and its new variants emerging, it is also necessary to verify the effect of the existing vaccines on these variants. So far, most vaccines have shown to be over 90 per cent effective against the original SARS-CoV-2 virus, but less effective against its variants, relying only on vaccines may prove to be detrimental. While the Centres of Disease Control and Prevention and the WHO had earlier stated that close to 70 per cent herd immunity would help to control SARS-CoV-2, with the emergence of the variants, the proportion is now being debated.

"We are still trying to understand what will classify as an appropriate proportion to say COVID is under control," Dr. Babu added.

Some countries to ensure that natural or induced immunity does not wane are giving booster shots to their population. Dr. Swaminathan, however said that the WHO has not come across enough evidence to support the need for booster shots.

Can We Stop Wearing Masks And Social Distancing?

Along with vaccination, COVID-19 appropriate behaviour and public health social measures are important key factors.

"The WHO's June 2021 advisory states that: The decision to introduce, adapt or lift public health and social measures should be based primarily on a situational assessment of the intensity of transmission and the capacity of the health system to respond, but must also be considered in light of the effects these measures may have on the general welfare of society and individuals. The WHO also reiterates that communities are fully consulted and engaged before any changes are made," Dr. Dasgupta shared in an emailed conversation.

"Eventually may be, but relaxing public health measures currently, we are not there, yet," Dr. Babu concluded.

After making masks voluntary in places, the US repealed its order and announced that people should wear masks again after the recent surge in cases that the country is witnessing.

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