Explainer I COVID-19 showing signs of reaching an endemic stage in India?

The third COVID-19 wave in India, fuelled by the Omicron variant, has been receding rapidly since January 21 after reaching a peak of 347, 254 cases. On February 15, for instance, a total of 27,409 new cases have been reported, a decline of over 92 per cent in just about three weeks. Also, the cases have remained below the 100,000 mark for the ninth consecutive day.

This has prompted many epidemiologists and public health experts to suggest that the pandemic is showing signs of reaching an endemic stage.

How could COVID-19 have shifted from a pandemic to an endemic? 

There have been several respiratory viruses that were introduced into the human population, swept across the world, and transitioned to endemic circulation, usually with annual wintertime peaks in incidence. The 1918 Spanish Flu, for example, was one such disease.

Unlike a pandemic, when a virus or a pathogen simultaneously hits a large geographical area and population and triggers an unpredictable wave of illness, in the endemic stage the disease occurs regularly in a much smaller area in an established pattern. Now, many scientists propose that enough people, particularly in India, have gained protection from vaccination and from natural infection, which means that there will be less transmission and much fewer COVID-19-related hospitalizations and deaths, even as the virus continues to circulate.

Epidemiologist Dr Naman Shah says that for an endemic disease, the focus is on control measures only around the vulnerable, elderly and immune-compromised; otherwise, life returns to normal. In other words, it means absence of restrictive measures such as lockdowns.

Also read: Coronavirus Omicron LIVE Updates 

Will there be a zero-COVID scenario? 

Most public health experts are of the view that during the endemic phase, some people, especially those who are unvaccinated and immune-compromised may continue to get infected, sick, hospitalised and even die. But COVID-19 is likely to cease as a major public health challenge.

Dr Oommen John, a public health researcher associated with the George Institute of Global Health in New Delhi, says that when a highly infectious agent like SARS CoV-2 is endemic the best interventions for the government may be to move from a fire-fighting mode to a system strengthening approach.

What could people and governments do in the times ahead? 

Life may need to move ahead with the new normal—with a “dial up” and “dial down” approach. While maintaining COVID-appropriate behaviour such as masking, social distancing, ventilation in closed spaces would remain crucial, at least in the months to come, more measures and restrictions may still be required in areas reporting a higher number of coronavirus disease cases. Dr John insists that as COVID-19 is a highly infectious disease, the best approach for the public is to take precautions to prevent getting infected; because vaccination reduces severity, being vaccinated is a key aspect. For the government, he says, ensuring that primary health services are able to respond adequately will be key, which requires investments in diagnostics and health infrastructure capacity at the sub-district levels. Continued surveillance, which includes environment and genetic surveillance, is also required.

Can there still be future waves of COVID-19? 

That’s unlikely—but not entirely impossible.  With the last Omicron variant having swept the globe already, experts say that in case there is a future variant of concern, it will be mostly be a highly infectious strain. Whether it is also capable of causing serious disease or a fresh wave of infections, that cannot be definitively predicted. “Future large waves are unlikely post Omicron as now everyone left is either recovered from previous infection or vaccinated unless a very different variant emerges,” says Dr Shah.

He, however, points that new COVID-19 cases may keep occurring, as existing immunity may not prevent breakthrough infections, but what matters now is hospitalization and treatment of severe illness.