After the second wave, the daily average of COVID-19 cases in India is spiralling down, even though there still are isolated outbreaks and a rising positivity rate recorded in some states. However, despite this, there’s some positive silver lining, which is the growing pace of vaccination in the country.
While we may not be able to bid goodbye to COVID-19 as yet, it might be the time the viral outbreak may have reached a state of ‘endemicity’ in the country, given the rather low levels of transmission right now and the already largely exposed population in the country.
But, with the virus very much an active threat, and possibilities of a potentially threatening third wave looking like an imminent threat, what does endemicity mean, in terms of COVID-19 spread, and how concerned should we be?
What have experts said?
World Health Organisation (WHO)’s chief scientist, Dr Soumya Vishwanathan recently commented on the spread of COVID-19 in India, adding that while the virus is showing exponential growth rates across the world, India, which saw the worst outbreak during the second wave may not continue to witness serious waves and spurts of outbreaks in the coming future, terming COVID-19 to be possibly becoming endemic in India.
While several experts have pinpointed that India’s large population, geographically diverse climate and pre-established immunity may lead to a differed timeline of COVID-19 peaking in the country, or a possibility of different regions witnessing different severity with the outbreaks, the rather low levels of transmission may actually mean that coronavirus pandemic, is indeed turning into an endemic. A statement reads:
“As far as India is concerned that seems to be what is happening and because of the size of India and heterogeneity of population and immunity status in different parts of the country in different pockets, it is very very feasible that the situation may continue like this with ups and downs in different parts of the country, particularly where there are more susceptible population, so those groups who were perhaps less affected by first and second waves or those areas with low levels of vaccine coverage we could see peaks and troughs for the next several months”
What does an endemic mean? How does it differ from a pandemic?
As per epidemiologic terminology, an endemic represents a disease outbreak that is limited to certain areas in a given time, and the rate of disease spread, severity and transmission can be estimated beforehand.
It can also occur regularly, and extremely severe outbreaks may not be expected in a state of endemicity. For example, illness outbreaks such as that of the seasonal flu, dengue are all considered to be endemics. This is also the stage the WHO and other health bodies refer to as the timeline when a given population learns to live with the virus.
In retrospect, a pandemic means something different. COVID-19, which was earlier declared as a pandemic in March 2020, measured the exponential, and wide spread of the disease on the global front, at the same time.
When a disease outbreak spreads worldwide, or to larger areas, it is referred to as a pandemic. An endemic which spreads over a wide area, and ends up afflicting a lot of people at the same time is referred to as a pandemic.
Unlike a pandemic, an endemic is constant and localized to a particular area.
How does such a prediction help?
Dr Vishwanathan’s recent statement of COVID-19 entering into a state of endemicity in India has made been in reference to the low-to-moderate levels of COVID transmission in India and a large section of society who have already been exposed to the virus (either through natural infection or vaccine-generated antibodies).
While the second wave was widely destructive for people in India, the outbreaks post the second wave have been restricted to some states. R-factor, which measures the rate of positivity and disease spread is comparatively high in some parts of the country, and bleakly present in other parts, where there’s high seroprevalence or prior exposure.
Thus, endemicity ascertains a certain level of presumption and predictability with the virus in a given population and could help medical experts, and authorities plan disease control better as well. With even better vaccine coverage, which is a key goal right now, the faster we get more people to get immunized, the easier it would be to mitigate the risk of COVID-19 on a country-wide level.
What it mean we will live with COVID-19 forever?
Ever since mutant variants of the virus have wreaked havoc and lowered the efficacy of vaccines, experts have pinpointed that achieving herd immunity, or removing COVID-19 from the world, altogether may not be actually possible.
While we do know that certain mandates, such as testing, mask hygiene, distancing would still need to be followed till we know there’s a low-graded risk, living while knowing that there’s a virus forever could be very well a reality to acclimatize ourselves too.
While learning to live with COVID-19 forever does mean that the virus may never ever go away, however, it does mean that the virus, over time, may become less threatening and as higher rates of immunization are achieved, the virus would have fewer chances of spreading or spell severe outcomes, as we are seeing today.
Several experts have also stressed that instead of trying for a zero-COVID-policy, transitioning from a pandemic to an endemic is the best probable scenario we may have currently.
What does it mean for COVID-19 vaccines?
High immunization rates and vaccination speeds are needed to provide peak protection and limit COVID from spreading. As we move into the future course of months, where there’s a possibility of seeing more mutations coming up, the current vaccines may be upgraded, or subjected to changes, which could help them offer more protection and efficiency than we currently have.
There’s also talk of booster shots right now, which may be suggested for those who are immuno-compromised.
In the future, COVID vaccination may also become an annual affair, much like flu vaccination and thus, with added immunity, it would our best shot of defence to mitigate the risks of COVID-19.