People with Covid-19 will no longer legally need to isolate in United Kingdom and the tests are likely to be scaled back as part of a plan to live with Covid-19.

California too has announced a shift to an endemic approach to Covid-19 that will focus on watching out for new variants and reacting quickly to outbreaks rather than issuing mandates for masking indoors.

What does endemic stage mean, and are we there yet?

An infection becomes endemic when the rates become static in a given geographical location. 

It means that the pathogen causing the disease — SARS-CoV-2 in this case — is likely to remain in circulation without causing large outbreaks as witnessed over the last two years.

• Although the number of infections in India is consistently declining, experts say they cannot give a deadline on when the disease will become endemic.
• It will depend on the number of susceptible people in the population, vaccination rates, and emergence of new variants that are able to evade the immune response.

“Endemic means that the virus will continue circulating in the population and there will be periodic ups and downs when the conditions are favourable to the virus and less favourable to humans.” 

• for example, flu which goes up in the winters and when the season is changing because of lower immunity in people or dengue which goes up after monsoons because of the availability of vectors. 
• Covid-19 also may become seasonal and cause disease in the vulnerable. 

An important determinant for whether we can “technically” say that the disease is endemic would be a representative sero-survey (population-level survey of antibodies against SARS-CoV-2) and laboratory susceptibility studies.

Does it mean we are safer?

A disease becoming endemic does not mean it is harmless. 

Expert says-

• A disease can be endemic and both widespread and deadly. Malaria killed more than 600,000 people in 2020. Ten million fell ill with tuberculosis that same year and 1.5 million died.
• Endemic certainly does not mean that evolution has somehow tamed a pathogen so that life simply returns to normal.
• Nor does it suggest guaranteed stability: there can still be disruptive waves from endemic infections, as seen with the US measles outbreak in 2019.

How will control measures change if the disease becomes endemic?

Although experts have pushed for easing of restrictions, they say that there is a need to maintain high levels of testing and good genomic surveillance.

According to the experts, The best way to find new variants was; 

• One, conduct a general survey; sequence probably 1% or 2% of the positive cases. 
• Two, wherever there are more cases from an area, we should sequence immediately. 
• Third, we need to keep a very close eye on hospitalised cases. 

The sample of any person admitted to the hospital with positive Covid-19 should be certainly sequenced. If they needed to come to the hospital with severe symptoms, it may be because of a new variant.

Should we continue to mask up?

There is no real benefit in declaring that the disease is now endemic.

• If we live with the new normal, we will be protecting the economy as well. We don’t know when a new variant might emerge.
• If we look at omicron, it did not cause severe disease in India but in the US it led to high rates of hospitalisations and deaths.
• US is a smaller country; it is a richer country. We cannot afford to do what they did. We have all suffered, let us not fall into the ditch of a new variant.

Concerns:

Another concern with officially declaring Covid-19 endemic would be fewer resources being made available for measures such as vaccination. 

• There is a vaccine inequity; not all countries are vaccinated. If the disease is declared endemic, then the 10% vaccination rate in some countries will remain 10%’ nobody will take care of that.
• The more a virus replicates, the greater the chance that problematic variants will arise, most probably where spread is highest. 
• The Alpha variant was first identified in the United Kingdom, Delta was first found in India and Omicron in southern Africa — all places where spread was rampant.

Source: Nature / Indian Express