Is Covid-19 entering an endemic stage? How far is India from getting there

It has been two years since the World health Organisation declared Covid-19 as a pandemic. Vaccination are taking place globally at a rapid scale and now the United Kingdom that was once the epicentre of Covid cases has asked its citizens to live with it. People with Covid in UK no longer need to isolate and tests are likely to be scaled back. California too rolling back restrictions and focusing on watching new variants to quickly react and resist outbreaks.

Here’s how the Covid-19 endemic stage will look like and what it will been to control measures in India and globally.

A disease enters endemic stage when its rates have stayed constant for  a while in a geographical area with the pathogen causing the disease(SARS-CoV-2 here) remaining in circulation without causing large outbreaks.

In India, the cases have been declining but experts can’t predict the exact time when it will become endemic. It depends on vaccination rate, emergence of new variants and on the susceptible population. According to Dr Pramod Garg, director, Translational Health Science and Technology Institute (THSTI)-Faridabad , Covid-19 will become seasonal like flu or Dengue in monsoons and cause disease to the vulnerable lot.

Dr Amit Singh, associate professor, Centre for Infectious Disease at the Indian Institute of Science-Bangalore finds serosurvey and laboratory susceptibility studies to be an important determinant that can tell if the disease has become endemic. The disease can be called endemic even when at least 90 per cent of the population has developed antibodies for the disease, he said. Further it needs to be studied if the antibodies can protect against current and new variants as well.

Does it mean we have crossed the worst phase of the pandemic

Disease becoming endemic doesn’t mean it is harmless. Oxford University professor on viral evolution Dr Aris Katzourakis argued, in a Nature editorial cited the example of malaria that killed 6,00,000 people in 2020 and argued that a disease can be both deadly and widespread in its endemic stage.

Another Nature article says that the high circulation of Delta and Omicron variants in countries with unequal coverage of vaccination or in wealthy countries with least control measures can offer fertile grounds for deadlier, more transmissible variants.

How endemicity can change control measures

Experts feel the level of testing and genome sequencing should remain high when restrictions are lifted.

For Dr Rakesh Mishra, former director of Centre For Cellular And Molecular Biology-Hyderabad which is one of the ten central labs of India’s genomic surveillance consortium, the period of lull is not time to relax. Genome sequencing should be high then. The best way to sequence according to Dr Mishra is conduct a general survey, sequence 1 to 2 percent of positive cases, areas with more cases to be sequenced more and keep a close eye on hospitalised cases.

Should we continue to mask up?

Dr Mishra considers living with the mask as the new normal. This way chances of spread will be lower and the economy will start running. For India, he said that it cannot afford to fall into the ditch of a new variant that might be lurking anywhere. Other experts too agreed on keeping restrictions.

However, declaring Covid as an endemic can affect the availability of resources for vaccination and other measures. Low vaccination rates in some countries will continue to remain low because nobody will care, Dr Singh said.