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COVID-19 Explained: What Is The Endemic Stage Of COVID-19 That India May Be Entering Into?

The United States’ Centers for Disease Control and Prevention (CDC) defines endemic as the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area, so has COVID-19 reached the endemic stage, yet?

COVID-19 Explained: What Is The Endemic Stage Of COVID-19 That India May Be Entering Into?
Highlights
  • Attaining endemic stage doesn’t mean the end of the COVID-19 pandemic: CDC
  • Endemicity means a low or moderate level of transmission of a disease: CDC
  • By the end of 2022, the world could reach an endemic stage of COVID-19: WHO

New Delhi: “We may be entering some kind of stage of endemicity where there is low-level transmission or moderate level transmission (of COVID-19) going on, but we are not seeing the kinds of exponential growth and peaks that we saw a few months ago. As far as India is concerned that seems to be what is happening”, said WHO Chief Scientist Dr Soumya Swaminathan, in an interview with The Wire. Ms Swaminathan believes that the situation in India may continue like this with ups and downs in different parts of the country, particularly where there is a more susceptible population.

Also Read: Explained: What Is A Breakthrough Infection And How To Prevent Catching COVID-19 After Getting Fully Vaccinated

But what does entering into an endemic stage mean? Does it mean an end of the COVID-19 pandemic? The United States’ Centers for Disease Control and Prevention (CDC) defines endemic as “the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.”

Explaining the endemic stage of a disease in simple terms, Dr TS Anish, Associate Professor of Community Medicine, Government Medical College, Thiruvananthapuram and Member, Kerala’s State Expert Panel of COVID-19, said,

Endemic means the disease is there along with the population, nobody is very much concerned about the disease, but it is there. The disease is affecting a very small proportion of the society, neither growing nor shrinking at a faster rate. It is just there with you. At any point in time, you may or may not get the disease. For example, every year we get some amount of diarrhoeal disease in Kerala. This happens with every pandemic, before it ceases to exist, there will be a sustained period of endemicity that means your system might not be concentrating on the disease and your health system may not be stretched by the disease.

Also Read: COVID-19 Explained: What Is ‘Long COVID’?

However, the CDC believes that under such a situation, in the absence of intervention and assuming that the level of the disease is not high enough to deplete the pool of susceptible persons, the disease may continue to occur at this level indefinitely.

Tuberculosis, dengue, malaria to name a few are endemic infectious diseases which we have learnt to deal with. If we dial the clock back because back then we did not have much information, dissemination of information, social media, media interest, we did not even look at these diseases with so much worry, said Dr Ravindra Mehta, Chief of Pulmonary and Critical Care Medicine at Apollo hospitals, Jayanagar, Bangalore.

Also Read: Please Send Your Child To School, Families And School Staff Should Be Vaccinated: Dr NK Arora, Expert Panel Chief

How Is An Endemic Different From Epidemic And Pandemic?

The CDC defines an epidemic as an increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area. Outbreak carries the same definition of epidemic but is often used for a more limited geographic area.

On the other hand, the term pandemic relates to the geographic spread of the disease. It refers to an epidemic that has spread over several countries or continents, usually affecting a large number of people. Pandemic is an epidemic on a global level. WHO explains that an epidemic becomes a pandemic when it spreads over significant geographical areas and affects a large percent of the population.

Pan means entire, demos means population; this means the entire population is affected. When the disease is spreading, cutting across the regional boundaries to maybe boundaries of continents and it is spreading all over the world then we call it a pandemic, said Dr Anish.

Also Read: Coronavirus Outbreak Explained: What Is The Difference Between Pandemic And Epidemic?

What Will Happen If COVID-19 Becomes Endemic?

COVID-19’s exit from the pandemic to endemic stage means it is there in some part or the other. It becomes like influenza; people are not worried about it. Endemic is desirable and better than a pandemic. It allows us to co-exist with the virus. Co-existence is another manifestation of endemicity, said Dr Mehta.

Further explaining the consequences of COVID-19 reaching the endemic stage, Dr Anish said,

If you look at the endemic diseases all over the world, especially airborne diseases, you will see that a significant proportion of endemic diseases are contributed by two families of viruses – influenza viruses and coronavirus. Both are originally animal viruses. Seasonal flu will affect the human population and may cause some kind of complications like a portion of our population may be affected. Most of them will be affected by a very mild disease but if the vulnerable group that means people with comorbidities and elderly age group are affected, it can complicate the situation in them. So, we will try to protect them by giving vaccines against seasonal flu. And wherever new flu viruses are introduced to the human population, we will modify our vaccines by incorporating the new flu viruses. This may happen for COVID-19 also. Even now, among the viruses which are causing flu like symptoms among human beings, almost 30 per cent of the viruses are in the group of coronaviruses.

Also Read: Study Shows Downside Of Not Receiving Second Shot Of COVID-19 Vaccine

Dr Anish added that COVID-19 is going to lose its teeth due to natural infection and vaccination. For example, during the Spanish flu, the virus affected the human population more than once and then died and sustained for a long time during the endemic stage. However, back then, there was no vaccine for Spanish flu. Whereas in the fight against COVID-19, we have vaccines that have the property to reduce the clinical severity of the disease, he said.

Talking about the steps needed to contain the pandemic, Dr Giridhara R Babu, Professor of Epidemiology at Indian Institute of Public Health, PHFI, Bengaluru, said,

With COVID-19 becoming endemic, the world has to evolve a control strategy to prevent flare up’s resulting in higher numbers than the background prevalence. In this stage, the goal is to prevent deaths and not to prevent infection. This is why the ‘zero COVID’ strategy failed. They fail to recognise that it is impossible to eliminate this virus, at least at this stage.

Also Read: Coronavirus Explained: What Are COVID Variants And Variants Of Concern?

Endemic Stage Of COVID-19: Can One Stop Wearing Masks?

Double masking, hand hygiene and physical distance are the basic COVID appropriate behaviour put in place by health authorities to break the chain of transmission of the virus. But will we have to continue with these protocols, especially masking even when COVID reaches the endemic stage? Answering the same, Dr Giridhara said,

As long as there is a high circulation of the virus, we need to continue with COVID-19 appropriate behaviour. The trouble is that we are viewing this as a negative thing to follow these behaviours. We need to alter that state of mind at the population level. Whether you are vaccinated to not, you are at the risk of getting an infection and transmitting it.

As the new variants of Novel Coronavirus, emerge, there are reports that some of the variants may be more infectious and evade vaccines. This essentially means, we might need a booster dose or a second generation vaccine, which would be better in terms of the immunity it provides. With the possibility of COVID entering the endemic stage, a question pops up, will we have to take booster shots annually like in the US people take influenza (flu) shots?

Also Read: New Variant (C.1.2) Of Coronavirus May Be More Infectious, Evade Vaccines: Study

Dr Giridhara said, a booster dose is no magic; it cannot change anything in minimising the need for COVID-19 appropriate behaviour. Adding to this, Dr Anish said, it will be an individual’s choice to take a booster dose but there will be a risk involved in not taking – you might get infected with the new variant. However, in India, adult vaccination is not as popular as immunisation of children against numerous diseases, he said.

Similar to our youngsters or children, our elderly population is also vulnerable to viral diseases. But the routine vaccination happens only for children because, in India, the proportion of people aged 60 and above is around 10 per cent. In the future, this figure will rise, and we have to take care of the elderly and protect them from common infections. It’s a good idea to inject them with new coronavirus and influenza strains just like it’s being done in the US and Europe annually. Also, we might want to give a booster dose to everyone, that’s not known currently, said Dr Anish.

Also Read: Coronavirus Explained: How COVID-19 Impacts People Living With HIV

When Will We Reach Endemic Stage?

In an interview with The Wire, Dr Swaminathan said that in a year and a half to two years, we will be in that position; hopefully by the end of 2022, we would be in a situation where we have achieved adequate vaccine coverage.

The WHO is calling for 70 per cent coverage in all countries by the middle of next year and if we can do that then I think, countries should start getting back to normal, she added.

In an interview with NDTV, Dr Randeep Guleria, Director, AIIMS said the Novel Coronavirus will not go away. However, it will become an endemic illness like flu which is happening to some extent in certain states and we will have to live with it.

This will happen in the coming months but I think it is too early to say that COVID-19 is entering the endemic stage in our country. We still have a large number of cases and a significant number of people who are susceptible. Unless we get a large number of people vaccinated and our cases come down, we can’t say that for the whole of India it has become an endemic disease, said Dr Guleria.

Also Read: The Kerala And Delhi Factor: How Can We Tame The Third Covid Wave? Experts Explain

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

World

22,95,44,435Cases
19,20,52,504Active
3,27,83,741Recovered
47,08,190Deaths
Coronavirus has spread to 195 countries. The total confirmed cases worldwide are 22,95,44,435 and 47,08,190 have died; 19,20,52,504 are active cases and 3,27,83,741 have recovered as on September 22, 2021 at 3:49 am.

India

3,35,31,498 26,964Cases
3,01,9897,586Active
3,27,83,741 34,167Recovered
4,45,768 383Deaths
In India, there are 3,35,31,498 confirmed cases including 4,45,768 deaths. The number of active cases is 3,01,989 and 3,27,83,741 have recovered as on September 22, 2021 at 2:30 am.

State Details

State Cases Active Recovered Deaths
Maharashtra

65,27,629 3,131

44,269 960

63,44,744 4,021

1,38,616 70

Kerala

45,39,926 15,768

1,61,765 5,813

43,54,264 21,367

23,897 214

Karnataka

29,69,361 818

13,769 617

29,17,944 1,414

37,648 21

Tamil Nadu

26,48,688 1,647

16,993 9

25,96,316 1,619

35,379 19

Andhra Pradesh

20,40,708 1,179

13,905 483

20,12,714 1,651

14,089 11

Uttar Pradesh

17,09,693 13

194 0

16,86,612 13

22,887

West Bengal

15,62,710 537

7,741 69

15,36,291 592

18,678 14

Delhi

14,38,556 39

400 21

14,13,071 18

25,085

Odisha

10,21,216 462

4,844 103

10,08,226 560

8,146 5

Chhattisgarh

10,05,120 26

297 0

9,91,260 26

13,563

Rajasthan

9,54,275 12

99 8

9,45,222 4

8,954

Gujarat

8,25,751 14

133 0

8,15,536 14

10,082

Madhya Pradesh

7,92,410 8

90 6

7,81,803 14

10,517

Haryana

7,70,754 8

328 12

7,60,618 20

9,808

Bihar

7,25,907 6

60 9

7,16,188 15

9,659

Telangana

6,63,906 244

4,938 53

6,55,061 296

3,907 1

Punjab

6,01,359 36

304 3

5,84,554 37

16,501 2

Assam

5,98,864 441

5,081 97

5,87,970 338

5,813 6

Jharkhand

3,48,139 14

65 10

3,42,941 4

5,133

Uttarakhand

3,43,405 12

249 18

3,35,765 29

7,391 1

Jammu And Kashmir

3,28,214 145

1,450 11

3,22,345 154

4,419 2

Himachal Pradesh

2,17,403 263

1,715 99

2,12,033 162

3,655 2

Goa

1,75,690 107

886 76

1,71,507 29

3,297 2

Puducherry

1,25,618 101

922 55

1,22,864 46

1,832

Manipur

1,18,870 197

2,174 9

1,14,861 203

1,835 3

Tripura

83,956 51

353 7

82,794 44

809

Mizoram

82,815 1,355

15,363 223

67,184 1,127

268 5

Meghalaya

79,817 150

1,878 18

76,558 167

1,381 1

Chandigarh

65,195 7

44 3

64,333 4

818

Arunachal Pradesh

54,190 64

413 3

53,504 60

273 1

Sikkim

31,014 43

627 27

30,007 70

380

Nagaland

30,959 52

470 3

29,832 46

657 3

Ladakh

20,743 6

144 6

20,392

207

Dadra And Nagar Haveli

10,670

0 0

10,666

4

Lakshadweep

10,360 1

9 1

10,300

51

Andaman And Nicobar Islands

7,607 7

17 4

7,461 3

129

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