To worry about COVID-19 endemicity or not; that is the question 

“At the moment we have to calibrate when we have to launch an outbreak-like response.”

Has COVID-19 become endemic nor not, that is the question. While the world over, the debate rages on whether COVID-19 has reached an endemic phase, in India there seems to be broad consensus that it has, in India, though epidemiologists might have taken various paths to get there. Interestingly, another question: whether endemicity is significant at all in the current context: is also cresting this wave of discussion among professionals, and might even take over the debate in the not so near future. 

Jacob John, retired professor of virology, Christian Medical College, Vellore, says the terms endemic and epidemic are based on patterns, and no one has attempted yet to post numbers that could establish the stage the SARS-CoV-2 virus is at currently. However, he uses a comparison with the numbers of the past, more a rule of thumb criteria to argue that the infection has entered the endemic stage in India. 

Considering the seven-day average of cases during the peak of the epidemic, the daily numbers have not crossed the 10% of that figure since the decline in numbers began, he points out. Despite the rise in cases in the last few days, the number has remained below 10 % of the seven-day average of cases during the peak of Omicron, Dr. John says. There has been a similar trend in South Korea, he adds. 

“If you look at Bharat COVID-19 or World-o-meter, the disturbances in the flat line since the drop have been very minor,” he says, adding that similar to what happens in an epidemic, the numbers have been going up only in certain cities in Maharashtra, Kerala, Delhi and Tamil Nadu. “It is still virtually a flat line.” Even when a disease is in the endemic stage, there can be seasonal outbreaks, and the spike in cases that a few cities in India are seeing now, could be equated to that, he reasons. 

 Chandrakant Lahariya, epidemiologist and public policy and health systems specialist, treads another path to arrive at his conclusion. Endemic and pandemic are all academic terms, not dependent solely on scientific parameters, he says. He draws attention away from the endemic-pandemic binary to a more experiential angle. “We know the extent of social and economic impact that COVID-19 had on the world. So, I believe that the idea is for societies to agree that the infection is an acceptable risk, as some countries are already doing so, despite the numbers going up. None of these countries are saying the disease is endemic, but they are saying ‘life is returning to normal.’ Of course, this will differ from country to country. 

Dr. Lahariya also says it is his firm belief that it is irrelevant to India to debate endemicity or not of the virus in the country. “We should approach it from the practical position of ‘acceptable risk’ - of whether or not it is disrupting social and ecomomic life in the country.” India has reached a stage wherein the virus is not creating great havoc in terms of death or morbidity. “Three years down the line, a nation could look back and mark the point of time in which it turned endemic, but it is not logical or practical to look for these signs now,” he explains. 

While he advances the view that the disease is no longer a population-level public health challenge, but rather an individual one, and recommends that our responses change appropriately, once again professionals are split in their opinion on this too. While Dr. Lahariya recommends protection of the vulnerable, continued economic surveillance, tracking the parameters (but don’t worry) and COVID-19 appropriate behaviour, he believes that the onus has moved on to the individual, from the health system.