COVID-19 will start becoming endemic in India in the next six months, a top health expert told NDTV on Wednesday, 15 September, adding that a new variant alone cannot bring a third wave.
"This pandemic has defied most of our predictions but in the next six months, we will approach endemic status," Sujeet Singh, the Director of the National Centre for Disease Control (NCDC) told NDTV.
The third wave can't be because of a new variant alone, but a "mix of behaviour and antibodies," he said.
But what does it mean by COVID-19 becoming endemic? Should we not worry about rising infections anymore?
All pandemics will eventually end, how they will end differs. Historically, pandemics end when either the number of cases plummets, and the disease becomes manageable and predictable; or they end when people grow tired of it.
For public health purposes, pandemics become endemic when they stop becoming a burden on health care systems, with small flair-ups that can be managed by healthcare systems.
World Health Organisation's Chief Scientist Dr Soumya Swaminathan, in an interview with The Wire, said that the COVID pandemic may be entering some kind of 'endemicity.'
Amid various predictions for the 3rd wave, and sluggish vaccination pace, what does 'endemicity' mean for India?
What is Endemicity?
In a previous article for FIT, Dr Shahid Jameel, a virologist, said,
“With increasing exposure viruses become less virulent and adapt to infect at lower levels and do that periodically. Mutations are part of the process. This is called becoming endemic to a population. Endemic means present all the time."
An outbreak is when many people in a closed group show disease around the same time.
An epidemic is when a large number of people do so across one or more country.
A pandemic is when epidemics happen on all continents.
Dr Swaminathan said that, "it’s very feasible we may continue like this, with a few local ups and downs." She added that she didn't think India will see severe outbreaks like the country did during the devastating second wave.
Dr Swaminathan's words have been echoed by other experts. In a previous interview with FIT, Dr Gautam Menon, professor of physics and biology at Ashoka University, had said, "much of modelling would suggest that the intensity of any future third wave should be distinctly less than the intensity we saw in the second wave for multiple reasons."
The reason he said was a combination of previous infections and increasing vaccination rates.
Other virologists like Dr Gagandeep Kang agree that future waves are more likely to impact areas with a larger susceptible population and low vaccination rates. She had earlier said that, "between the vaccination and the horror of the second wave, when we had such a high rate of infection in the country, we are actually not in as bad a position as many other places."
The US’s Center for Disease Control and Prevention says, “Endemic refers to the constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.” This may not be the desired level of disease - which is zero - but the expected level.
Watch Out for Variants
The rider of course is that no new variant comes along that upends these efforts. While the Delta variant was behind India's 2nd wave, it has also hit countries with high vaccination rates, leading to higher breakthrough infections even among those who have been double vaccinated.
In this article on FIT, we examine the situation if Israel, among the highest vaccinated countries in the world, that is now seeing nearly the same numbers at it did in January, 2021, before vaccinations took off.
While nearly half of those new infections in Israel are among the unvaccinated, many are among the vaccinated, but elderly with co morbidities.
Israel, like the US, another country witnessing a massive rise in new infections, is considering booster doses for its vulnerable, epidemiologist Dr JP Muliyil says India still has an advantage.
While for most Israelis, immunity was achieved via vaccination, "In India, the majority of Indians acquired immunity through natural infection, which seems to be much more robust than vaccines."
COVID-19 Will Become Endemic: But Are We There Yet?
Scientists have warned from as far as May 2020 that the novel Coronavirus may 'never' go away.
In March 2021, in a survey by the science journal Nature, nearly 90% of 100 immunologists said that the virus will become endemic and will continue to circulate in parts of the world for years to come.
Till then, public health measures are not going to go away. We need to continue masking, increase vaccination coverage, work on indoor ventilation, avoid public gatherings and maintain hygiene.