By Eliz­a­beth Me­limopou­los | AL JAZEERA

■ Some po­lit­i­cal lead­ers are call­ing for COVID to be treat­ed as an en­dem­ic dis­ease, but sci­en­tists warn that talk of a pan­dem­ic endgame is pre­ma­ture ■

(AL JAZEERA) — Al­most two years in­to the pan­dem­ic, some coun­tries have de­clared their in­ten­tion to start treat­ing COVID-19 like oth­er en­dem­ic dis­eases, such as sea­son­al flu.

De­spite wit­ness­ing rel­a­tive­ly high in­fec­tion rates amid the fre­net­ic spread of the Omi­cron vari­ant, which ap­pears to cause less se­vere dis­ease but is high­ly trans­mis­si­ble ac­cord­ing to ear­ly stud­ies, coun­tries in­clud­ing Eng­land and Ire­land have dras­ti­cal­ly loos­ened re­stric­tions on pub­lic life.

Den­mark has an­nounced plans to lift all re­stric­tions next week, as its health min­istry an­nounced that COVID “will no longer be cat­e­gorised as dan­ger­ous to so­ci­ety.”

Of­fi­cial mes­sag­ing from po­lit­i­cal lead­ers in Spain, the Unit­ed King­dom, and else­where has stressed that so­ci­eties need to learn to live with the virus.

“COVID is not go­ing away. It’s go­ing to be with us for many, many years, per­haps for­ev­er, and we have to learn to live with it,” Sajid Javid, the UK health min­is­ter, said last week.

“I think we are lead­ing Eu­rope in the tran­si­tion from pan­dem­ic to en­dem­ic and we’re lead­ing the way in show­ing the world how you can live with COVID.”

How­ev­er, of­fi­cials from the World Health Or­ga­ni­za­tion have warned that it is too ear­ly to treat COVID-19 as an en­dem­ic dis­ease, stress­ing that the evo­lu­tion of the virus is un­cer­tain and not­ing that on a glob­al scale the pan­dem­ic con­tin­ues to rage.

“We still have a huge amount of un­cer­tain­ty and a virus that is evolv­ing quite quick­ly, im­pos­ing new chal­lenges. We are cer­tain­ly not at the point where we are able to call it en­dem­ic,” WHO’s se­nior emer­gency of­fi­cer for Eu­rope, Cather­ine Small­wood, told a press brief­ing.

The Omi­cron vari­ant con­tin­ues to cause surges of in­fec­tion, which have in­creased pres­sure on pub­lic health sys­tems. Ac­cord­ing to the WHO, 21 mil­lion new coro­n­avirus cas­es were re­port­ed glob­al­ly last week, the high­est num­ber of week­ly in­fec­tions since the pan­dem­ic be­gan. The Pan Amer­i­can Health Or­ga­ni­za­tion (PA­HO) said on Wednes­day that the Amer­i­c­as re­gion saw its high­est num­ber of in­fec­tions since the pan­dem­ic start­ed, with more than eight mil­lion new cas­es.

Mean­while, much of the glob­al pop­u­la­tion has not been ful­ly vac­ci­nat­ed against COVID, in­creas­ing the chances of more se­vere dis­ease among them. Low vac­ci­na­tion rates in many coun­tries al­so make the emer­gence of a new vari­ant more like­ly, which could de­rail at­tempts to treat COVID as en­dem­ic.

What does en­dem­ic mean?

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”.

Dr Ebere Ok­ereke, a se­nior tech­ni­cal ad­vis­er at the Tony Blair In­sti­tute for Glob­al Change and hon­orary se­nior pub­lic health ad­vis­er to Africa CDC, said one key fac­tor is “pre­dictabil­i­ty and sta­bil­i­ty”.

“In pub­lic health [dur­ing en­demic­i­ty] we have an ex­pect­ed and an­tic­i­pat­ed num­ber of cas­es over a time pe­ri­od in a ge­o­graph­i­cal re­gion.”

Mike Ryan, ex­ec­u­tive di­rec­tor of the WHO’s health emer­gen­cies pro­gramme, re­cent­ly not­ed, “En­dem­ic in it­self does not mean ‘good’. En­dem­ic just means ‘it’s here for­ev­er’.”

An epi­dem­ic is de­fined as a dis­ease that af­fects a large num­ber of peo­ple with­in a com­mu­ni­ty, pop­u­la­tion and re­gion. A pan­dem­ic is an epi­dem­ic that has spread to mul­ti­ple coun­tries or con­ti­nents.

When au­thor­i­ties de­cide to tran­si­tion to treat­ing a dis­ease as en­dem­ic, it some­times af­fects the mea­sures that were pre­vi­ous­ly im­ple­ment­ed dur­ing the pan­dem­ic stage.

“If some­thing is a pan­dem­ic or an epi­dem­ic, we have to take cer­tain pre­cau­tion­ary mea­sures against it to lim­it its spread. And with an en­dem­ic, those same mea­sures aren’t need­ed or re­quired,” Dr An­na Blakney, an as­sis­tant pro­fes­sor in the Michael Smith Lab­o­ra­to­ries and School of Bio­med­ical En­gi­neer­ing at the Uni­ver­si­ty of British Co­lum­bia, told Al Jazeera.

In the case of COVID, Blakney said this could mean gov­ern­ments are start­ing to im­ply they would like to do “less to con­trol this as far as re­stric­tions, test­ing, mask­ing or any of the mea­sures that have been shown to work against COVID”.

Is COVID-19 tran­si­tion­ing to an en­dem­ic dis­ease?

Any po­ten­tial tran­si­tion would vary from coun­try to coun­try, de­pend­ing on sev­er­al fac­tors such as how wide­spread the dis­ease is with­in na­tion­al bor­ders and the lev­el of im­mu­ni­ty with­in the pop­u­la­tion.

Ac­cord­ing to the Unit­ed Na­tions, two out of three peo­ple have been vac­ci­nat­ed with at least one dose in high-in­come coun­tries. In low-in­come coun­tries, one in nine peo­ple have been vac­ci­nat­ed with at least one dose as of Jan­u­ary 19.

“When you say that a dis­ease [has] tran­si­tioned from epi­dem­ic to en­dem­ic, there are no hard and fast rules to de­ter­mine that,” Dr Amesh Adal­ja, a se­nior schol­ar at the Johns Hop­kins Cen­ter for Health Se­cu­ri­ty, told Al Jazeera.

How­ev­er, he said one mark­er could be when you do not see the dis­ease un­der­min­ing hos­pi­tal ca­pac­i­ty.

“Once COVID-19 los­es that abil­i­ty through enough im­mu­ni­ty … I think the world is go­ing to get to en­demic­i­ty, but it’s go­ing to be on dif­fer­ent time­lines de­pend­ing up­on where you are at,” he added.

Ac­cord­ing to Adal­ja, en­demic­i­ty is in­evitable in the case of COVID.

“I think that from the very first day in the COVID-19 pan­dem­ic, it was al­ways go­ing to be the case that this be­came an en­dem­ic res­pi­ra­to­ry virus,” Adal­ja said.

He added that the main pri­or­i­ty was to get more tools, like vac­cines, an­tivi­rals, and mon­o­clon­al an­ti­bod­ies, that would help to re­duce the strain on hos­pi­tals and health sys­tems.

“Omi­cron has ac­cel­er­at­ed this process … we are ba­si­cal­ly at the cusp of en­demic­i­ty and it may be the case that af­ter Omi­cron surge wash­es over the coun­tries of the world, we will be clear­ly in the en­dem­ic phase,” Adal­ja added.

Comparison of COVID19 endemic diseases. [Source: Al Jazeera]

How close is the world to ex­it­ing the pan­dem­ic phase?

Hans Kluge, the WHO Eu­rope di­rec­tor, said on Sun­day the Omi­cron strain has moved Eu­rope in­to a dif­fer­ent stage of the pan­dem­ic.

“It’s plau­si­ble that the re­gion is mov­ing to­wards a kind of pan­dem­ic endgame,” Kluge told news agency AFP in an in­ter­view, adding that Omi­cron could in­fect 60 per­cent of Eu­ro­peans by March.

He said Eu­rope could ex­pect months of glob­al im­mu­ni­ty once the cur­rent wave sub­sides due to the vac­cines or the in­fec­tion.

“We an­tic­i­pate that there will be a pe­ri­od of qui­et be­fore COVID-19 may come back to­wards the end of the year, but not nec­es­sar­i­ly the pan­dem­ic com­ing back,” Kluge said.

But the fol­low­ing day, WHO Di­rec­tor-Gen­er­al Tedros Ad­hanom Ghe­breye­sus ap­peared to shoot down Kluge’s com­ments.

“It is dan­ger­ous to as­sume that Omi­cron will be the last vari­ant, or that we are in the endgame … glob­al­ly the con­di­tions are ide­al for more vari­ants to emerge,” he said.

Ok­ereke shares a sim­i­lar out­look, not­ing a lack of knowl­edge about the coro­n­avirus that is need­ed for the world to be able to pre­dict the be­hav­iour of new strains and en­ter en­demic­i­ty.

“I don’t be­lieve we know enough about SARS-Cov-2 to say that if a new vari­ant emerges, this is how it will be­have, or to say new vari­ants will not emerge, we don’t know,” Ok­ereke said.

“The key thing to re­duce the emer­gence of new vari­ants is to en­sure that we op­ti­mise vac­ci­na­tion pro­grammes glob­al­ly.

“Un­til we do that, we run the risk of hav­ing new vari­ants, whose be­hav­iour we cur­rent­ly can­not pre­dict,” she added.

Rates of vac­ci­na­tion against COVID-19 have re­mained low in Africa, with about 8 per­cent of the con­ti­nent’s pop­u­la­tion ful­ly vac­ci­nat­ed against the dis­ease.

“In Africa … we do not have the lux­u­ry of sig­nif­i­cant pop­u­la­tion pro­por­tions of our pop­u­la­tion be­ing im­mu­nised enough for us to start to say, we’ve got this, we are in a pan­dem­ic endgame,” Ok­ereke said.

Ex­perts warn there is still not enough in­for­ma­tion to know with pre­ci­sion what fol­lows next, par­tic­u­lar­ly with new strains.

“If the virus starts be­com­ing a milder virus, we would be okay,” Blakney said. “But if it sud­den­ly be­comes re­al­ly con­ta­gious and lethal then we’re not go­ing to be in a good place.”

What does the ear­ly da­ta around the Omi­cron vari­ant tell us about the pan­dem­ic?

Omi­cron was first dis­cov­ered in South Africa in late No­vem­ber and ear­ly re­search has found the strain ap­pears to be high­ly trans­mis­si­ble. Symp­toms of the in­fec­tion ap­pear to be less se­vere than in oth­er vari­ants, while ear­ly stud­ies in­di­cate that the symp­toms ex­pe­ri­enced by vac­ci­nat­ed pa­tients seem to be milder than among the un­vac­ci­nat­ed.

Its high trans­mis­si­bil­i­ty has al­so proven to be a chal­lenge. Its spread has caused a sig­nif­i­cant strain in health sys­tems, with many coun­tries strug­gling with an in­flux of pa­tients.

“Omi­cron is so wide­spread that we’re still see­ing a spike in the hos­pi­tal­i­sa­tions and deaths from it,” Blakney said.

The cur­rent sit­u­a­tion “tells us that as long as there is a risk of sig­nif­i­cant trans­mis­sion and emer­gence of new vari­ants we have to keep our guard up”, Ok­ereke said.

” It tells us that, al­though our vac­cines may not be the per­fect so­lu­tion … they have a sig­nif­i­cant role in re­duc­ing the sever­i­ty of ill­ness in the vac­ci­nat­ed.

“But the Omi­cron vari­ant al­so shows us that we can’t let our guard down, we need to con­tin­ue to im­prove the tools we have in our port­fo­lio to man­age this pan­dem­ic,” she added.

How can the world ex­it the pan­dem­ic?

There is a con­sen­sus among most health ex­perts that a way of end­ing this pan­dem­ic is by mak­ing vac­cines and treat­ments avail­able on a glob­al scale.

“Vac­ci­na­tions are key,” Blakney said.

“We need to keep mak­ing new vac­cines, and un­der­stand­ing how long that im­mu­ni­ty lasts. We al­so need to scale up the pro­duc­tion of every tool that we have, an­tivi­rals, test­ing, mon­o­clon­al an­ti­bod­ies, and make sure they are wide­ly ac­ces­si­ble.

“We have the tools, it is just a mat­ter of mak­ing them ac­ces­si­ble to peo­ple all around the world,” she added.