Has COVID Become Endemic in Delhi? It's Here to Stay, Say Experts

2021 was welcomed with open arms as the year things could go back to the ‘old normal.’

On Sunday, 7 March, Delhi Health Minister Satyendar Jain said that COVID-19was nearing an “endemic” phase in the national capital. A disease becomes endemic when it becomes a regular and expected part of the population, region or environment, for example like chicken pox which occurs at “a predictable rate,” as per Medicine Net.

As India’s vaccination plan is in phase 2 and cases seem to be on the downward spiral in most states, could this be true?

A a deeper look into the way viruses generally work, combined with what we know so far about SARS-CoV-2, reveals that the coronavirus is here to stay - perhaps for all times to come. So when exactly does a disease become endemic?

FIT explains.

Has Delhi Become Endemic?

First let’s break down the jargon. Virologist Dr Jameel explains,

• “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, eg ice in Antarctica

• 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”

Satyender Jain said,

“Coronavirus is nearing an endemic phase in Delhi. Experts say some cases continue to occur in the endemic phase. Delhi witnessed a swine flu outbreak around 10 years ago, but still some cases are reported every year. Coronavirus is not going to end completely … we will have to learn to live with it.”

Delhi Health Minister Satyendar Jain

As per the US’s Centre for Disease Control and Prevention (CDC), “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.

Virologist Dr Shahid Jameel further explains,

“Once there is enough exposure of the population the virus will become endemic just like many other cold causing viruses like other corona viruses, adenovirus, etc.”

Dr Shahid Jameel, virologist

The Indian Medical Association on 8 March, Monday condemned the latest narrative developing around the Covid-19 disease in the political sphere in which leaders are attributing the fallen trajectory of positive cases to a situation of an 'endemic'.

“It is painful to note the discussions on endemic vs pandemic status of Covid-19 are echoing in the political corridors. However, it ought to be substantiated by scientific evidence by the World Health Organization (WHO) or ICMR only.”

Indian Medical Association

Delhi, for over a week, has been witnessing a rise in daily new cases.

"Unauthorized political statements shall invoke false sense of security. The IMA feels as the world's countries are still reeling under the clutches of this disease, we need to deem it as pandemic only at this stage and work hard from all cylinders of preventive, curative and rehabilitative works," the association stated. The IMA noted that for the last one week the infection has shown 35 to 40% increase in the number of cases from different parts of the country and even in the national capital, the daily average has risen up from 100 to 140 patients.

“It is not appropriate to call the current stage the end of pandemic or an endemic. The introduction of much efficacious and safe corona vaccine in our country, is a tool for us to face this challenging war with confidence. The invasion of muted virus from UK, South Africa and Brazil are still haunting us.”

Dr JA Jayalal, President, IMA.

Dr Jameel adds that Jain said Delhi is “becoming endemic,” not that it already has. “It’s a play of words but the distinction is important.”

Can we say when COVID will be endemic in India? Are we there yet?

“Yes, the virus is going towards becoming endemic globally - not just Delhi or India. We just don’t know the time frame yet. Perhaps in a couple of years,” says Dr Jameel.

COVID-19 Will Become Endemic, Just Not Yet

The World Health Organisation (WHO) had warned us months back in May 2020, that the novel coronavirus ‘may never go away’. Dr Michael Ryan, emergencies director, WHO, had said at a virtual press briefing,

“It is important to put this on the table: this virus may become just another endemic virus in our communities, and this virus may never go away.”

Dr Michael Ryan

While over 100 vaccines are being developed in the world right now against COVID-19, it cannot be guaranteed that the virus will get eradicated. Dr Ryan also said that he doesn’t think "anyone can predict when this disease will disappear.” In fact, diseases such as measles have still not been eliminated despite vaccines.

In a survey by the science journal Nature, almost 90% of 100 immunologists were of the belief that the virus will become endemic, i.e., it will continue to circulate in some pockets of the world for years to come. Michael Osterholm, an epidemiologist at the University of Minnesota in Minneapolis, was quoted in the report as saying:

“Eradicating this virus right now from the world is a lot like trying to plan the construction of a stepping-stone pathway to the Moon. It’s unrealistic.”

Michael Osterholm

Be Wary of Mutations

While the virus is still very real, cases in most states of India have gone down and our case fatality rate has remained low.

We can’t put our guard (or mask) down yet, but the situation is not as critical as it was during the initial few months of battling the COVID-19 wave for most of the world. We know more about the virus than we ever did - and our understanding only continues to expand with each passing day. Several countries are in the middle of their vaccination drives, and the antibodies acquired through natural infection and immunisation (or eventually attaining herd immunity), would help bring down the scale and transmission of the virus.

Moreover, if the virus continues to stay but vaccines or natural infection are able to prevent disease severity by building some level of immunity, there would be much less to worry about in the long run - once a majority of the people have either been infected or vaccinated.

But here, again, there is a caveat. The virus is mutating.

Mutations are a part of a virus’ life cycle and are bound to happen. But at times, they can lead to more transmissible variants which can further cause newer waves of infection - as has been seen in the United Kingdom and South Africa, among other regions.

Across the country, five states - Maharashtra, Kerala, Punjab, Chhattisgarh, and Madhya Pradesh - are seeing a rise in the number of COVID cases and fresh infections. Virologist Jacob John says, “We don’t know the cause of the rise in cases yet, but if it is a new variant we must be careful and alert.”

Besides, we don’t yet know if our vaccines, Covishield and Covaxin, are effective against any new variants yet.

So while there is hope, India is still not in the clear as the vaccine will take time to reach everyone, we may see spikes in certain states and we still have various mutations to worry about.

“The cause for concern never went away,” says Dr Swapneil Parikh, an internal medicine specialist in Mumbai and author of ‘The Coronavirus: What You Need to Know About the Global Pandemic’.

Living With COVID in 2021

Vaccine developments are coming in as a ray of sunshine, but as previously established, expecting life to resume and get back to normal will be too far-fetched. In an earlier story, FIT had spoken to experts to provide the much-needed reality check. According to them, we may have to hold our horses before making any plans for 2021 - because we would still have to be cautious and safe next year.

Dr Arvinder Singh Soin, Chairman, Liver Transplant at Medanta said,

“Common people will have to wait long for the vaccine. They will not get the vaccine before we are at least six months into 2021. Therefore, it is obvious that we will have to follow all necessary precaution.”

Dr Arvinder Singh Soin

These safety measures would include: responsibly wearing masks, maintaining physical distancing, avoiding public gatherings, and following hand and respiratory hygiene. It would also mean upgrading ventilation and air-conditioning systems in schools and enclosed spaces to prevent airborne spread.

Although this is a personal choice, we must only try and travel when absolutely necessary.

“We should restrict our travels because the state of infection in different regions is not uniform. Cases are rising in some countries but coming down in others. This is the case even within a nation - with some states or cities witnessing worse outcomes than others.”

Dr Arvinder Singh Soin

He also cautioned that till at least 60-70% of the population is not vaccinated and herd immunity is not attained, there will always be the chance of more outbreaks.

Most importantly, we must not forget that vaccines are not enough to bring the virus under control. With uncertainty about mutations, new and emerging variants, questions over immunity and unequal distribution, pinning all our hopes on immunization would not be wise. As Dr Shahid Jameel, Virologist and Director, Trivedi School of Biosciences at Ashoka University, had said in conversation with FIT, “Vaccine is not the answer to all our problems. For now, we will have to be cautious. We have to live with the virus in 2021 as well. But we can hope that in a few years, vaccines can help control it to a great extent.”

(With inputs from Nature )