From pandemic to epidemic to endemic

While many countries lift mask mandates and coronavirus restrictions, Hong Kong and China are reeling from an Omicrons surge. Britain, the US and some parts of Europe are seeing a new spike in cases.

In Nepal, the public is determined to believe that the worst is over. But there is a danger that China's Omicron surge will bring out a new variant. Hong Kong's Centre for Health Protection, Department of Health has urged all residents to avoid non-essential travel. The territory may soon impose a lockdown, just as China has isolated entire provinces. The surge in China and Hong Kong has been attributed to low natural immunity because of the zero-Covid strategy, the relative inefficacy of Chinese vaccines to Omicron, and the emergence of the Omicron BA.2 sub-variant.

Meanwhile cases of a new hybrid strain that is as transmissible as Omicron and as serious as Delta, dubbed the 'Deltacron', has broken out in the United States and Europe.

The WHO warned this week that the world is “only half-way” through the pandemic, and although news of Russia’s invasion of Ukraine has overshadowed Covid-19, the virus is still spreading in unpredictable ways.

Given all this, it may be prudent for Nepal not to lift all vaccine restrictions just yet. Masks and avoiding crowds must still be enforced to spread a future surge. Even though, as we have seen in the last two years, new variants can easily come in from travelers and spread in the community.

Read also: The story of Nepal’s first COVID-19 fatality, Laxmi Basnet

A number of European countries have relaxed restrictions and several states of the US have moved to eliminate mask mandates after a new guideline by the Centers for Disease Control and Prevention (CDC).

The hope is that the pandemic is giving way to an endemic. An endemic has been described by the CDC as a ‘constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area’.

"We're almost there, it is now the beginning of the end, at least in the UK," Prof Julian Hiscox at the University of Liverpool told the BBC recently. "I think life in 2022 will be almost back to before the pandemic.”

CDC director Rochelle Walensky echoed this, saying earlier this year that the pandemic is likely to become endemic in the US and around the world.

Virologist Ian Jones of the University of Reading in the UK also said recently: “There is now no doubt that Omicron is attenuated and taking as a step toward endemicity”.

Medical historians argue that most pandemics last between two and a half to three and a half years. Without a clear explanation and vaccination, the 1918 Spanish pandemic that infected one-third of the world’s population and claimed over 50 million lives fizzled out in 1919.

An analysis suggests that the Omicron variant has now changed the shape of the global pandemic and this is likely to lead to the 'endemic world'. Chris Murray of the University of Washington takes the fact that despite the surge in infections, hospitalisation and fatality rates are still low as indication that we are now entering an endemic phase.

Stephen Kissler at the Harvard T H Chan School of Public Health has been quoted as predicting: “Omicron will soon become endemic much like flu."

Read also: Survive, revive, thrive, Editorial

What is puzzling scientists is why Hong Kong’s fatality rate is so high, while Omicron has not killed people at the same rate elsewhere. The risk of reinfection from Omicron is estimated to be 5–fold higher and this poses a danger to the high risk groups, elderly and to those not yet infected.

Epidemiologists warn that the worst may yet to come of new variants emerge from the spread in China. Spreading to other parts of the world not yet infected to Omicron, this could have a devastating effect.

Nevertheless, turning back the pages of the history of pandemics, we have seen that viruses naturally mutate and slowly evolve into an endemic phase that circulates at more manageable levels. The 1918 influenza strain may never have disappeared, and continued to mutate and circulate to this day.

What we need to develop and adopt is sustainable coping strategies, including vaccinations. What are critically missing and paying least attention to is social interventions such as behavioural change, communication for mask wearing and avoiding crowds for the near future.

Medical historians also agree that the pandemic ends socially before it ends medically. And proof of that is Nepal, where mot people seem to think that they no long have to worry about the pandemic. What if the virus has decided not to enter an endemic phase just yet?

Mohita Upreti is Journalism student at St. Xavier's College, she regularly contributes to the College’s monthly newsletter - The Xavierian Chronicles.

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