India has seen two Covid-19 waves in the past and a third wave is presumed to occur. The likelihood of Covid-19 becoming an endemic – meaning the virus will continue to circulate in pockets in the coming years – is what most epidemiologists say might happen.

Eradicating Covid-19 may not be possible and we will have to live with it even with a full-fledged vaccination process going on. Learning about what a Covid-19 endemic means will help a great deal in navigating the next few years in this country. If it does turn into an endemic, then the public should be able to know how to continue to take care of themselves.

What does an endemic mean?

Diseases are divided based on the spread and rate of new cases and geographical distribution, into the following categories:

(1) Endemic: cases are confined to a particular geographical location and that the cases are constantly present in low numbers in that specific area

(2) Epidemic: when there is an unexpected increase in the number of cases in a specific geographical area

(3) Pandemic: when the cases grow exponentially and are not confined to a particular location

Usually, any infectious disease causing pandemic gets eradicated like in SARS or diminishes over time, but cases remain in the community for a certain period with low to moderate levels of transmission, like in influenza, and eventually are eradicated. But with COVID-19, eradication is far from reality, at least for now, and when it could enter an endemic state, cannot be predicted.

Failure to eradicate a virus does not necessarily mean that the case incidence, hospitalisation, and deaths will be as grave as the previous days. Endemicity will lead to low to moderate levels of transmission and this can be predictable. We have other viral infections like flu or measles, which are in the endemic stage. The reason for a virus to convert from a pandemic to an endemic is because most individuals have developed immunity, either in the form of infection or through the vaccine. Infections are caused in areas where there is a vulnerable population or low vaccine coverage areas. Even if the population is vaccinated, we can have mild infections, but not severe as in the case of an endemic. It is unlikely to have another pandemic as the immunity developed offers some protection. Though there are variants that keep emerging due to mutations, they can cause outbreaks, but not a pandemic.

There are still chances for the third wave to ensue. India for now is recording cases that are not as high as it was during the summer months. Though the cases that are being recorded in confined areas are what is making scientists think that India is already experiencing an endemic. We still need to be cautious and cannot go back to normalcy yet. We need to vaccinate as many people as possible, which will reduce the emergence of variants and also go through genome sequencing to understand if there are new variants emerging, so that the infections are contained. We should be vigilant and still follow the safety protocols, especially now that the lockdown restrictions are lifting and schools/offices are reopening. Should you have any symptoms or come in contact with a Covid-19 positive patient, make sure to confirm your diagnosis with an RTPCR test and consult a doctor online. Not all Covid-19 positive patients need to be hospitalized, some can recover from home with treatment advice from their doctors.

( Dr. Sreelekha Daruvuri, MBBS, has over 5 years of experience working in primary care. She is a physician on Mfine. She initially worked with corporate hospitals and then as a resident in JIPMER for 2 years. She believes in a holistic approach to health care. She is also a public speaker, a blog writer and holds an interest in spreading awareness on health through digital media .)

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