What does 'endemic Covid-19' really mean?

The removal of mandated restrictions means that we have to make decisions based on our individual risk tolerance, e.g. some might only want to eat out at places with open-air dining. — Photos: Filepic

There is a lot of ongoing debate regarding classifying the disease caused by the SARS-CoV-2 virus as a pandemic or as endemic.

Many of us would like definitive answers, in order to “get on with things”.

Unfortunately, reality often has a way of interfering with ideality.

Minimise disruption

Epidemics end in one of two ways: we either stop all chains of transmission and drive cases to zero, or we learn to live with the disease.

The first outcome is possible if an infection is contained, and measures are continuously put in place to monitor and quickly stamp out any flare-up.

We see this in diseases such as the one caused by the Ebola virus.

In the other scenario, eliminating a disease is not feasible.

This may be due to the inherent nature of the disease itself, or other non-medical factors, such as socioeconomic deprivation or the inability to shut down borders.

An example of this would be tuberculosis.

Endemic disease does not mean harmless or unmanaged disease.

It is a shift in the manner we approach the disease, i.e. primarily in terms of minimising its disruption to our daily lives.

In the case of Covid-19, many of us are in a position to relax some of the public health restrictions due to the changing nature of the disease (i.e. the dominant viral variant changing from Delta to Omicron) and due to the high uptake of vaccines in the community.

However, each country has different thresholds to consider when it comes to determining their policies regarding Covid-19.

For example, many in the United States seem to have come to a conclusion that it is acceptable for thousands of people to die daily in return for an easing in public health measures, such as the wearing of face masks.

On the opposite end of the spectrum, China is struggling with their “zero Covid” policy as case numbers and deaths begin to creep up.

It is clear to many of us that policies, and the approach countries make when determining measures, are as much political as they are medical.

A volunteer in personal protective equipment disinfects a neighbourhood placed under lockdown in Shanghai, following China’s ‘zero Covid’ policy, which is appearing less realistic as the virus continues to mutate. — Bloomberg

Milder disease

The waves created by the Omicron variant highlighted a number of things.

First and foremost, countries with high levels of vaccination (including the uptake of booster jabs) did better in terms of health outcomes.

Although their number of cases rose, the number of those requiring hospitalisation decreased, leading to an easing of the stress faced by their healthcare system.

Although viewed by some as milder, the Omicron variant is still devastating to the unprotected, as seen in Hong Kong and parts of the US.

The relative drop in severe cases has allowed many of us to start viewing Covid-19 as something we can live with.

As we become more desensitised to the disease and more of us experience milder symptoms, there is a yearning for things to go back to normal.

Calculating risk

There are various things that we can do to minimise the risk of contracting the SARS-CoV-2 virus.

However, this very much depends on an individual’s risk tolerance.

One ongoing issue is that of wearing a face mask.

The ongoing use of appropriate masks – irrespective of official policy – makes sense, especially when exposed to high-risk areas such as indoor in-person conferences, inside a taxi, or at busy public areas such as an airport or market.

Decisions to eat out can be made on the basis of the capacity of the restaurant, the degree of crowd congestion, and the availability of good ventilation or an al fresco set-up.

The culture of periodically self-testing with a rapid antigen test kit (RTK) is also worth practising, as this can help reduce infectivity.

This is especially true if we not only do it for our own personal benefit, but also as a preventive measure to avoid potentially passing it on to elderly relatives or young children.

A rehabilitation physician examines a long Covid patient. Despite the decreasing number of Covid-19 cases and deaths, long-term consequences like long Covid are still a problem.

Risk still present

Even if we accept the presence of the SARS-CoV-2 virus as commonplace, it is worth reminding ourselves that living with the virus is not without risk.

All the above interventions are in place to reduce risk, not completely eliminate them.

People still die from Covid-19, albeit in far lower numbers.

Not all of us manage it in the same way.

Some have severe co-morbidities that preclude them from mounting an appropriate immune response; others have significant socioeconomic restrictions that prevent them from obtaining appropriate healthcare interventions in a timely fashion.

We are also seeing an increase in the number of long Covid cases.

The impact can range from mild annoyance to severe debilitation.

There is increasing evidence to suggest that some long Covid patients are more at risk of developing blood clots, as well as declining brain function.

There are also those who have difficulty breathing, fatigue and significant mental health issues.

The underlying cause for the long Covid phenomena still needs elucidation, although there is some evidence to suggest that an overactive immune system is the root cause for it.

We are still far from being certain, and significant studies and resources are required to identify potential treatment options.

As these symptoms can sometimes affect even those with mild cases of Covid-19, it only makes sense for us to continue taking preventive measures.

Personal responsibility

Accepting that a disease is endemic is also accepting the fact that we will be taking more responsibility for ourselves.

As we have seen, government legislation and policies from across the globe vary and we will need to interpret these in our own local context.

We need to be more cognisant of our own risk profiles and identify if we are potentially risking the lives of vulnerable loved ones, after which we can decide on the level of risk that we are comfortable with.

Dr Helmy Haja Mydin is a respiratory physician and chief executive officer of the Social & Economic Research Initiative, a thinktank dedicated to evidence-based policies. For further information, email [e-mail]. The information provided is for educational and communication purposes only. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.