Is Covid-19 endemic to India?

Staying put.
Staying put.
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A third wave or not, Covid-19 may remain in India possibly forever.

The country is fast reaching—if it already hasn’t—a stage where Covid-19 will be endemic, with a few cases of the deadly flu always in circulation. “We [India] may be entering some kind of stage of endemicity where there is low-level transmission or moderate level transmission going on but we are not seeing the kinds of exponential growth and peaks that we saw a few months ago,” Soumya Swaminathan, chief scientist at the World Health Organization, told journalist Karan Thapar in an interview.

At present, the country has been logging between 30,000 and 45,000 new cases of Covid-19 every day, down from a peak of 400,000 cases in April and May. The fresh cases have now stayed put in this range, a majority of these coming from the southern state of Kerala.

In the backdrop is India’s Covid-19 vaccination programme, which, after several bumps along the road, has been able to cover a little over 50% of the country’s adult population with at least one dose. But it appears now that even with the vaccine, Covid-19 may never completely go away.

Vaccines may not eradicate Covid-19

“From what we know, it seems very unlikely and I would say it’s impossible [to eradicate Covid-19 from the community],” Gautam Menon, professor at the departments of physics and biology, Ashoka University, told Quartz India.

This is because vaccines don’t prevent you from getting infected again, even while they help to prevent symptomatic disease, especially severe disease requiring treatment. “And vaccines don’t seem to prevent you from infecting others, at least not as effectively as we might have liked,” he said.

This is a concern given the fears around a possible third wave of Covid-19 in India, which, according to the Indian Council for Medical Research, may already be on the anvil. According to the government medical body, uninfected populations in states where the second wave was not as intense could be leading the third wave. Other mathematical models suggest that this third wave could peak around October or November, which constitutes the hectic festival season in India.

These models also predict that in terms of intensity, the next wave will be only a fourth of the brutal second wave. “For the future, once we are all vaccinated, we might expect having to take booster shots of the vaccine once every year or two and the occasional flare-up in cases, but nothing like what India saw during its second wave,” said Ashoka University’s Menon.

Given these possibilities, what does it mean for public health when Covid-19 remains in the community?

What does it mean for Covid-19 to be endemic?

Diseases like HIV/AIDS and malaria are endemic to many parts of the world. In such cases, Menon explains, the recoveries are balanced by new infections. This means that there are no major outbreaks as we currently see with Covid-19, even in countries like the US, UK, and Israel with significant vaccine coverage.

If Covid-19 were to become endemic to India, health policy would need to be more nuanced and account for disease management. This would mean that “we must shift from a focus on eradication to management and mitigation,” says Menon. Since vaccines are effective at preventing severe disease and hospitalisations—even with the highly contagious delta variant—getting the Covid-19 vaccines to all those eligible should continue to remain a priority.

“The hope is that  Covid-19, for vaccinated people, will then become like a seasonal flu, where one feels miserable for a few days but suffers no lasting consequences and certainly should not have to go to hospital,” he adds.