Pandemic vs. Endemic creates two controversial Covid end games

After the regional head of the World Health Organization for Europe expressed hope last weekend that the continent could move towards a “pandemic end”, his WHO chiefs rushed to downplay that optimism.

Tedros CEO Adanom Gebrejesus clarified Hans Kluge’s remarks the next day, insisting it was “dangerous to assume. . . we are at the end of the coronavirus game, while WHO Europe has emphasized that “the pandemic is not over yet”.

The confusing messages cut through the heart of a debate that was raging even before Omicron’s version sparked a global influx of infections: at what point did the world start from the pandemic?

The various positions can be crystallized as “pandemic versus endemic”. On the one hand, there is the scientific community, which sees the continuing threat of variants and the uneven global scope of vaccinations as evidence that the pathogen has not been overcome.

On the other hand, there are often politicians who want the virus that hangs like a millstone around the world for two years to be treated like any other problematic disease – a threat, but one that can be managed.

Pedro Sanchez, the Prime Minister of Spain, did so this month when he said that “we are moving towards an endemic disease, not the pandemic we have had so far”. However, few health experts believe that the path to endemicity will be easy.

Some countries, including England, have moved to remove Covid restrictions in an attempt to return to normal © Justin Talis / AFP via Getty Images

Tim Colburn, a professor of global health epidemiology at University College London, said “many politicians do not know what endemicity means”, even if “there is reason to say that the worst is over”.

“That doesn’t mean the burden will go down,” he said. “The endemic usually involves a steady state of equilibrium without big peaks, so we’re not really there yet. You could argue that the politicians who say this are dealing with wishes.

Mark Van Ranst, a professor of virology at the University of Leuven, believes that endemics is a broad, ill-defined and often misunderstood term, but it is also too early to say that the world has reached such a place.

“While Omicron is still present in such numbers, causing massive diseases, albeit relatively mild, and while overloading the health sector. . . we can and should not call this an “endemic situation”. Not yet, “he said.

However, countries, including Denmark and England, have moved to remove Covid’s restrictions in a bid to return to normal, as hospital pressures remain low.

Graph showing that the Danish government removes all restrictions on Covid, as the cases differ from the more severe results in its Omicron wave

Denmark has lifted the restrictions, despite rising levels of Omicron BA-type infections. 2, which according to health authorities may be 50% more contagious than the original Omicron. The end of the measures in England this week coincided with the cessation of the sharp decline in interest rates this year.

Even Thailand, which followed a policy of zero Covid until last summer, took a test step Friday to treat the virus as endemic, as health officials have outlined guidelines on how to start treating it as the flu virus within six months to a year.

David Heyman, a professor of hygiene and tropical medicine in London, said England, where the population’s immunity to vaccines and previous infections is over 95 per cent, has effectively treated the virus as endemic since the summer.

“They have transferred the government’s risk assessment to individuals, provided rapid diagnostic tests that we can use or wear masks,” he said.

Experts also note that just because a disease is endemic does not mean it is not deadly – tuberculosis, malaria and HIV / AIDS are endemic and have killed millions. At the other end of the scale, everyday illnesses such as influenza are also classified as endemic.

Graph showing that Covid is gradually growing less deadly during the pandemic, mainly due to immunity, but remains more dangerous on average than the flu

“Endemic diseases. . . they are just a disease that has taken root in human populations and continues to be transmitted until measures are taken to stop the transmission, ”Heyman said. “Tuberculosis is endemic, HIV is endemic – all these infections that come from the animal kingdom have become endemic.”

Omicron does appear to be less virulent, but its significantly increased transmissibility compared to previous versions poses a challenge in the huge number of hospitalizations it can cause, especially among the unvaccinated.

The very fact that it is spreading so fast could also accelerate the emergence of new worrying options, the WHO and others have warned.

The WHO, which began using the term pandemic in March 2020, is considering moving from an “acute pandemic response to long-term, sustainable control of Covid-19 disease.” But because the powers of the health authority are global, any leadership must take into account the situation in the world, not just in some countries.

Denmark has lifted the restrictions, despite the growing rate of infections caused by the Omicron BA subtype. 2 © via REUTERS

Francois Balu, director of the UCL Institute of Genetics, said the root of the problem was people’s understandable desire to return to life – and as such it was no surprise that many elected officials wanted to pass on the good news their constituents crave. .

“There is a pattern of over-promise. . . we are all to blame for this because we want to believe in things, “he said, adding that” vaccines in the relatively long term would prevent transmission that we knew intellectually would not happen in a certain way. “

Nelson Lee, a professor of public health at the University of Toronto, predicts that Covid will not become a “community-based disease” but will grow once or twice a year, similar to the way holds the flu virus.

“It will be like an epidemic. It will come and go depending on the evolution of the virus against the combined immunity of the population, “he said.

As the coronavirus evolved, scientists agreed that the end would come. “It is very important to give the impression that there is light at the end of the tunnel and that the pandemics do not last forever,” Balu said.

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