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Endemic COVID-19

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As of January 2023, the global COVID-19 pandemic is still ongoing. COVID-19 has become endemic.[1][2] Endemicity is characterized by people continuing to be infected and becoming ill, but in relatively stable numbers. The observed behavior of the SARS-CoV-2 virus suggests it is unlikely it will die out, and the lack of a COVID-19 vaccine that provides long-lasting immunity against infection means it cannot be eradicated.[3]

From 2021 onwards, politicians and health officials in some countries have said that COVID-19 is endemic or that their country was beginning to transition to an endemic phase. These include Cambodia,[4] Finland,[5] Indonesia,[6] Malaysia,[7] Mexico,[8] the Philippines,[9] Singapore[10] and Vietnam.[11]

Background

There is no single agreed definition of what it means precisely for COVID-19 to become endemic.[12]

During the course of the COVID-19 pandemic, it became apparent that the SARS-CoV-2 virus was unlikely to die out, but was more likely to become endemic. Endemicity is characterized by the continued existence of the virus, but with lower levels of infection that in the preceding epidemic. People continue to become infected because of changes and movement within populations, and endemic disease may have seasonal infection patterns, but the largest determinant of how endemicity manifests itself is the levels of immunity people have, both as a result of vaccination and infection. In the absence of a vaccine that provides long-lasting immunity against infection from COVID-19, it will be impossible to eradicate the disease.[3]

The severity of a disease in an endemic phase is dependent on how long-lasting immunity against severe outcomes is. If such immunity is lifelong, or lasts longer than immunity against infection, then reinfections will be mild, resulting in a mild endemic phase. In existing human coronaviruses, protection against infection is transient, but observed reinfections are mild.[3]

Coronaviruses display remarkable evolutionary diversification due to mutation and homologous recombination.[13] Like numerous other RNA viruses, coronaviruses frequently recombine during viral genome replication causing production of new genetic variants that perpetuate endemic disease[13].

Global view

On 14 April 2022, the World Health Organization (WHO) said that COVID-19 is far from becoming an endemic disease and could still trigger large outbreaks around the globe.[1] In December 2022, WHO chief Tedros Ghebreyesus said that the death toll was still too high, but that "we have come a long way. We are hopeful that at some point next year, we will be able to say that Covid-19 is no longer a global health emergency." He added, "It's here to stay and all countries will need to learn to manage it alongside other respiratory illnesses."[14]

In June 2022, an article in Human Genomics said that the pandemic was "still raging" but "now is the time to explore the transition from the pandemic to the endemic phase. The latter will require worldwide vigilance and cooperation, especially in emerging countries", and suggested that developed countries should assist in boosting COVID-19 vaccination rates worldwide.[2]

Brazil

Main article: COVID-19 pandemic in Brazil

In early March 2022, then Brazilian President Jair Bolsonaro said that the country was looking to downgrade COVID-19 to the status of an endemic.[15]

Cambodia

Main article: COVID-19 pandemic in Cambodia

On 24 January 2022, Hok Kim Cheng, a spokesman for the Cambodian Health Ministry said that Cambodia was entering the endemic stage of the coronavirus. He cited milder outcomes for Omicron variant infections, and high vaccination rates. The World Health Organization representative in Cambodia, Dr Li Ailan, disagreed, responding: "We are still at the pandemic phase globally including Cambodia".[4]

Finland

Main article: COVID-19 pandemic in Finland

In June 2022, all restrictions had been lifted in the country.[16] In July 2022, the Finnish Institute for Health and Welfare issued a statement[17] arguing that Finland was transitioning into the endemic phase of COVID-19.[18][19][20][21][22]

Hong Kong

Main article: COVID-19 pandemic in Hong Kong

On 19 January 2023, Chief Executive John Lee Ka-chiu announced the forthcoming termination of Hong Kong's mandatory isolation rule starting 30 January as part of a decision to downgrade COVID-19 status to an endemic disease. He stated that the decision was made partly due to high vaccination and infection rates, and mild symptoms in infected persons. Edwin Tsui, the controller of the Centre for Health Protection said that asymptomatic individuals that are infected can go out freely or return to the workplace, but advised continued quarantining for students and symptomatic individuals. He stated "we will monitor COVID-19 similar to...influenza" and that "[COVID-19] is an endemic respiratory disease".[23][24]

India

Main article: COVID-19 pandemic in India

On 31 March 2022, following a communique from the Union Home Ministry stating to end all COVID-19 restrictions; several Indian states began lifting curbs.[25] By September 2022, experts[who?] believed the virus had become endemic in the country.[26][27]

Indonesia

Main article: COVID-19 pandemic in Indonesia

On 18 May 2022, the Governor of Bali, I Wayan Koster, requested that Bali receive an endemic status to COVID-19 in order to "accelerate the recovery of Bali's tourism and economy".[28]

On 20 September 2022, the Executive Board of the Indonesian Medical Association's (IDI's) COVID-19 task force head Erlina Burhan stated that Indonesia is on the right track in its endeavors to enter the COVID-19 endemic stage.[6]

On 30 December 2022, Indonesian President Joko Widodo announced the removal of all coronavirus related restrictions in the nation, and the COVID-19 Handling Committee chair Airlangga Hartarto said that the government will shift its response to an endemic approach.[29]

Italy

Main article: COVID-19 pandemic in Italy

On 15 November 2022, the Italian Minister of Health Orazio Schillaci appeared on a broadcast of Porta a Porta where he discussed the reduction of quarantine guidelines[30] and said Italy is in an "endemic phase of COVID, we must take the same precautions we had before for the flu".[31]

Macau

Main article: COVID-19 pandemic in Macau

At a press conference on 5 January 2023, the Macau Health Bureau director Alvis Lo Iek Long stated that COVID-19 has become an endemic disease in Macau, and announced the cancellation of almost all entry curbs and measures. The statement follows a transition period that began on 8 December with the gradual easing of transmission curbs.[32][33]

Malaysia

Main article: COVID-19 pandemic in Malaysia

In September 2021, Malaysian Minister of Health Khairy Jamaluddin announced that the government would transition to treating COVID-19 as if it was in an "endemic phase" by the end of October 2021, after vaccinating 80% of the population.[34][35] Movement controls in the country were lifted in October 2021.[36] In March 2022, Khairy said that Malaysians could start "to live with COVID-19" while maintaining some public health measures.[7]

Mexico

Main article: COVID-19 pandemic in Mexico

On 26 April 2022, President Andrés Manuel López Obrador said that COVID-19 was "retreating almost completely" and had moved on to an endemic stage.[37] Hugo Lopez Gatell, Mexico's deputy health secretary and coronavirus czar, later clarified, "The endemic stage is not the end of the epidemic. There's been a lot of confusion. Some articles and commentators have said we'd declared the epidemic was over. We never said the epidemic had ended."[38]

Philippines

Main article: COVID-19 pandemic in the Philippines

In February 2022, the Philippines Department of Health began shifting toward the endemic phase of COVID-19, despite caution from the WHO that it may be too early to declare. During a media briefing, Health Undersecretary Maria Rosario Vergeire said that the "transition to an endemic state for COVID-19 does not mean that the government would stop its interventions or even remove minimum health protocols such as masking, physical distancing, and hand sanitation." WHO Acting Philippine Representative Rajendra Yadav said that while the continued drop in the number of new cases is "encouraging," the country should be careful in moving from the "acute phase" of the pandemic.[9]

Singapore

Main article: COVID-19 pandemic in Singapore

In June 2021, Gan Kim Yong, Ong Ye Kung and Lawrence Wong—chairs of Singapore's COVID-19 task force—stated that "COVID-19 may never go away", but that due to high vaccination rates, a roadmap was being developed for how the city state could eventually live "normally with [COVID-19] in our midst", and manage it as an endemic disease, which would include:[10][39]

  • Using rapid COVID-19 tests for screening, as opposed to slower PCR tests, contact tracing, and quarantine.
  • Deemphasis on COVID-19 case numbers in favour of "outcomes"
  • Emphasis on COVID-19 patients being able to recover at home[40]
  • Easing restrictions on gatherings and avoiding lockdowns
  • Easing travel restrictions for those who are fully-vaccinated

They stated that "Science and human ingenuity will eventually prevail over COVID-19. Cohesion and social consciousness will get us there faster. We must all do our part."[10][39] Shortly after the plans were revealed, however, outbreaks tied to the Delta variant began to emerge, leading the Singapore government to reintroduce restrictions on gatherings. In October 2021, Prime Minister Lee Hsien Loong admitted that it would take at least six months to reach a "new normal", but that Singapore's high vaccination rates and low mortality meant that COVID-19 "has become a treatable, mild disease for most of us", the impact of COVID-19 variants had made a COVID-Zero strategy less feasible, and that maintaining restrictions would impact the economy and mental health of the country.[41][42]

Spain

Main article: COVID-19 pandemic in Spain

On 17 January 2022, Prime Minister Pedro Sánchez said the Spanish government was exploring how and when the management of the COVID-19 pandemic would shift to the management of the coronavirus as an endemic illness, saying that "the virus is no longer so deadly".[43] The following day, Ghebreyesus of the WHO stated that the pandemic was "nowhere near over", warning that new variants were still "likely to emerge".[44]

United Kingdom

On 4 March 2022, the Welsh government announced the forthcoming removal of all remaining COVID-19 restrictions on 28 March. The decision was made as part of a long-term plan to transition from pandemic to endemic.[45][46]

United States

Main article: COVID-19 pandemic in the United States

On April 26, 2022, Chief Medical Advisor to the President and director of the National Institute of Allergy and Infectious Diseases (NIAID) Anthony Fauci argued that the United States was "out of the pandemic phase".[47] The following day, Fauci stated that the country was in a "transitional phase" into "hopefully a more controlled phase and endemicity", but that "the world is still in a pandemic", and the United States could still see new waves of infection. Fauci's comments followed a report from the CDC indicating that the United States had a much higher level of collective immunity due to the Omicron variant.[48]

During a 60 Minutes interview aired September 18, 2022, President Joe Biden stated that the pandemic was "over", but that "we are still doing a lot of work on it".[49][50] This declaration was met with some debate in the medical community as the United States still has roughly 400 deaths from the disease per day, and when extrapolated to 150,000 per year it is three times the fatality rate of a bad flu season.[51] Epidemiologist Jennifer Nuzzo of Brown University's Center for Pandemic Preparedness and Response called Biden's remark "an unfortunate sound bite".[52]

Vietnam

Main article: COVID-19 pandemic in Vietnam

In March 2022, Prime Minister Phạm Minh Chính said COVID-19 was "endemic" and considered ending daily reporting of new cases.[53]

Analysis

A 2021 article in The Lancet called restrictions being lifted in the United Kingdom "dangerous and immature" and expressed concern that mass infection could lead to vaccine resistance and would impact young people, children and health services.[54] In The BMJ in February 2022, several health policy and public health experts criticised the British government's "living with COVID" plan, suggesting the end of free COVID-19 testing could exacerbate health inequality, and suggesting the plan did not account for required resources for localised contact tracing and hospital capacity.[55]

Elizabeth Stokoe and colleagues wrote in March 2022 that the phrase "living with COVID-19" is a cliché that has two opposed, disputed meanings. On the one hand it can mean simply returning to pre-pandemic living; on the other it can mean that life now must incorporate public health mitigation measures to reduce the impact of the disease as it circulates at high rates. In the United Kingdom, the phrase had enjoyed wide currency among politicians and the popular media, particular in the later, post-2021, phases of the pandemic.[56]

See also

References

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