The COVID-19 expert panel of the Government of India had predicted a few days earlier that the much feared Third Wave of the pandemic could start in the month of September or even in August 2021 and is likely to peak in October. The panel sounded a sinister warning that daily cases could reach 4 to 5 hundred thousand (lakh) or more, and accordingly they recommended further strengthening of the health infrastructure of the country in terms of ICU beds, beds with ventilators and oxygen. There has also been a fear that it could infect a large number of children and some states of India are already on the job of creating more pediatric facilities in hospitals. The panel, however, said there is still lack of data to confirm such a fear. In the meantime the Drug Controller General of India (DCGI) had already approved India-made Zydus Cadila’s Zycov-D vaccine for emergency use for children above the age of 12 and the vaccination process is likely to start from the month of September 2021. This is a big boost for reopening high schools, but no breakthrough has been made so far to vaccinate children below 12 due to which the reopening of primary school hangs in uncertainty that has been affecting children of the rural areas severely, creating a digital divide in the country.
Although the warnings of the panel come as a timely step to encourage people to go for vaccination and go on following the COVID protocols strictly and also to further strengthen the health sector, it could also be seen as an over-cautious approach in light of what happened in the disastrous second wave. This assertion is due to the fact that it is still not certain if the second wave had indeed concluded; there are still fluctuations in daily cases in at least six states including primarily Kerala and Maharashtra while in in the rest of the country the spread has more or less been controlled. Further, the fluctuations of the country’s daily cases have largely been due to Kerala and Maharashtra, and even though the new variant Delta Plus has infected around 60 people in Maharashtra it being a variant of concern and its likely spread is not yet confirmed even after extensive genome investigations. These are indeed hopeful trends and it would be the best thing to happen to the pandemic-ravaged country if the third wave is effectively prevented.
In this perspective comes the statement made to the Indian media by the Chief Scientist of the World Health Organization (WHO), Dr. Soumya Swaminathan that the COVID-19 pandemic in India may have reduced to an endemic as the fluctuations in daily cases have been confined to only limited areas and there has been no exponential rise in infections in the last 2-3 months. She, however, cautioned that large chunks of the Indian population are still susceptible to infections as the fully vaccinated people of the country is hardly 10%, and therefore the rate of vaccination must be speeded up immediately. In support of her theory the fluctuations in daily cases have been found to be limited to a few geographical areas only as we already mentioned, and she further said that such fluctuations are likely to continue. Here, we must mention the immunity data that we presented in an earlier piece where the immensity of the second wave was established in terms of huge number of deaths and infections all across the country, not officially endorsed.
Dr. Swaminathan’s endemicity probability theory is a kind of mixed news for us all. The good news part of it is that the third wave may not possibly invade the country as feared, and the disappointing part is that the SARS-Cov-2 virus is never going to leave us alone. This brings us to the meaning and implications of an endemic. The endemic is a disease that stays always in particular parts of a country, but it is mostly predictable as far as the number of affected people and the specified areas concerned. The WHO defines endemicity as “the constant and usual prevalence of a disease or infectious agent in a population within a geographic area”. There are more than a dozen endemic diseases in India including most prominently Malaria, virus-driven Hepatitis, chikungunya, chicken pox and rabies, dengue, kala-azar, scabies leprosy, encephalitis, viral fever, cholera and others some of which can take the form of an epidemic at times. Even Diarrhoea sometimes becomes an epidemic from an endemic.
There are differences between endemic, epidemic and pandemics: the US Center for Disease Control and Prevention (CDC) clarifies it as, “a disease is endemic when its presence or usual prevalence in the population is constant. When the cases begin to rise, it is classified as an epidemic. If this epidemic has been recorded in several countries and areas, it is called a pandemic”. In case, the COVID-19 pandemic has indeed become an endemic in India the strategies to control its possible spread within or outside the specified areas and prevent serious disease and deaths must be readied in advance. As we mentioned earlier an endemic can again become an epidemic and God forbid, considering the highly infectious nature of the Delta variant it can quickly convert itself into the form of a pandemic.
Whatever unfolds in the near future, we must get ourselves vaccinated as fast as possible the responsibility for which continues to rest with the Government of India, and it is almost conclusively proved that the vaccines can prevent hospitalization and mortality, if not infections or rarely re-infections; there has also been deliberations about giving vaccine booster shots to people who had taken the vaccine more than six months back across the globe; and that we must continue with wearing masks, stick to hand hygiene and maintain social distancing as far as possible without despairing for how long. We must accept that the virus is never going to leave us alone as per scientific data, and we can do nothing but positively hope for the best in the coming months or years.