KUCHING: Being in an endemic phase of Covid-19 means that the infection is at a level that is acceptable and manageable, according to public health expert Prof Datuk Dr Lokman Hakim Sulaiman.
The International Medical University pro vice- chancellor of research, and Institute for Research, Development and Innovation director, explained that this was a level that did not constitute a major public health problem — smaller number of infections, fewer hospitalisation, and deaths.
“But what is considered acceptable? It is a complex and dynamic situation. Several factors will influence this such as the strength and duration of people’s immunity, transmissibility of the virus itself, healthcare capacities to manage the infection and the public health interventions that are put in place.
“It is also dependent on people’s behaviour — how they conduct themselves will either spread the infection or keep it in check.”
Prof Lokman further said that there was no prescribed universal level, and there would be a variation between countries, and that each country had to analyse its own circumstances and determine its own criteria for endemicity.
“We have to each ask ourselves what is a number that we are comfortable with?”
He said to visualise what living with Covid-19 endemicity would be to think of it like dengue and malaria, which are both endemic and where cases are reported regularly every year.
He added that when Covid-19 becomes endemic, it meant that the infection would not go away and would continue to be transmitted.
“This is not to say that doom and gloom is our path going forward. Rather, transitioning from a pandemic to an endemic stage is about the community seeing a growing number of people who are immune to the virus, either through surviving natural infection or through vaccination.
“As less and less people are susceptible to the infection, the number of cases will not be as high as before.”
He stressed that effective vaccines would be an important tool as the level of immunity in the population was vital to shift from pandemic to endemic phase.
“Data from around the world has shown that the vaccines had successfully brought serious cases down and this will help drive us towards an endemic state faster. However, vaccination rates are not the only indicator of endemicity.”
On whether hitting endemic state meant that the country had reached the finishing line, Prof Lokman said no.
“Just as we can move from pandemic to endemic, we can easily make a U-turn back into an epidemic or pandemic status.
“New variants can push infections and cases back up to an unacceptable rate.”
He gave an example of how the Delta variant had caused a resurgence of cases in some countries and how other newer variants of concern such as the Lambda and Mu were being closely monitored by the World Health Organisation.
“As access to the Covid-19 vaccine is not equal globally, a large proportion of the world population is still susceptible to infection.
“An emergence of a highly infectious variant can trigger a new epidemic, which can escalate into a pandemic level in terms of global spread,” he warned.
Prof Lokman said most countries had accepted that public health interventions alone were never going to stop infections.
“In an endemic state, what we are looking at is public responsibility to help manage the disease. The public must continue to be educated on the importance of risk assessment and management so that they will take appropriate action to minimise the risk of being infected and infecting others.”
However, he said while nationwide lockdowns would be phased out, other measures would need to be pushed forward such as the strengthening of the healthcare system to adequately deal with the continuous threat of infection.
“Remember, even if we have entered an endemic phase, an epidemic can still occur.
“The way the daily case statistics that are being looked at will also need to change and need to be focused on the number of high-risk cases rather than total number of infected.
“We already see this happening where numbers are broken down in the various risk categories. This will give us a better idea of whether our health system is overwhelmed or not.”
The good news, he said, was that in an endemic state, people could expect to go back to an almost normal, or new normal, routine.
“The infection itself is still evolving, and there are still many uncertainties. Public health measures will still need to be continued.
“Masking, physical distancing, crowd control and improving ventilation must continue to be implemented in areas where transmission is still active.
“Yes, life needs to go on and an endemic state will help us do that. But until such a time when we understand this infection better, we cannot let our guard down.”
