Many experts have said they expect Covid-19 to become an endemic disease. But how does a disease go from being acute to endemic? What factors shape the transition to endemicity? The expectation that Covid-19 will become endemic essentially means that the pandemic will not end with the virus disappearing; instead, the optimistic view is that enough people will gain immune protection from vaccination and from natural infection such that there will be less transmission and much less Covid-19-related hospitalizations and death, even as the virus continues to circulate.
If we take a look at Spain, when the coronavirus pandemic was first declared, Spaniards were ordered to stay home for more than three months. For weeks, they were not allowed outside even for exercise. Children were banned from playgrounds, and the economy virtually stopped. But officials credited the draconian measures to prevent the health system’s full collapse. Lives were saved, they argued.
Now, almost two years later, Spain is preparing to adopt a different Covid-19 Playbook. With one of Europe’s highest vaccination rates and its most pandemic-battered economies, the government is laying the groundwork to treat the next infection surge not as an emergency but as an illness that is here to stay. Similar steps are under consideration in neighbouring Portugal and Britain. The idea is to move from crisis mode to control mode, approaching the virus in much the same way countries deal with flu or measles. That means accepting that infections will occur and providing extra care for at-risk people and patients with complications.
Spain’s centre-left prime minister, Pedro Sánchez, wants the European Union to consider similar changes now that the surge of the omicron variant has shown that the disease is becoming less lethal.
“What we are saying is that in the next few months and years, we are going to have to think, without hesitancy and according to what science tells us, how to manage the pandemic with different parameters,” he said Monday. Sánchez said the changes should not happen before the omicron surge is over, but officials need to start shaping the post-pandemic world now: “We are doing our homework, anticipating scenarios.”
The World Health Organization has said that it’s too early to consider any immediate shift. The organization does not have clearly defined criteria for declaring Covid-19 an endemic disease. Still, its experts have previously said that it will happen when the virus is more predictable, and there are no sustained outbreaks. “It’s somewhat a subjective judgment because it’s not just about the number of cases. It’s about severity, and it’s about impact,” said Dr Michael Ryan, the WHO’s emergencies chief.
The strategy has been nicknamed “flu-ization” of Covid-19 by Spanish media, although officials say that the systems for influenza will need to be adapted significantly to the coronavirus. For now, the discussion about moving to an endemic approach is limited to wealthy nations that can afford to speak about the worst of the pandemic in the past tense. Their access to vaccines and robust public health systems are the envy of the developing world. It’s also unclear how an endemic strategy would coexist with the “zero-Covid” approach adopted by China and other Asian countries, and how that would affect international travel. If Malta is considering the switch in approach, it remains to be seen.