The beginning of endemicity

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This article was exclusively written for The European Sting by Ms. Ketevan Khetsuriani, a 22-year, enthusiastic 5th-year medical student at David Tvildiani Medical University in Tbilisi, Georgia. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.


Since the World Health Organization declared COVID-19 a pandemic on March 11th, 2020, our lives have changed tremendously. SARS-CoV-2 has caused significant morbidity and mortality. Governments across the globe had to implement multiple lockdowns and social distancing measures, which certainly helped to turn the tide to some extent but had unfavorable social and economic consequences of their own. The desire to end the pandemic unites us all. Therefore, it is only natural that the question of when we will see the light at the end of the tunnel and get rid of the virus is a huge matter of public concern. In the article, we will tackle this very issue.

 The epidemiological term for completely getting rid of the virus is Eradication, defined as “permanent reduction to zero of the worldwide incidence of infection caused by a specific agent as a result of deliberate efforts.” To this date, the only human infectious disease that has been eradicated is smallpox. If we compare these two viruses, we will see that some characteristics of SARS-CoV-2 make it less amenable to eradication. For instance, it has less specific clinical features, making it challenging to distinguish from other respiratory infections without certain diagnostic laboratory tests, plus the virus has the ability of asymptomatic transmission. Immunity to the COVID-19 wanes after some time, individuals can get reinfected. Moreover, the virus is prone to mutations, and the emergence of new viral variants of concern, like highly transmissible Delta strain, is possible. By no means, these indicate that the pandemic is incessant. The aforementioned statements give us more right to think that a gradual transition to endemicity is the more realistic scenario of the pandemic endgame.

So, what is endemicity? When can we get to that phase?

Endemicity refers to a constant prevalence of the disease in a population within a geographic area. In other words, If COVID-19 becomes endemic, it will keep circulating, but susceptibility to infection, as well as the number of virus-related hospitalizations and deaths, will reduce. To achieve this stage, enough population percentage should be immune either from vaccination or natural infection. Every country will go through this transition at a different pace, so giving an exact timeframe is impossible. However, we can conclude that those with high vaccine coverage are more likely to tame the virus faster. Vaccine hesitancy and unavailability halt our progress towards the end of the pandemic and beginning of endemicity.

 To accelerate this process, global organizations responsible should keep working for vaccine equity so that everyone has equal access to sufficient vaccine doses and other potential medical tools that help us fight the virus. As for vaccine hesitancy, refusal to vaccinate is mainly fueled by anti-vaxxer propaganda and misinformation. All of us, especially medical students, can combat this notorious “infodemic” by spreading science-based information in a comprehensible way to raise public awareness about vaccines. The sooner we realize that the world shares collective responsibility, the sooner we will come out of the crisis.

References

Dowdle W. R. (1998). The principles of disease elimination and eradication. Bulletin of the World Health Organization76 Suppl 2(Suppl 2), 22–25.

Rustom Antia, M. Elizabeth Halloran, Transition to endemicity: Understanding COVID-19,Immunity,Volume 54, Issue 10,2021,Pages 2172-2176, ISSN 1074-7613, https://doi.org/10.1016/j.immuni.2021.09.019.

Chawla N, Maramraj KK, Ray S, Naidu C S, Goyal S, Gopinath A. Transition towards “end” emicity. When and how can a country possibly declare endemicity of the COVID-19 locally?. J Mar Med Soc 2021;23:113-6

Machingaidze, S., Wiysonge, C.S. Understanding COVID-19 vaccine hesitancy. Nat Med 27, 1338–1339 (2021). https://doi.org/10.1038/s41591-021-01459-7

About the author

Ketevan Khetsuriani is a 22-year, enthusiastic 5th-year medical student at David Tvildiani Medical University in Tbilisi, Georgia. She is planning to further her studies in the field of pulmonology.  The epidemiologic and public health matters of the ongoing pandemic interest her as well. Ketevani is part of the Georgian Red-Cross COVID-19 reaction group. In addition, she takes part in projects organized by UNICEF and USAID to help raise public awareness about vaccine-related matters in her country. She used to be a part of local non-governmental organizations working on human rights. She also loves taking care of homeless or sheltered animals.

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