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26/10/2021
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Pandemic to endemic: what should the public expect?

With the high vaccination rates achieved among the adult population, in addition to the improved COVID-19 situation in the country, most of the states have been declared as phases 3 and 4 of the National Recovery Plan, with the reopening of almost all economic sectors.

This is in transition from a pandemic to an endemic state of COVID-19.

What is meant by the word “endemic”? Does this imply that we will have to coexist with COVID-19 in the future? Will COVID-19 be successfully eradicated?

Before we unravel some of these questions, let us briefly review the meanings of epidemic, pandemic and endemic.

An epidemic is when the number of disease cases in a specific geographic area increases unexpectedly1. A good example is the 2014-16 Ebola outbreak in West Africa.

A pandemic is an epidemic that has spread over several countries or continents, usually affecting a large number of people1, like the current COVID-19 pandemic.

Lastly, an endemic refers to the constant presence of a disease or infectious agent in a population within a geographic area1. A good example is dengue fever in Malaysia. Since the dengue outbreak in the 1980’s, the disease has remained endemic in this country with no signs of complete eradication anytime soon.

Lately, there has been widespread belief among experts globally that the SARS-CoV2 virus will become endemic in their respective countries.

In order for a country to enter an endemic phase, a baseline number of COVID-19 cases should be achieved within the country, accompanied by occasionally unpredictable outbreaks2.

Once Malaysia has successfully established this baseline, only then will the country shift from a pandemic into an endemic phase3.

Will COVID-19 ever be eradicated?

During the early phase of the National COVID-19 Immunization Program (PICK), herd immunity was a widely discussed goal.

Herd immunity is achieved when enough people within the community are immune against a disease, thereby conferring protection to individuals who are not protected against the disease4. This curbs the transmission of infection within the community.

Polio is an example in which the virus was eradicated by achieving herd immunity by means of mass vaccination5.

In recent months, our government has shifted from the idea of herd immunity and is set on preparing the country for an endemic phase.

Although there is growing evidence that COVID-19 vaccination reduces the risk of getting a severe infection, prevent hospitalization and death, it appears that the vaccine does not completely eliminate the risk of getting infected. This can be seen from reports of breakthrough infections after vaccination6.

However, it does not mean we have failed as this largely depends on the type of immunity people acquire through infection, how the virus evolved and the effectiveness of vaccines7.

We are unsure if COVID-19 can be completely eradicated in the future. Nevertheless, this continues to be the main objective in the fight against the virus.

Several adjustments are expected to take place once Malaysia enters the endemic phase of COVID-19.

Minister of Health Khairy Jamaluddin revealed that the government would be announcing simplified standard operating procedures (SOPs) to prepare the country for the endemic phase8.

Despite some changes that are to be expected, mandatory mask wearing would still be continued due to the emergence of more contagious variants. Regular testing may be required among the public for specific events with mass gathering.

Undoubtedly, it is highly likely that the SOPs will be here to stay for an indefinite period of time.

As for the healthcare system, entering an endemic phase may mean fewer admissions to hospital wards, especially the intensive care units, resulting in a healthcare system that can cope better.

Additionally, once a baseline number of COVID-19 cases is achieved, the government may no longer report the number of daily cases. Instead, more focus will be put towards monitoring the number of severe cases (i.e. categories 4 and 5), ICU admissions and deaths.

Vaccination will continue to be a priority.

To date, researches have shown that the benefits of COVID-19 vaccines overwhelmingly outweigh the risks and adverse effects.

With the introduction of vaccines, chances for Malaysia to win the fight against COVID-19 have substantially improved.

If the country does eventually enter a COVID-19 endemic with no signs of the virus disappearing, the rakyat should not lose faith in this uphill battle.

We urge Malaysians to continue observing the SOPs, maintain confidence in our healthcare system and frontliners, and regularly keep ourselves informed with factual evidences provided by experts and reliable sources.

Only with firm solidarity and resolve can we prevail.

References:

1 Principles of Epidemiology in Public Health Practice 2012 [updated October 12; cited 2021 October 20]. Third Edition.

2 Torjesen I. COVID-19 will become endemic but with decreased potency over time, scientists believe. BMJ. 2021;372:n494.

3 Herrero L, Madzokere E. COVID-19 will likely shift from pandemic to endemic – but what does that mean? 2021 [updated September 23, 2021; cited 2021 October 20].

4 Vaccines & Immunization Glossary: Centers for Disease Control and Prevention; [cited 2021 October 20].

5 Bowler J. Can The World Ever Eradicate COVID-19? Scientists Crunched The Numbers: Science Alert; 2021 [cited 2021 October 20].

6 The Possibility of COVID-19 after Vaccination: Centers for Disease Control and Prevention; 2021 [updated 2021 September 7; cited 2021 October 20].

7 Phillips N. The coronavirus is here to stay – here’s what that means: Nature; 2021 [cited 2021 October 19].

8 Zolkepli F. Hisham: 181 COVID-19 SOPs condensed into one SOP with nine guidelines, awaiting approval: The Star; 2021 [cited 2021 October 20].

(Written by Fourth year Medical Students of Group 4B, Community Posting Project, Faculty of Medicine, Universiti Malaya (Chuah Ming Li, Khaw Kar Wei, May Esther Wong Sze En, Muhammad Fikri bin Mohd Fadhli, Muna Syazriny Binti Izhar, Ngan Chun Hong, Nur Rafiqah binti Mohd Rosdi, Pane Malar A/P P. Sivaganam) under the supervision of Professor Dr. Moy Foong Ming, Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya.)

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