MALAYSIA is expected to enter the endemic stage of Covid-19 at the end of October, Health Minister Khairy Jamaluddin has said.

The endemic stage of a disease is when a country achieves high vaccination coverage of its population. It is when most people have immunity against the disease, whether because of vaccination or after recovering from an infection.

The government expects 80% of the adult population in the country to be fully vaccinated by next month. As of yesterday, almost 75% of the adult population have been fully vaccinated.

Besides achieving wider immunity against Covid-19, the disease is also considered endemic because scientific consensus widely holds that the virus that causes Covid-19 is here to stay.

This means the disease will be regularly found among particular sets of people or in a certain area. Clusters will continue to emerge but the virus’ impact will be manageable, with less people experiencing severe infection.

To understand this, think of dengue, a mosquito-borne disease Malaysians are familiar with and continue to fall ill with.

Prior to the 1970s, there were only nine countries which had severe epidemics of dengue. Since then, it has become endemic – occurring regularly – in about 100 countries including Malaysia.

In May last year, the World Health Organisation had already said that Covid-19 may never go away and would become endemic.

According to Yonatan Grad, associate professor of immunology and infectious diseases at the Harvard T.H. Chan School of Public Health, Covid-19 will not end. 

He said the SARS-CoV-2 virus that causes the Covid-19 disease will continue to circulate but there will be less transmission and much less Covid-19-related hospitalisations and fatalities as enough people will have gained immune protection from vaccination and from previous infection.

“The pandemics generally began with infection fatality rates higher than observed in the years following their introduction as the viruses continued to circulate.

“While declining fatality rates after pandemics may be due to a number of factors, one likely key contributor is that the first round of exposure to a pathogen confers some degree of protection against reinfection and severity of disease if reinfection does occur,” Grad was quoted as saying in a Q&A on the school’s website.

“Vaccines confer protection in much the same way, as the data from the Covid-19 vaccines has demonstrated,” he added.

Grad also cited examples such as the swine flu as respiratory viruses which evolved to become endemic, with a peak season.

He said it is difficult to anticipate when Covid-19 will shift to endemicity as viruses tend to spread where there are enough susceptible individuals and enough contact among them to sustain spread.

“It’s dependent on factors like the strength and duration of immune protection from vaccination and natural infection, our patterns of contact with one another that allow spread, and the transmissibility of the virus.

“So the patterns will likely differ considerably from what we saw with the other pandemics because of the heterogeneous responses to Covid-19 across the world—with some places engaging in ‘zero-Covid’ policies, others with limited responses, and widely variable vaccine availability and uptake,” he added.

According to a survey by science journal Nature, 89% of 119 immunologists, infectious researchers and virologists from 23 countries surveyed believe that Covid-19 is very likely to stay and circulate in pockets of the global population.

Another 29% said endemicity is “likely” while just 6% thought that there was a lack of evidence to suggest this.

About 35% thought it is unlikely for the virus to be eliminated while 17% thought it was very unlikely.

The journal also noted that more than 70% of survey respondents said that “immune escape” – when the virus evades the body’s immune response to continue surviving and being transmitted – will be a reason the SARS-CoV-2 virus will remain in the population.

Other driving factors for endemicity are waning immunity (59%), uneven vaccine distribution (45%), vaccine hesitancy (37%), lack of political will (29%), animal reservoirs (14%) and others (5%).

Touching on animal reservoirs, the journal said if it indeed originated from bats as per earlier reports out of Wuhan, it might have passed on to people through an intermediate host.

As such, it is possible the virus is also circulating in the animal population.

At this stage of the global pandemic, information on managing Covid-19 endemicity is still scarce, as some countries are slowly beginning to feel their way around what this means by easing restrictions to varying degrees.

Neighbouring Singapore has embraced endemicity and last month announced a four-stage “Covid-endemic roadmap” for life to return to normal as much as possible while keeping the coronavirus at bay.

It involved a “preparatory stage” before transitioning to Stage A, where the group limit for social gatherings was increased to five, dine-ins were allowed for up to five fully-vaccinated people, and event sizes and capacity limits for large events were increased.

However, the transition did not happen as daily cases climbed.

For Malaysia, Khairy has said that its endemic stage of Covid-19 will see more sectors re-opening along with improvements to the standard operating procedures. 

Some things, however, are here to stay along with the virus, such as mask-wearing, he also said. – September 15, 2021.