As mentioned in the article Sustaining Endemicity in Pre-endemic Time, it is a misnomer to think that we are already in the endemic stage.

Those who think so is focusing on the definition of endemic as co-existence with the virus, per se, when the correct definition is co-existence with the virus without a staggering loss of lives so normalcy will be the order of the day.

When the article was written on October 31 last year, daily Covid-19 deaths stood at 37. On February 22 this year, 43 deaths were recorded and the next day saw 55 deaths. The last time the country recorded zero daily deaths was on December 4, 2020.

More than three months after the publication, daily deaths are still increasing. We have come a long way, after going through much trial and error in combatting the health crisis.

Malaysia is not the only country that has been experimenting with various methods, as Covid-19 is a new animal that has caused many governments to face difficult trade-offs given subsequent the economic, health and social challenges, and operate in a context of radical uncertainty.

There are already two approaches in combatting the pandemic:

- The zero-Covid route, which emphasises border closures, lockdowns and strict curbs. This route has been successfully implemented by countries like China and New Zealand.

- The endemicity route based on the notion that the virus is here to stay for the long haul. This route has been accepted by Malaysia, Singapore and many European countries.

To achieve zero transmission is almost impossible, and we have to learn and live with the virus. But the endemicity approach is yet to see any success so far as it is still a process i.e. work in progress.

According to Harvard infectious disease expert Yonathan Grad, “this distinction between pandemic and endemic has been put forward as the checkered flag”, a clear line where Covid-related anxieties are put to rest, restrictions disappear overnight and we are “done” with this crisis.

That is not the case; and there are zero guarantees on how or when we will reach endemicity or whether we will reach it at all.

Many are clueless on what endemicity is all about and hence, fail to distinguish between the process and end result.

The endemicity approach is hinged on one basic premise – a truly endemic state is reached when the virus is circulating among us without posing a threat and large number of hospitalisation.

But what does it mean when proponents of endemicity say “when the virus is circulating among us without being the threat that it is now”? Obviously, it means the high daily transmission rate that is now in the five digits in Malaysia.

The problem is proponents of endemicity have not specified a daily transmission digit that constitutes a non-threatening situation. As an endemic situation is one where it is impossible to attain a zero transmission, does a one-digit, two-digit, three-digit or four-digit daily infection constitutes a non-threatening situation?

This failure to specify has led to many saying that the number of daily coronavirus cases is not important, as serious cases constitute less than 1%.

What if a country records six-digit daily infections as seen in many Europeans countries as early as last month? Assuming daily cases stand at 100,000, of which 0.5% are serious cases, that would mean 500 serious cases in need of intensive care unit (ICU) beds, oxygen aid and ventilator support.

As a typical hospital would have 1,000 beds, of which up to 500 are in ICU, 500 serious cases are manageable if six-digit daily infections are only a one-off event.

But based on experience, once a country records five- or six-digit cases a day, the number will keep on rising or falling for at least a week, and those hospitalised with severe Covid-19 will not be discharged within four days.

This will put tremendous pressure on the healthcare system, resulting in poor patient care and have a knock-on effect in terms of simultaneously raising the death and transmission rates – even among the frontliners.

An important cornerstone of the endemicity approach is that a country cannot reach endemicity without waves of transmission as without infections, there can be no natural immunity.

A high natural immunity (or herd immunity) in the community can occur only when people are infected, according to proponents of endemicity.

The more infections (and people recovering from the infection), the greater the herd immunity. This is why you cannot reach endemicity without waves of transmission.

The natural immunity in the community increases with every wave, making the population more resilient.

The main weakness in this argument lies in assuming infected people will recover. Some do not and become a statistic in the daily death chart, while others may regress from Category 1 to 2 or 2 to 3 and so on.

The fact that in most countries daily recoveries are always less than daily infections during waves of transmission shows that this argument should be treated with a pinch of salt.

Moreover, it will lead only to an act of stupidity in wanting to get infected so one’s natural immunity will increase.

However, there is a merit in the argument that endemicity does not mean an attempt to stop the transmission, as it aims at only slowing it down to ensure the healthcare system is not overwhelmed and every sick person is be cared for.

This is also the reason why some restrictions are still in place, which means it is a process towards endemicity because when endemicity is reached, there should not be any restriction.

People should get it in their heads that endemicity is a long process. There is still a need to observe restrictions and standard operating procedures, and be circumspect when one needs to go outdoors.

This does not mean you cannot go out. It is a personal decision with responsibility i.e. you decide whether it is necessary to go out. If it is, by all means go! Just take the necessary precautions, otherwise stay at home. – February 26, 2022.

* Jamari Mohtar is the editor of Let’s Talk!, an e-newsletter on current affairs.

* This is the opinion of the writer or publication and does not necessarily represent the views of The Malaysian Insight. Article may be edited for brevity and clarity.