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‘Pandemic vs endemic’ sets up two conflicting Covid playoffs

After the World Health Organization's regional head for Europe last weekend expressed hope that the continent could move to a "pandemic endgame", his WHO chief quickly went on to downplay such optimism.

Director-General Tedros Adhanom Ghebreyesus clarified Hans Kluge's remarks the following day, insisting that it was "dangerous to assume ... we are in the playoffs" of coronavirus, while WHO Europe stressed that "the pandemic is not over yet".

The confused messages cut into the heart of a debate that bubbled even before the Omicron variant triggered a global rise in infection: at what point does the world move on from the pandemic?

The different positions can be crystallized as "pandemic versus endemic". On the one hand, the scientific community considers the continuing threat from variants and patchy global vaccination coverage as evidence that the pathogen has not been overcome.

On the other hand, those, often politicians, are keen that viruses that have hung like a millstone around the neck of the world for two years should be treated like any other problematic disease - a threat but one that can be dealt with.

Pedro Sánchez, Spain's prime minister, did so this month, saying "we are heading for an endemic disease rather than the pandemic it has been so far". Still, few health experts believe the road to endemism will be simple.

Some countries, including the UK, have moved to lift Covid restrictions in an attempt to return to normal © Justin Tallis / AFP via Getty Images

Tim Colbourn, professor of global health epidemiology at University College London, said "many politicians do not know what endemic means", although "there is reason to say the worst is over".

"That does not mean the level of difficulty will be lower," he said. "Endemic usually involves a stable state of equilibrium without large peaks, so we are not really there yet. One could argue that politicians who say that engage in wishful thinking."

Marc Van Ranst, a virology professor at the University of Leuven, accepted that endemic was a broad, poorly defined and often misunderstood term, but it was also too early to say that the world had reached such a place.

"As long as Omicron is still present in such numbers, it's causing massive illness, no matter how relatively mild, and as long as it's overburdening the healthcare sector ... we can and should not call this an 'endemic situation'. Not yet ," he said.

Despite this, countries including Denmark and the UK have moved to lift Covid restrictions in an attempt to return to normal as hospital pressure remained low.

Diagram showing that the Danish government lifts all Covid restrictions, as cases deviate from more serious outcomes in its Omicron wave

Denmark dropped restrictions despite rising infection rates, driven by the Omicron subtype BA. 2, which the health authorities estimate could be 50 percent more contagious than the original Omicron. The end of the measures in England this week coincided with a halt to the sharp fall in case rates this year.

Even Thailand, which pursued a zero-Covid policy until last summer, took a preliminary step on Friday toward treating the virus as endemic, as health officials outlined guidelines on how to begin treating it as the flu virus within six months to a year.

David Heymann, a professor at the London School of Hygiene and Tropical Medicine, said that England, where the population's immunity to vaccines and previous infections was over 95 per cent, had effectively treated the virus as endemic since the summer.

"They have transferred the risk assessment from the government to individuals, they have provided rapid diagnostic tests that we can use or we can wear masks," he said.

Experts also point out that just because a disease is endemic does not mean it is not fatal - tuberculosis, malaria and HIV / AIDS are all endemic and have killed millions. At the other end of the scale, everyday diseases such as influenza are also classified as endemic.

Diagram showing that Covid has gradually become less lethal during the pandemic, mainly due to immunity, but it remains more dangerous than the flu on average

"Endemic diseases... Are just a disease that has taken up residence in human populations and continues to transmit until measures are taken to prevent it from being transmitted," Heymann said. "Tuberculosis is endemic, HIV is endemic - all these infections, which have come from the animal kingdom, have become endemic. "

Omicron seems less virulent, but its greatly increased transmissibility compared to previous variants poses a challenge in the large number of hospitalizations it can cause, especially among the unvaccinated.

The mere fact that it spread so fast could also accelerate the emergence of new cumbersome varieties, the WHO and others have warned.

The WHO, which began using the term pandemic in March 2020, is considering how to move from an "acute pandemic response to long-term, sustained Covid-19 disease control". However, as the responsibility of the health body is global, any guidance will have to take into account the situation around the world, rather than in some countries.

Denmark dropped restrictions despite rising infection rates driven by the Omicron subtype BA. 2 © via REUTERS

François Balloux, director of the UCL Genetics Institute, said the root of the problem was an understandable desire from people to get back to life - and as such, it was no surprise that many elected officials were eager to deliver the good news that their constituents demanded.

"There's been a pattern of overlifting. happen in a certain way ".

Nelson Lee, a public health professor at the University of Toronto, predicted that Covid would not become "a disease that constantly occurs in a community" and would instead increase once or twice a year, just as the flu virus behaved.

"It will be like an epidemic. It will come and go depending on the development of the virus versus the combined immunity of the population," he said.

Regardless of how the coronavirus plays out, the researchers agreed that the playoffs would come eventually. "It's pretty important to give an idea that there is light at the end of the tunnel and that pandemics do not last forever," Balloux said.

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