Moving towards endemic phase

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

This is a 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 co-exist with Covid-19 in the future? Will Covid-19 be successfully eradicated?

Before we answer these questions, let us briefly review the meaning of “epidemic”, “pandemic” and “endemic”. An “epidemic” is when the number of disease cases in a specific geographical area increases unexpectedly. A good example is the 2014-2016 Ebola outbreak in West Africa.

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

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

Lately, there has been a widespread belief among experts globally that the SARS-CoV2 virus will become endemic in their respective countries. In order for a country to be in an endemic phase, a baseline number of Covid-19 cases should be achieved within the country, accompanied by occasionally unpredictable outbreaks.

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

Will Covid-19 be eradicated? During the early phase of the National Covid-19 Immunisation Programme, herd immunity was a widely discussed goal.

Herd immunity is achieved when sufficient people within the community are immune against a disease, thereby conferring protection to individuals who are not protected against the disease. This curbs the transmission of infection within the community. Polio is an example in which the virus was eradicated by achieving herd immunity through the means of mass vaccination.

In recent months, our government has shifted from the idea of herd immunity and is set on preparing our country to enter an endemic phase. Although there is growing evidence that Covid-19 vaccination reduces the risk of severe infection, hospitalisation 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 vaccination.

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 vaccines.

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 Covid-19. Several adjustments are expected to take place once Malaysia enters the endemic phase. Health Minister Khairy Jamaluddin revealed that the government will be announcing simplified standard operating procedures (SOP) to prepare for the endemic phase.

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 gatherings. Undoubtedly, it is highly likely that the SOP 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 the wards, especially in intensive care units (ICU), allowing the healthcare system to 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 may be on monitoring the number of severe cases (i.e. categories 4 and 5), ICU admissions and death. Vaccinations may also 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, the chances of Malaysia winning the fight against Covid-19 have substantially improved.

If the country does eventually enter an endemic phase with no signs of the virus disappearing, the rakyat should not lose faith. They should continue to observe the SOP, maintain confidence in our healthcare system and frontliners; and be regularly informed of factual evidence provided by experts or reliable sources. Only with firm solidarity and resolve can we prevail.

Written by the fourth year medical students of Group 4B, Community Posting Project, Faculty of Medicine, University of Malaya (Chuah Ming Li, Khaw Kar Wei, May Esther Wong Sze En, Muhammad Fikri Mohd Fadhli, Muna Syazriny Izhar, Ngan Chun Hong, Nur Rafiqah Mohd Rosdi, Pane Malar P.Sivaganam) under the supervision of Prof Dr Moy Foong Ming, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya.