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Business News/ News / India/  Pandemic can end only when we eradicate the virus, say experts

Pandemic can end only when we eradicate the virus, say experts

Living with a virus doesn’t mean that we don’t have to prepare for an increase in hospitalizations or to limit surveillance in any way,  says Gagandeep Kang, Professor, CMC Vellore

From left: William Hanage, Gagandeep Kang and C.S. PrameshPremium
From left: William Hanage, Gagandeep Kang and C.S. Pramesh

MUMBAI : As covid-19 cases driven by the Omicron variant drop across the world and countries in the West and certain parts of Asia, including India, reach record vaccination numbers, is it time to conclude that the pandemic is reaching an endemic state? In an interview held as part of the Harvard T.H. Chan School of Public Health-India Research Center’s Covid19 webinar series, Gagandeep Kang, vaccine expert and professor at CMC Vellore; William Hanage, assistant professor of epidemiology Harvard T.H. Chan School of Public Health; and C.S. Pramesh, director, Tata Memorial Hospital, spoke on the way forward from the pandemic, lessons learnt, and implications for public health policy. Edited excerpts:

Denmark, one of the wealthiest countries in the world, earlier this month declared that it no longer considers covid-19 a socially critical disease. The UK, too, has announced that it will loosen restrictions including those that are travel-related. Can we say that we are at the end of the pandemic? Is there a way to measure this?

Hanage: The word endemic doesn’t mean “end" of the disease. There are three definitions of endemic. The most theoretical one is it is at the point when the number of infections declines to a point where it becomes stable and the rate of infections is determined by the number of people who are susceptible. But that does not mean it is particularly mild and those infections are easily dealt with. For example, TB and malaria are endemic in most parts of the world. Polio was endemic in parts of India a few years ago. The popular definition that is going around is that it is the kind of infections that people are willing to tolerate within their societies, because otherwise the only way a pandemic can end is when we eradicate the virus completely.

Kang: I have worked pretty much on most endemic diseases throughout my professional career and it is not like endemic means there is no disease, it does not cause hospitalization or deaths. Nor does it mean we will not see an increase in cases ever again. A lot of endemic diseases fall into seasonal patterns. So, the definition that we have to live with the virus makes a lot of sense. But we have to remember that living with a virus doesn’t mean that we don’t have to prepare for an increase in hospitalizations or we have to limit surveillance in any way, including genomic surveillance.

Pramesh: We see that there is a sense that we can now go back to business as usual but we have to ensure that our level of preparedness is adequate. We have to make sure that our health care systems have to be on alert and we have to be prepared to deal with what will come in the future.

So will we ever go back to the pre-pandemic days or this sort of “normalcy" what most people seem to be yearning for?

Kang: Well, some years ago, before the pandemic, we were saying that non-communicable diseases are taking over the world and we don’t need to worry about communicable diseases as India has gone through an epidemiological transition. Cancer and cardiovascular diseases were more important than any infectious disease. But the reason the SARS CoV-2 was so much in the news as compared to other infectious disease was that all of society was susceptible and most other diseases we just “deal" with in India. We don’t see them highlighted among the rich or in urban diseases as they are easy to take off the front page. But SARS CoV-2 was different. So, going to business as usual means that we treat SARS CoV-2, maybe we define this as reasonably democratic virus until some countries could put in place measures to handle the disease better than the others. There is still vaccine inequity. So, the Denmark of the world with high level of immunizations can think about what they consider the acceptable level of hospitalizations and deaths and move forward. But other countries don’t have the luxury to be there yet.

Two years down the pandemic, have we managed to gather evidence on the impact of covid on patients with other diseases such as cancer and how bad they are?

Pramesh: There is enough body of evidence that shows that patients of cancer do worse than all other co-morbidities. It ranges anywhere from 5 to 8 fold in mortality. So, it is not a small number. For example, if the overall fatality rate with covid-19 in India is 1-1.5%, among cancer patients it is 10-11% . But from the public health point of view, the curbs have led to access to cancer care being compromised. Second, owing to covid overwhelming health care systems, cancer care has also been impacted. In India, there are 30-70% reduction in patients seeking cancer care.

There is a debate on boosters and Omicron. Are they working against the new variant and should everyone get it?

Hanage: Omicron has been talked about as an escape variant. It is the closest we have come to seeing one. But it causes less severe disease. That is really important as we want to keep people out of hospitals. So, vaccination that will not prevent infection and prevent severe disease is really helpful. The vaccines are capable of doing it. You can take a booster or the third dose that is shown to further reduce the risk of severe disease and for a period infection. It is particularly helpful for those who are most at risk of severe disease. In the US, several people above the age of 65 have not received boosters.

Pramesh: It is really important to triage the vaccines to those who need them the most but also go beyond our borders to share the vaccines. It is more important to vaccinate the world than give boosters and it will be more beneficial to vaccinate the sub population who need them. A healthy 62-year-old will benefit less from a booster than a 15-year-old with acute leukaemia who is on therapy for cancer. So, these kind of distinctions we have to make. So, also from the vaccine equity perspective, it is shameful to see that large parts of health care workers in Africa are still not vaccinated and children who are low-risk are getting vaccines. So, we should ensure that rather than having these age distinctions, we need to look at the overall picture of co-morbidities and ensure that those who are at risk of getting severe covid get boosters ... and in India that is not happening yet. 

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Published: 14 Feb 2022, 02:20 AM IST
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