As mentioned in an article Sustaining endemicity in pre-endemic time, it was a misnomer to think that we are already in an endemic stage. Those who thought so are 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 that normalcy will be the order of the day.
When the article was written on Oct 31 last year, the death figure was 37. On Feb 22 this year, it was 43 deaths followed by 55 the next day. The last time the daily death number was zero was on Dec 4, 2020.
After more than three months since the article was written, the daily death figures have increased though still in the two digits. We have come a long way to this situation after going through much trial and error in combatting the scourge.
It is not only in Malaysia that there was trial and error, as Covid-19 is a new animal that has caught many governments operating in a context of radical uncertainty, being faced with difficult trade-offs given the health, economic and social challenges it raises.
Already there are two approaches to combatting the pandemic. One is the zero-Covid path with its emphasis on lockdown, border closure, and strict preventative measures which were being implemented successfully by countries like China and New Zealand, among others.
The other approach is via the endemicity path whose proponents include Singapore, Malaysia, and many European countries, which is based on the notion that the virus is here to stay for the long haul.
As such to achieve zero transmission is almost impossible and we just have to learn and live with it. But the endemicity approach is yet to see any success so far because it is still a process or a transition towards endemicity i.e. work in progress.
According to a Harvard infectious-disease expert, Yonathan Grad, ‘this distinction between pandemic and endemic has been put forward as the checkered flag,” a clear line where restrictions disappear overnight, Covid-related anxieties are put to rest, and we are “done” with this crisis.
That’s not the case. And there are zero guarantees on how or when we’ll reach endemicity, or whether we’ll reach it at all.
Many are clueless on what endemicity is all about and hence, fail to distinguish between the process and the 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 being the threat that it is now and without a large number of hospitalizations.
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 refers to the high rate of daily transmission that is now in the five digits in Malaysia.
The problem is proponents of endemicity have never specified the digit of daily transmission that constitutes a non-threatening situation. Given that an endemic situation is one where it is impossible to attain a zero transmission, so 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 daily infection number is not important, as what is important is that serious cases are below 1% of the total daily cases.
But what if the daily infection number is in the six digits, as happened in many European countries as early as last month? Assuming the daily case is 100,000 and 0.5% of these are serious cases that would mean 500 serious cases needing ICU beds, oxygen supplementation, and ventilators.
Seeing that a hospital would normally have 1,000 beds, out of which about 300 to 500 are ICU beds, 500 serious cases are manageable only if the six-digit daily case is a one-off event.
But as experienced in many countries, once the five or six-digit figure is hit, it will go on and on for at least a week or so, sometimes longer, and those who were hospitalised will not be discharged for the next three to four days because these are serious cases we are talking about.
This will put tremendous pressure on the healthcare system, resulting in poor care of the patients, which will have a knock-on effect in terms of simultaneously raising the death rate and the transmission rate, even among the frontliners.
An important cornerstone of the endemicity approach is you cannot reach endemicity without the waves of transmission because there can be no natural immunity without infections.
High natural immunity (used to be called herd immunity) in the community can come about only when people are infected, so say the proponents of endemicity.
The more infections there are (and people recover from their infection), the greater will be the natural immunity in the population. This is why you cannot reach endemicity without the waves of transmission.
With every wave of transmission, the natural immunity in the population also increases, making the population more resilient.
The main weakness in this argument lies in assuming people who are infected will necessarily recover. Some don’t and become a statistic in the daily death number, while others may regress from Category 1 to 2 or from 2 to 3 and so on.
The fact that in most countries during waves of transmission, the daily recovery number is always less than the daily infection number shows that this argument should be treated with a pinch of salt.
Moreover, it will only lead to an act of stupidity in wanting to get infected so that your natural immunity will increase.
There is, however, merit in the argument that endemicity doesn’t mean an attempt to stop the transmission, as it aims only at slowing it down to ensure the healthcare system is not overwhelmed so that every sick person can be cared for.
And 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 shouldn’t be any restrictions.
So people should get it in their head that endemicity is a long process, and there is still a need presently to observe restrictions and their SOPs and be circumspect when you have to go out in the open.
This does not mean you cannot go out of your house. It is just 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.
Jamari Mohtar is the Editor of Let’s Talk!, an e-newsletter on current affairs.
The views and opinions expressed in this article are those of the author/s and do not necessarily reflect the position of BusinessToday. Any content provided by our contributing authors is of their own opinion.
