'No need to give special attention to COVID-19 anymore'

'All actions for COVID-19 should be the same as for other routine health conditions.'
'There is no need to report the matter in the media all the time; not on front page please.'

After two-and-a-half years, according to data collected by Bloomberg, more than 12.4 billion vaccine doses have been administered across 184 countries; around 8.46 million doses a day and 159 shots for every 100 people worldwide.

Has the time come for WHO to declare the COVID-19 outbreak as an endemic?

According to Dr Chandrakant Lahariya, an infectious diseases specialist, vaccine and public health and policy expert, that moment has not arrived yet.

Though he argues that the world is still in the midst of the pandemic, the disease can be considered endemic in India as well as in some other countries which have experienced high transmission and achieved high coverage with at least two shots of COVID-19 vaccines in the 18+ years population.

Dr Lahariya is the lead author of Till We Win: India's Fight Against the Covid-19 Pandemic along with Dr Randeep Guleria of the All India Institute of Medical Sciences, New Delhi and Dr Gagandeep Kang of the Christian Medical College, Vellore.

"There is no need to give any special attention to COVID-19 anymore," Dr Lahariya tells Rediff.com's Shobha Warrier in the concluding segment of a two-part interview.

• PART I: 'We can't expect the virus to disappear'

We see newspapers reporting the number of covid cases every day. Do you think this also should stop; the undue importance given to COVID-19 cases?

Definitely, while counting the cases is important for public health specialists and epidemiologists, and it should be continued.

However, the number of daily new COVID-19 cases has no relevance for the general public anymore.

All actions for COVID-19 should be the same as for other routine health conditions. Similarly, if someone needs an RT-PCR test, it should be available, and that's all.

Not only for covid but for all diseases, all the parameters should be recorded. It is crucial that the government records all the cases and not just COVID-19. That way, we can determine when there is an outbreak in an area.

But there is no need to report the matter in the media all the time; not on front page please.

You mean it should be treated like any other disease that's there in the community?

Exactly. There is no need to give any special attention to COVID-19 anymore.

There are many parts of the country where there is this virus without causing any public impact.

As a public health expert, would you say that in India, COVID-19 has become endemic?

As a public health expert, I can say with confidence that there is no reason to be worried about COVID-19 as it has become endemic in India.

Also, the social and economic impact of COVID-19 is over.

Would you say the same thing about the global situation too? Or, is it confined to certain countries?

Any country that is doing testing at the same rate as before the Omicron wave in Dec 2021 and January 2022 is reporting more cases.

We also know that Omicron is far more transmissible and present in most settings. So, many people with fever and cold is likely to have COVID-19. In some cases it could be with other viral infections.

Cases are being reported globally but the impact of those cases is very different in each country. It depends upon the population profile. For example, the impact will be high in the countries with high proportion of elderly population.

Similarly, any country with a high number of unvaccinated people, the impact continues to be high. In the US, many people refused to get vaccinated and that is a reason for the continued spread and some hospitalisation.

So, every country would achieve endemicity at different point of time. India and many European countries have achieved it but countries in Africa are still not there.

A country like Japan has a large elderly population. So also Kerala...

Kerala is reporting more cases. The elderly population is more there, but then Kerala also may be testing more. But the good news is that Kerala also has high vaccination coverage and that is reducing the impact in terms of hospitalisation and deaths.

In India, in last few weeks, 30 to 40 Covid deaths are being reported daily. However not all the reported deaths are happening due to COVID-19. They are the people who had other diseases and when they die, you find that they also had covid.

There is a difference between dying due to covid, and people had covid when they died.

The current situation in India is that people have covid because the virus is circulating. For example, India with a population of 1.4 billion people report 28,000-29,000 deaths every single day due to all causes including the old age.

The number of deaths due to covid is around 30 on an average which is only 0.1% of the total deaths happening daily. That means 99.9% of daily deaths in India are due to other illnesses or natural deaths, and not due to covid.

So, we cannot keep paying attention only to the 0.1% of total deaths all the time, ignoring 99.9%.

Do you think we may need to take the vaccine for COVID-19 every year like people in some countries take the flu vaccine every year?

Even the flu vaccine is recommended only for the high risk population and children, and not for the entire population.

In my opinion, more research is needed for COVID-19, but it is likely that the high risk population may require additional shots.

In the current situation, with the available vaccines, giving additional shots has minimal benefits. However, it can be expected that in the months ahead, newer generation and advanced or bi-valent vaccines would become available.

There are discussions on universal COVID-19 vaccines which are expected to provide protection against a broad range of SARS CoV2 variants. As and when such vaccines are available, the rationale and recommendation for boosters would be very different than what it is now.

The situation of Covid cannot be compared with flu as flu is a seasonal disease. We know when there is going to be an outbreak. So, you give the vaccine when the season starts. But that is not the case with covid. We do not know when the cases would rise.

I am of the opinion that people with three covid shots get sufficient protection.

Even the mRNA vaccines won't provide long-term protection?

Even with the mRNA vaccines, the researchers have found that with the 4th shot, while the antibodies levels rise to decline equally rapidly, usually within three months.

You cannot keep vaccinating people every three months!

Is it possible to achieve herd immunity in COVID-19?

No. The reason is that the concept of herd immunity is applicable when it is a natural infection, or when vaccine gives lifelong or fairly long protection.

IMAGE: Dr Chandrakant Lahariya. Photograph: Kind courtesy Dr Chandrakant Lahariya

Like..?

Like in the case of measles. Even in that case, it is close to 100%, but rarely people may get an infection the second time after a natural infection.

The efficacy or protection after a single dose of measles vaccine is around 80% and after two doses, it is around 95%.

Is it because the virus keeps mutating that it is not possible to attain herd immunity in the case of COVID-19?

Yes. This is an RNA virus, and that too a respiratory virus. And then, SARS CoV2 has turned out to be more prone to mutations than many other viruses.

Why is it that some people get infected many times? We heard about US President Biden. Sonia Gandhi, Priyanka Gandhi Vadra have gotten infected twice.

Everybody in the community is getting infected multiple times. Prior infection or vaccine does not protect a person from getting subsequent infections.

But then politicians either get themselves tested more often or their health protocol mandate routine testing, but we commoners do not. That's why they are identified.

Does that mean we also must be getting infected without us knowing?

There is no doubt about that. The real number of cases must be much higher than what is reported. Most cases must be asymptomatic or mild. And that's why we need not worry.

Does that mean people can breathe free, without a mask?

Yes, most of us can breathe free. I strongly feel that masks should be a voluntary choice. Wearing a mask should now be left to individual choice.

Masks are protective, but right now, the government need not have any role in telling you to wear a mask.

I don't think a healthy adult or a child in an open space or most space should wear a mask. The only exception is anyone who is interacting or coming in close contact with an individual confirmed with a COVID-19 infection.

But everyone should be aware of how to protect from COVID-19 infection. Even if mild, we should not try to get infected. More so, if there is a steep rise in COVID-19 cases in an area, you should try to protect yourself.

There is no need to worry unnecessarily; be informed and proactive.

Feature Presentation: Ashish Narsale/Rediff.com