 Hello and welcome to NewsClick. Today we are going to discuss again with Professor Satyajit Rath on the COVID-19 and its progression towards is it a more benign phase? Is it a new uptick? Where are we going? And this extremely loaded word called endemic that is now we are proceeding towards an endemic state. What does it really mean? Satyajit first, we are seeing some uptick for instance in places like Delhi, in Kerala a small uptick, couple of other places we can see uptick in the states small. But we also have seen upticks in various countries around the world and which is after Omicron has come we had a big huge wave in many of these countries. Numbers came down and again seemed to be going up all of it because we have now started a behavioral change. We are not really masking as much, we are going about in crowds, a lot of the people are probably partying at home or elsewhere. So how do you see the uptick uptick that is taking place? Do you expect the numbers to grow up with your crystal ball of course? And do you expect that it will have some uptick but it will not be a new wave? I know you don't like being, like look at your crystal ball but what is it that we shouldn't do at the moment? So let me make the standard whistle statement first that anything we guess in any informed fashion is always going to be in the absence of the emergence of a new variant strain. Whether a strain emerges is uncertain and if one emerges the properties, the characteristics that it has will determine the directions that it will then take. So at that point all bets are off. Let me interrupt for a moment because it's only about a two and a half, three years duration, this particular course of events. We have had one outlier of this kind where from a long past strain suddenly a completely new variant Omicron emerged. But whether it can happen once in two years, whether it happens in once in 10 years, we don't know. So a completely new variant emerging like Omicron, what is the frequency of that is not statistically possible to state at this point? Absolutely. So that was the sort of standard disclaimer if you will. That said the general approximation that is being discussed in public discourse on social media is that Omicron lineages even be a point two is a relatively mild virus. And I am emphatically saying there is no good evidence that in itself it causes milder illness. If it was spreading amongst the unvaccinated, the likelihood of its causing serious illness amongst unvaccinated is quite likely not dramatically different from the 2020 strains of the virus. The reason that it is causing much more likely mild infections is that it is spreading amongst all of us who have already been vaccinated and or previously infected. And it's that prior experience that our bodies have that is letting us not avoid infection altogether. But when we are infected to have only mild and quite frequently asymptomatic infection, this has public health consequences because case numbers are becoming less and less reliable because so many people are not testing because they are so mildly infected that they are not even seeing the need because public health authorities are not insisting on widespread emphatic I won't say coercive but emphatic testing. And because in many countries there are home tests available which are not getting necessarily reported with high reliability to public health registries. So these case numbers are getting less and less reliable, less and less mutually comparable. All of them are infection numbers. Hospitalization numbers are not rising anywhere at the same rate. Of course, they are rising. This is not to say that there are no increases in hospitalizations, but they're not rising at the same rate. And as a result, Omicron infection optics are not necessarily the major public health emergencies that delta infection optics or the 2020 infection optics would have been number one. Number two, these spreads amongst the vaccinated because they are in the vaccinated are not at the wildfire rate at which delta spread for example amongst a largely unvaccinated and mostly inexperienced unexposed community. And therefore the increases in numbers are driven by as you point out a combination of people now becoming completely blasé in the main about the pandemic and about physical distancing measures coupled to the fact that the Omicron lineages are capable of infecting people who've been vaccinated or previously infected with non-Omicron strains coupled to the fact that we are now diagnosing and reporting infections still rather than focusing on hospitalizations. In all of this therefore we are going to see little increases in numbers, but it would surprise me crystal ball wise. It would surprise me if we see explosive large growths in numbers. I should also point out that the actual numbers that we are talking about are so small in public health terms in demographic terms that this 90% increases and the 107% increases should be taken with a pinch of statistical salt. It's also the number if it is small. Doubling is not the same issue. If you have 10,000 you double 20,000 instead of 20 to 40 or 100 to 200. So I think that's a part of what we should really be clear about. And as you said all bets are off if you have a completely different variant that emerges in which case our immune system, how it will cope with it, whether it will lead to more serious cases or less serious cases we have no clue at the moment. The crystal ball unfortunately doesn't go that far. Coming back to the issue of again, the crystal ball is only one issue here. The other issue is the word called endemic. We have even in India now, August persons with a lot of degrees and a lot of public positions coming out and saying we are moving towards an endemic state. So there are two things to parse here. One is what does endemic mean? Does it mean that we can be comfortable or does it mean just a technical term which shows certain things about the virus? And the second part of it is if it becomes endemic, does our public health policies then change? So the technical part unfortunately is overshadowed by a peculiarly binary response of these conversations where there is the impression that it was epidemic and at some definable, identifiable point in time and space, it can now be declared to be endemic and that's not how it works. You have a pandemic situation, you have an epidemic situation more correctly. Pandemic is simply a global epidemic. You have an epidemic situation where numbers are very large, numbers keep exploding periodically into really, really large magnitudes as we've seen. That begins to settle down in numerical terms. Settle down meaning that the explosive growths in numbers don't reach very high peaks, they become less and less frequent. Even when they happen, their rates of up and down are slower and the periodicity begins to be correlated to some features of the environment. Typically, for example, with influenza, the weather seasons correlate and you get a little uptick of cases then it goes down. That's the endemic state. So you can see that going from the epidemic state to the endemic state is actually a slow shift over a continuum, over a spectrum. Drawing a line somewhere is really not going to work. Number one, number two, this settling is going to take place at different times in different places. So this oversimplification of the transition is something of a disservice to the community. That's the first part. The second part of the question raised about what difference does it make to the public health policies involved? Certainly it makes a difference in the straightforward issue that the huge upticks that strain public health and critical care medical facilities and therefore demand crisis mode responses will be needed less and less and less, less and less frequently. Again, this is not a matter of they were needed until yesterday and they are no longer needed. It is a matter of the strain on public health critical care services will slowly reduce as we go from the epidemic situation to the pandemic, to the endemic situation. However, again, this is going to happen at different rates in different times in different places and that is going to be driven by how easily accessible and adequate these public health critical care facilities have been in the first place and even within the country these are not uniformly distributed. Urban privilege to metropolitan India has had much more access than underprivileged rural areas. So this recalibration of public health policies is again going to be a local phenomenon that is going to be driven by local socio-economic political configurations as well. However, the fact that SARS-CoV-2, the virus and COVID-19, the disease are with us over the long term will remain regardless of whether we are talking about the epidemic situation or the endemic situation. The endemic situation does not mean what we seem to be seeing particularly in affluent urban India. People have taken it to mean which is oh, the problem is over. We can go back to 2019. The infection is available. It will spread. It will therefore carry the low but significant risk of people landing up in hospitals and it will still carry the un-understood outcome of long COVID which we have ignored so far to our great future cost and it still maintains the possibility as you pointed out of bringing up new variants with unpredictable properties and characteristics for which we need preparedness. And just for our viewers, typhoid can be considered as endemic, smallpox before eradication could be considered endemic. So just because something is endemic does not mean it is not dangerous individually and to society. It may not have the consequence of a huge pandemic as a worldwide epidemic but it still remains a public health issue and one of the issues that we then need to think about rather than our focus right now which has been almost entirely on COVID-19 and another endemic disease like tuberculosis which is a big killer in India seems to have gone into the back burner. So we need to bring all of this now into even if COVID-19 becomes pandemic we need to endemic. We need to think about how to handle this as a part of the larger public health issues that you have talked about and look at it in its entirety. Thank you very much Satyit for being with us. This is all the time we have a news click today. We will come back with Professor Rat on this and other issues as we go along depending of course on how the pandemic goes and how endemic it becomes.