 Hello and welcome to Newsclick. Today we're going to do a review, not only of the COVID-19 scenario in India, but also this whole issue of what is pandemic, what is endemic, particularly as we now have more countries which were in fact ahead of the curve on Omicron, going towards the discussion at least, what is endemic and what is a pandemic. So before we go into that quick question to you, how do you look at the questions of rise and rapid fall in various states in India, looking at particularly the urban centers which of course, as you have discussed with us, are the first to show signs of either fall or rise. So clearly, as we've been saying over the past two or three weeks, it remains true that there are local outbreaks, particularly in urban areas that are increasingly fueled by Omicron. This is by no means to suggest that the earlier strains such as Delta have disappeared, but the dominant viral lineages now are the Omicron lineages. As an aside, let's keep in mind that the Omicron lineage has also now begun to split into multiple substrains, so to say. There is much talk of BA1 and BA2 lineages, BA1B, which was earlier dominant, earlier meaning a month ago dominant. BA2 is now beginning to become more and more dominant, and BA1 was relatively easier to recognize, BA2 is relatively less easy to recognize, but the fact of the matter is that at various locations within the country, the Omicron strains are now steadily taking over or have already taken over. Associated with this is the fact that some of these local outbreaks in metropolitan India, particularly Mumbai and Delhi began very early, peaked and are now clearly going down. Now the downward trajectories are not as rapid as the upward trajectories, and there is noise in them. Delhi's test numbers have fallen, so Delhi's test positivity rates have sort of stabilized or gone up a little, but case numbers being detected are still going down. Hospitalization numbers have not gone beyond the abilities of the healthcare systems to deal with so far, anywhere that's been reported. However, in other cities, metropolitan areas, Andabad, Bangalore, Pune, in large parts, the length and breadth of Kerala, case numbers are still going up and this is essentially the picture that we had expected when we pointed out that this is not going to be a nationwide wave that goes up and comes down, this is going to be local outbreaks sort of merging together into national numbers. So national numbers are still up there, but early outbreaks are going down and late outbreaks are beginning to come up. How much more spread into the rural hinterland will occur and how rapidly that will spread will depend both on chance and on local configurations and therefore it remains to be seen. For instance, in US now, we are beginning to see the number of deaths really catching up with the Delta wave earlier. So is it because the number of unvaccinated immune compromised people are still large and comparatively the death rates in India haven't gone up by that amount. Is it also because it's a younger demography? I think there are a number of reasons for that. I'm a little reluctant to ascribe really dramatic values to this in part because as we've discussed earlier, case numbers are a very difficult metric to compare. Even in the same country from month to month case number definitions have been shifting a little bit based on who is being tested, which categories are being tested, how energetically they are being tested and so on and so forth. And since case numbers form the denominator of the so-called case fatality rate, there is a little bit of uncertainty. Nonetheless, if at all it is what seems to the eye does turn out to be correct that American fatalities are a little more prominent one way or another than in other places. There can be two or three components to this one, certainly that like much of the global north, the US has an older population to like unlike the global unlike many other parts of the global north in the US, the underprivileged communities and the irrational vaccine denying communities are both tightly knit communities with a very large proportions of particularly severe illness susceptible co-morbid individuals, whether because of age or because of other co-morbidities, and so on and so forth. And as a consequence, it's possible to imagine the convergence of all of this, being unvaccinated, being elderly, being in tight knit communities where transmission is very rapid and efficient, having other co-morbidities such as illness and so on, maybe driving the US death prominence higher than in the rest of the global north perhaps. And of course, the fact that the US still has a very large peak, it's a very, very current peak is very large, much higher than the earlier peak. So of course, not only the ratio, but also the numbers of sheer numbers of infected are much larger. So all of this can go to explain, but we certainly have one good thing to say that for instance in Delhi or in Mumbai or in, you know, Calcutta, we haven't seen the kind of rush that we saw in hospitals. So we seem to be still, though there is a lag in the death, in the serious cases rising, there's a lag between the numbers rising and these numbers rising, still this seems to be under control, shall we say, as of now. Though we are beginning to hear, of course, your friends, relations, old people also dying of COVID at the moment. But leaving that out, let's come back to what everybody has been talking, which we have not discussed in detail over here. We thought we still have time for it. This talking about what is endemic. And for laypeople like us, I have a little bit of a problem that it can be considered that polio is still endemic because we have not eradicated. We have not eradicated it completely because we still have about 150 cases a year. And flu is also endemic, which we can have up to 600,000, 800,000 cases a year. Now, what does endemic mean for laypeople like us, not for, shall we say, the medical community, or as a subset of that, which to which you belong, the immunologists. So the term actually does not come from immunology. And to be honest, although I will be castigated for this, many of my friends and colleagues in mainstream classical medicine will be hard put to explain it with any great accuracy because it really does belong to the domain of epidemiology. For us, epidemiology and immunology are all very similar. No, they're not. But let's talk about what the distinction that we are awaiting is, rather than getting into definitions. Why are we worrying about a pandemic? And how are we going to arrive at the stage that we are going to stop worrying about a pandemic? And whether such a situation is to be called endemicity or not? Let's just think about those questions because those are the practical questions, rather than worrying about pedantic definitions. So we are worrying about a pandemic for not simply because this is a virus that can infect everybody. If it was a virus that can infect everybody, but will not cause anything more than mild illness, we would not even notice the appearance of a new virus. Leave alone, call it a pandemic and get into the convoluted connections that we've gotten into over the past two years as a global community. So we are not worried about infection in the sense that a virus, for example, comes into the body, grows and is transmitted. What we are worrying about is when the outcome of this infection frequently enough leads to severe illness and or death. And you will remember almost two years ago, a year and a half ago, there were many people, particularly in the United States of America, that most prominently scientific nation in the world. There were many people arguing that, oh, it's just another flu, the former president being quite prominent amongst that community. It's just another flu, why are we worrying about it? And it steadily became apparent that it was not just another flu for a number of reasons and therefore it was reasonable to call it a new pandemic. And the reasons were number one, it was very easily transmitted because it was a new virus and therefore none of us had been exposed and therefore all of us were susceptible, first condition. The second issue was that severe illness, even amongst identified cases, was leading to hospitalization in as many as 10% of the cases and case fatality rates were certainly higher than case fatality rates for influenza, for example. So the question is, which of these factors will change and needs to change before we stop worrying about this as a pandemic? The first question is transmission changing and until the Omicron strain appeared, we thought transmission efficiency was going down. Our values, as you pointed out in some of our conversations two, three months ago, were going down. But the Omicron transmission has come to the point where our values are still quite high. So transmission of infection is not yet going down. In fact, people are getting infected all over the place. So what is going down? What is going down is the percentage of infected people who are ending up in hospital and of those the percentage will die. And as this declines steadily, as we have discussed over the past three weeks or so, it will make less and less sense to identify, to need to identify each and every infected case because the virus in some strain form or another will be spreading all over the place. But if it ceases to cause severe illness, let alone death in particularly high frequency, then at that point we are going to stop worrying about it. And that's one way when the pandemic will be over simply because we'll stop worrying about it, but the virus will not have disappeared and that's an endemic state. So what you're saying is that A, as and when that transmission either drops or it does not proceed to a very serious case, at least frequency of that really comes down because even today, influenza is a big killer. So it's not that it doesn't kill people, and it kills exactly the same kind of people that also COVID. It's even compromised older population. But as long as those numbers are small and the transmission does not cause visible impact on us, the body, people and so on, we can consider that we have reached an endemic stage, at least for our popular audience. If we look at it, then what you're saying is once we stop thinking about it too much, meaning that it doesn't have that kind of an impact on our bodies or due to transmission, it does not have that kind of an impact on society or a combination of both. When you come to that stage, we stop worrying about it and we start calling it endemic without bothering when what is a hard boundary between pandemic and endemic. If I understand you correctly. Yes. Let me point out two things. In the first place, this transition is not necessarily because the virus has become mine. We've said this in other contexts repeatedly over the past month, so I'm saying it again. There's no clarity that the Omicron strain necessarily causes biologically, intrinsically milder disease or causes severe illness at a much lower frequency. It does so in vaccinated individuals. Vaccinated or infected people have been infected because we are no longer, as you put it, a population which I never seen the virus. So we already have some either natural because of infections or because of vaccination, we have some antibodies now in your body. The distinction is this is therefore not evidence that the virus has changed. This is therefore evidence that we've changed. In fact, in fact, there is some evidence to show that at least it causes the same impact as the original Wuhan virus as the Americans called it or Trump called it. The original basically variants. The 2020 strains caused the kind of illness that Omicron is also causing among the population which has not seen this virus. Correct. If you have that as a case, then you are likely to see a similar level of intense, you know, of illness. There's a couple of issues that I would like to flag as footnotes. Firstly, shifting from pandemic to endemic is not going to be, as you point out, one hard line brawl. It's going to be slow, gradual, number one, number two, it's going to be different in different places across the world at different times in different places across the world over relatively short period of time, we hope, but nonetheless. And thirdly, it is therefore no guarantee about the future. And this is why I pointed out that so far, the changes in the virus have simply improved its transmissibility have not made it less unfriendly to us. Nor have they made it terribly more unfriendly. They've just made it more easily infectable. We've changed, but what we've changed in is our immune responses. So if virus strains arise that are for some odd reason, a little bit more dangerous in terms of causing severe illness, even in vaccinated, then we're going to be back in a pandemic or if not a pandemic at least an outbreak situation. So we need to learn the lessons of this pandemic over the long term. And those lessons are twofold. Number one, we need monitoring, we need global cooperation, we need global evidence based science driven cooperation. And we need the investments in nonprofit public health that allows us to identify these problems anywhere in the world and to respond to them substantially in accessible ways and means across the world. That note, we're going to close the discussion, but I leave it to our viewers that next time we are going to discuss one of the key elements of public response that Satyajee talked about, which is vaccination, not only reaching doses to countries, but also the delivery mechanism, because what we're now saying is large numbers of vaccines are being sent to the countries, which could in future also produce new variants, which then of course would affect everybody else. And we have discussed this earlier. Nobody is safe unless everybody is safe. But not only there's a vaccine inequality there, but also the ability of the health system to reach those vaccines to the people. And in which in all of this, there is this war cry by the American pharma companies and their allies that only the mRNA vaccines are good, but the Chinese have done is no good, but the Russians have done is no good. We don't even count. Even AstraZeneca is not mentioned in this discussion. Is it helping? Can it stop Omicron? It cannot. We only hear about the Russians being bad, the Chinese being bad, almost in the Cold War mode, but the real intent is really pharma markets. And I think that is something we will leave our viewers with, that with Satyajee, our expert on this will come back next week on this topic. Thank you very much for watching this clip. Do visit us on our website as well.