 For more videos on people's struggles, please subscribe to our YouTube channel. India is among the countries where there have been spikes in the number of COVID-19 cases in recent times. This has led to fresh concerns. Will there be a drastic rise in cases again? Is a new wave in the offing? Or are these just isolated and local outbreaks? These developments have also contributed to the debate between COVID-19 being a pandemic or being endemic? What does the future hold in this regard? Immunologists Dr. Satyajit Rath discusses these issues. We have seen over recent days that a number of places in the world here in India, but not simply here in India and many other countries around the world, there are small local growths in COVID-19 case numbers, not simply in COVID-19 case numbers, but also in what has been called the test positivity rates. And people have been asking concernedly, number one, why are these numbers going up locally despite the fact that so many of these communities have been so extensively both vaccinated and or naturally infected? And number two, are any of these optics in numbers likely to prove the harbingers of yet another wave? It's always a little risky to make predictions of this sort, especially when the virus is so widespread that the emergence of a new and extra successful variant strain of the virus still remains a possibility. And even when a new variant emerges, it's the incidental properties of the new variant strain of the virus that will determine what the likely outcomes and the directions of those outcomes can be. None of us will be able to predict that. All bets will be off, as one would say. But in the absence of a new variant or strain emerging, the likelihood is that these small increases in local situations are driven by local consequences. Many of these numbers remain more and more uncertain because testing is not as systematic either in the performance or in the reporting in very many places across the world as it used to be. Test positive rates suffer from something of the same uncertainty. But the fact remains that the virus is widespread. The fact remains that the virus currently belongs to the Omicron lineages of the virus. And the Omicron lineages are quite capable of establishing infection in people who've been vaccinated, as well as in people who were infected in 2020 or 2021. And therefore, spread of infection is not at all severely connected. On the other hand, because it is spreading in vaccinated communities, in vaccinated groups, the rate of transmission, the rate of spread is still relatively low. And the outcome in terms of illness is relatively mild. However, we need to keep in mind that this mild outcome of the Omicron lineages is not a consequence of the virus biology itself. It's not as if the Omicron strain always causes mild illness. It's much more that because it is spreading amongst vaccinated communities, and because vaccination protects against severe illness, what we are seeing is mostly mild infections. So let this not be seen as, oh, the virus is evolving into a mild version. The virus is causing mild infections in the main because we have been vaccinated. What that means is that the unvaccinated, underprivileged communities, especially in the global south at large, still remain at some substantial risk of severe illness beginning to grow in those communities, as and when the Omicron lineages spread amongst them. That said, these numbers are unlikely, these local increases are unlikely to grow into really large waves, as it were, in the absence of a new variant. What all of this is beginning to be interpreted as is that in very many places, senior figures in health authorities are beginning to describe this as we have made the transition from epidemic to endemic stage. While this is not incorrect, there are two reservations about the way that this is commonly phrased that I think public health activists across the world must keep in mind. The first is the transition from an epidemic to an endemic stage is not an epidemic today, endemic tomorrow transition. It's a slow and uncertain transition that will take place over time that it will not be easy to make a simple decision that, oh, until last month it was in epidemic stage, but from this month onwards, it is in pandemic stage. And that is because the explosive growths and controls of the epidemic stage will become numerically smaller and smaller and more and more spread out over time so that it will eventually settle into an endemic stage where the ups and downs are relatively shallow, are relatively widely spaced. That transition is much more likely to be certainly seen looking backwards and saying, oh, until six months ago, we still had measure out breaks of the epidemic kind, but now we seem to have settled into an endemic stage. Number one, number two, this transition is going to happen locally. So it's going to happen at different times in different places, suddenly in different countries and even within countries, especially in large countries in Brazil, in India, this is going to happen in different places within countries at different times. But even more importantly than that, we are beginning to think about the epidemic to the endemic transition as a way of saying the risk is over, the epidemic is over, we can go back to life as it was lived in 2019. And this would be a fallacy. One aspect of this fallacy is visible when we see that these local increases in numbers are driven by the fact that physical distancing has been largely abandoned, particularly for, to give an Indian example, particularly in urban metropolitan India, where in Delhi and its surrounding regions numbers and test positive rates of growing, because masks have been abandoned, any attempts at physical distancing have been largely abandoned. And we see the consequences of that in rates of transmission, rates of test positivity, infection numbers, and even hospitalization numbers beginning to grow up to a certain extent. This is therefore something of a concern. And therefore, so long as the virus does not globally settle down into a some degree of stable endemicity, physical distancing measures, focus on the virus, focus on non-pharmaceutical interventions is necessary. The second and the last point about this is that the transition from epidemic to endemic stage simply means that the crisis mode interventions in public health and critical care facilities that the epidemic stage demands will have receded over time. The broader, more integrated public health and policy responses that the epidemic has thrown up remain viable, valid, and of urgent concern, even in the endemic stage, except that now our responses to SARS-CoV-2 virus and COVID-19 infection must also encompass and incorporate all the other endemic infections, the tuberculosis, the influenza, the malaria, that in crisis mode, epidemic situations we've been ignoring. I think that for all of us in public health activism, it is essential in endemic stage COVID-19 situations to begin to demand an integrated public health policy response.