Endemic phase of COVID-19

Last updated

As of November 2022, the global COVID-19 pandemic is still ongoing, but the disease may shift from a pandemic stage to an endemic stage in the future. [1]

Contents

The following countries have declared the COVID-19 virus endemic or have begun transitioning to an endemic phase as of 4 November 2022: Cambodia, [2] Finland, [3] Indonesia, [4] Lebanon, [5] Malaysia, [6] Mexico, [7] Philippines, [8] Singapore, [9] South Korea, [10] Spain [11] and Vietnam. [12]

Medical view

On 14 April 2022, the World Health Organization (WHO) said that COVID-19 is far from becoming an endemic disease and could still trigger large outbreaks around the globe. [13]

In June 2022, an article in Human Genomics said that the pandemic was "still raging" but "now is the time to explore the transition from the pandemic to the endemic phase. The latter will require worldwide vigilance and cooperation, especially in emerging countries", and suggested that developed countries should assist in boosting COVID-19 vaccination rates worldwide. [14]

On 14 September 2022, Tedros Ghebreyesus of the WHO stated that "[The world has] never been in a better position to end the pandemic", citing the lowest number of weekly reported deaths since March 2020. He continued, "We are not there yet. But the end is in sight—we can see the finish line". [1] [15] [16] [17]

By countries

Australia

Australia initially pursued a zero-COVID strategy of suppressing any community transmission of COVID-19, which led to strict border controls both internationally and between states and territories, extensive contact tracing, and localised "snap lockdowns" and restrictions in response to even small numbers of new positive cases (with the city of Melbourne having faced some of the longest lockdown periods worldwide). [18] [19] [20] [21] This strategy proved successful in most of the country, until the emergence of variants of SARS-CoV-2 in mid-2021, and especially Omicron, which made it increasingly difficult to contain outbreaks. [18] [19]

By July 2021, most of the country had begun to shift their focus towards a strategy focusing on vaccination, with the National Cabinet agreeing on a four-phase framework based on vaccination targets. As vaccination rates increase, travel restrictions would be eased, and larger lockdowns would become "less likely"; by the final phase, COVID-19 would be treated as endemic. [22] [23] [24] An exception is Western Australia, which continued to enforce strict entry restrictions and infection control measures. [18] [25] The state also enforced a ban on rapid antigen testing due to accuracy concerns in an environment with little community transmission (with fines of up to A$20,000 for individuals and A$100,000 for companies), [26] [27] which was only lifted on 9 January 2022 in anticipation of the reopening of borders. [28]

At a media conference on 22 December 2021, Queensland Premier Annastacia Palaszczuk said that "we are living with this virus. This is the next stage of the pandemic." She noted that only one person was hospitalized with COVID-19 in Queensland and encouraged continued masking and booster shots for those eligible. [29] Queensland's Chief Health Officer John Gerrard said that spreading COVID-19 is "necessary" to transition from the "pandemic stage to an endemic stage", noting that people can develop immunity by being vaccinated or getting infected. [29]

In January 2022, Prime Minister Scott Morrison stated that Omicron's severity was "far less than perhaps was anticipated" despite its quick spread, and argued that "you've got two choices here: you can push through or you can lock down. We are for pushing through." [18] The Omicron wave had led to supply chain issues, labour shortages, [18] [25] as well as supply issues surrounding rapid test kits. [26] [27]

On 5 January 2022, Western Australia indefinitely delayed a planned lifting of its hard interstate border scheduled for 5 February. [30] Premier Mark McGowan stated that it would be "reckless and irresponsible" to open its borders without sufficient distribution of booster doses to protect against Omicron variant, explaining that "if you have a look at the alternative, which is what is going on in the eastern states at the moment, they basically have hundreds of people dying, they have mass dislocation in the economy, in logistics, freight, and all elements of the economy." [31]

On 18 February 2022, McGowan announced that Western Australia would lift some entry restrictions on 3 March 2022, with interstate travellers required to be fully-vaccinated with three doses, and international travellers subject to the federal entry criteria. Other restrictions, including mask mandates, social distancing, and vaccine passports remain in effect. McGowan admitted that "the virus is already here and we cannot stop its spread". These changes came amid modelling projecting at least 10,000 cases per-day by the end of March. [32] [33]

On 25 March 2022, the Minister for Health Greg Hunt announced that the Biosecurity Emergency Determination, as well as pre-flight COVID-19 tests for international arrivals will end on 17 April. [34] [35]

Brazil

In early March 2022, then Brazilian President Jair Bolsonaro said that the country is looking to downgrade COVID-19 to the status of an endemic. [36]

Cambodia

On 24 January 2022, Hok Kim Cheng, a spokesman for the Cambodian Health Ministry said that Cambodia was entering the endemic stage of the coronavirus. He cited milder outcomes for Omicron variant infections, and high vaccination rates. [37]

Denmark

On 2 February 2022, Denmark announced that it would lift most restrictions implemented since the Omicron wave (including those on gatherings, masks, and vaccine passport). [38] Despite having the highest case numbers within the European Union (and increasing presence of the BA.2 sublineage) at that time, health minister Magnus Heunicke argued that COVID-19 was no longer a "socially critical" disease, citing the country's high vaccination rate, that there were fewer patients being admitted to intensive care, and an increasing number of hospitalizations were incidental. [39] [38] It was noted that the Danish population had a high degree of trust in their government for imposing and lifting health measures in their best interest, and that a survey by government advisor and Aarhus University professor Michael Bang Petersen showed that they were more concerned about the state of their hospital system, and that their "feeling of societal threat" was at its lowest since the start of the pandemic. [40]

Finland

By June 2022 all restrictions had been lifted in the country [41] . In July 2022, the Finnish Institute for Health and Welfare issued a statement [42] arguing that Finland was transitioning into the endemic phase of COVID-19 [43] . It was covered widely in Finnish media [44] [45] [46] [47] .

Iceland

On 23 February 2022, the Ministry of Health lifted all remaining COVID-19 restrictions, including gathering limits, restricted opening hours for bars, and border restrictions. Adopting a herd immunity approach, [48] the ministry stated that "widespread societal resistance to COVID-19 is the main route out of the epidemic," and "to achieve this, as many people as possible need to be infected with the virus as the vaccines are not enough, even though they provide good protection against serious illness". [49]

In June 2022, Þórólfur Guðnason said that around 100 new cases of COVID-19 are detected every day, noting that many are not being formally tested or providing information to the health authorities. He said that "we have acquired a good herd immunity, because otherwise the situation would be much worse." [50]

India

On 31 March 2022, following a communique from the Union Home Ministry stating to end all COVID-19 restrictions; several Indian states began lifting curbs. [51]

Indonesia

On 18 May 2022, the Governor of Bali, I Wayan Koster, requested that Bali receive an endemic status to COVID-19 in order to "accelerate the recovery of Bali's tourism and economy". [52]

On 20 September 2022, it was reported that the country of Indonesia is "...posed to reach COVID-19 endemic stage". [53]

Ireland

On 15 September 2020, the Government of Ireland announced a medium-term plan for living with COVID-19 that included five levels of restrictions. [54] A revised Living with COVID-19 plan was published in late February 2021. [55]

After infections fell sharply following a fifth wave caused by the Omicron variant in late December 2021, almost all COVID-19 restrictions were eased on 22 January 2022, but rules on self-isolation and the wearing of masks in certain settings remained. [56] Remaining restrictions were lifted on 28 February; [57] when announcing the change in policy on 21 January, Taoiseach Micheál Martin said "it is time to be ourselves again" and admitted that "the pandemic isn't over" and that "it will still require all of us to be vigilant." [58] The Irish government titled its February 2022 plan to lift remaining restrictions "COVID-19: Reframing the Challenge, Continuing our Recovery and Reconnecting". [59]

Lebanon

On 21 February 2022, Dr. Abdul Rahman Bizri, the head of the National Committee for the Administration of coronavirus vaccines stated that Lebanon has been able to deal with the COVID-19 pandemic well despite its "critical and difficult circumstances," and that the coronavirus "has begun to turn from a pandemic to an endemic". [60]

Malaysia

In September 2021, Malaysian Minister of Health Khairy Jamaluddin announced that the government would transition to treating COVID-19 as if it was in an "endemic phase" by the end of October 2021, after vaccinating 80% of the population. [61] [62] Movement controls in the country were lifted in October 2021. [63] In March 2022, Khairy said that Malaysians could start "to live with COVID-19" while maintaining some public health measures. [64]

Mexico

On 26 April 2022, President Andrés Manuel López Obrador said that COVID-19 was "retreating almost completely" and had moved on to an endemic stage. [65]

Philippines

In February 2022, the Philippines Department of Health began shifting toward the endemic phase of COVID-19, despite caution from the WHO that it may be too early to declare. During a media briefing, Health Undersecretary Maria Rosario Vergeire said that the "transition to an endemic state for COVID-19 does not mean that the government would stop its interventions or even remove minimum health protocols such as masking, physical distancing, and hand sanitation." WHO Acting Philippine Representative Rajendra Yadav said that while the continued drop in the number of new cases is "encouraging," the country should be careful in moving from the "acute phase" of the pandemic. [66]

Singapore

In June 2021, Gan Kim Yong, Ong Ye Kung and Lawrence Wong—chairs of Singapore's COVID-19 task force—stated that "COVID-19 may never go away", but that due to high vaccination rates, a roadmap was being developed for how the city state could eventually live "normally with [COVID-19] in our midst", and manage it as an endemic disease, which would include: [9] [67]

They stated that "Science and human ingenuity will eventually prevail over COVID-19. Cohesion and social consciousness will get us there faster. We must all do our part." [9] [67] Shortly after the plans were revealed, however, outbreaks tied to the Delta variant began to emerge, leading the Singapore government to reintroduce restrictions on gatherings. In October 2021, Prime Minister Lee Hsien Loong admitted that it would take at least six months to reach a "new normal", but that Singapore's high vaccination rates and low mortality meant that COVID-19 "has become a treatable, mild disease for most of us", the impact of COVID-19 variants had made a COVID-Zero strategy less feasible, and that maintaining restrictions would impact the economy and mental health of the country. [69] [70]

Spain

On 17 January 2022, Prime Minister Pedro Sánchez said the Spanish government was exploring how and when the management of the COVID-19 pandemic would shift to the management of the coronavirus as an endemic illness, saying that "the virus is no longer so deadly". [71] The following day, Ghebreyesus of the WHO stated that the pandemic was "nowhere near over", warning that new variants were still "likely to emerge". [72]

South Korea

On 4 November 2022, the Korea Times indicated that "the government is shifting its focus from controlling the virus spread to treating it as an endemic". [73]

United Kingdom

The initial lifting of most restrictions in England (besides those requiring self-isolation after a positive test or close contact if unvaccinated) on 19 July 2021 was popularly referred to as "Freedom Day" by residents and the press. [74] However, due to Omicron variant, restrictions were partially reimposed in England from 10 December 2021, including mask mandates and a proof of vaccination requirement for large gatherings and events. [75] These restrictions ended on 27 January 2022; when announcing the change in policy on 19 January, Prime Minister Boris Johnson admitted that "we must learn to live with COVID in the same way we live with flu". [76] The British government titled its February 2022 plan to lift remaining restrictions "Living with Covid". [77] [78]

On 4 March 2022, the Welsh government announced the forthcoming removal of all remaining COVID-19 restrictions on 28 March. The decision was made as part of a long-term plan to transition from pandemic to endemic. [79]

United States

During his State of the Union Address on March 1, 2022, President Joe Biden stated that the country had been "moving forward safely, back to more normal routines", but that the federal government would "continue to combat the virus as we do other diseases." The next day, it was announced that the government would make COVID-19 antiviral medication available for free to high-risk patients at testing locations such as pharmacies and clinics, provide funding in support of vigilance and preparedness in the event of new surges and variants, aim to avoid the closure of schools and businesses, and aim to ensure global vaccine distribution. [80] [81]

Most remaining state mask mandates were lifted by April 2022, [82] and a federal mask mandate for public transport was struck down by the District Court for the Middle District of Florida for exceeding the authority of the Centers for Disease Control and Prevention (CDC). [83] On 26 April 2022, Chief Medical Advisor to the President and director of the National Institute of Allergy and Infectious Diseases (NIAD) Anthony Fauci argued that the United States was "out of the pandemic phase". [84] The following day, Fauci stated that the country was in a "transitional phase" into "hopefully a more controlled phase and endemicity", but that "the world is still in a pandemic", and the United States could still see new waves of infection. Fauci's comments followed a report from the CDC indicating that the United States had a much higher level of collective immunity due to the Omicron variant. [85]

During a 60 Minutes interview aired September 18, 2022, President Biden stated that "the pandemic is over" but said "we are still doing a lot of work on it". [86] [87] This declaration was met with some debate in the medical community as the United States still has roughly 400 deaths from the disease per day, and when extrapolated to 150,000 per year it is three times the fatality rate of a bad flu season. [88] Epidemiologist Jennifer Nuzzo of Brown University's Center for Pandemic Preparedness and Response called Biden's remark "An unfortunate sound bite". [89]

Vietnam

In March 2022, Prime Minister Phạm Minh Chính said COVID-19 was "endemic" and considered ending daily reporting of new cases. [90]

Analysis

A 2021 article in The Lancet called restrictions being lifted in the United Kingdom "dangerous and immature" and expressed concern that mass infection could lead to vaccine resistance and would impact young people, children and health services. [91] In The BMJ in February 2022, several health policy and public health experts criticised the British government's "living with COVID" plan, suggesting the end of free COVID-19 testing could exacerbate health inequality, and suggesting the plan did not account for required resources for localised contact tracing and hospital capacity. [92]

Elizabeth Stokoe and colleagues wrote in March 2022 that the phrase "living with COVID-19" is a cliché that has two opposed, disputed meanings. On the one hand it can mean simply returning to pre-pandemic living; on the other it can mean that life now must incorporate public health mitigation measures to reduce the impact of the disease as it circulates at high rates. In the United Kingdom, the phrase had enjoyed wide currency among politicians and the popular media, particular in the later, post-2021, phases of the pandemic. [93]

See also

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