Classifying Covid as an endemic rather than a pandemic is not yet possible, experts say

Brazil and the world are still not in a position to change the character of Covid from a pandemic (when there is a situation of global health emergency) to then consider it an endemic (stage of coexistence with the virus, with a stable number of cases and deaths ). The finding is from experts consulted by the sheet.

In the case of Brazil, the daily moving average of deaths above 800 for the 15th consecutive day makes this reality even more distant, say the scientists.

Last Monday (21), the Minister of Health, Marcelo Queiroga, spoke of “the end of the pandemic character” of the virus. In São Paulo, Governor João Doria (PSDB) already sees the reduction in the number of deaths as a “control” of the pandemic situation.

England was the first major economic power in Europe to fully lift restrictions against the coronavirus. Last Monday (21), Prime Minister Boris Johnson announced a program of “living with the virus”, in which self-isolation for infected people is no longer mandatory.

Even with a positive test, people are now able to use shops and public transport. In addition, the government will stop distributing free tests for the diagnosis of Covid from April 1.

The withdrawal of a pandemic character restricts public and exceptional measures to combat the disease. According to experts, this does not mean that Covid-19 will not pass into the endemic phase, but we are just not there yet.

“What defines the end of an epidemic or pandemic is a series of factors together, not just a specific indicator of deaths or cases”, explains Maria Amélia Veras, epidemiologist at the Faculty of Medical Sciences at Santa Casa de São Paulo.

Some diseases, such as AIDS, after four decades still haven’t left the pandemic character, she recalls. “An epidemic remains a very big social problem, so it’s an emergency appeal,” she says.

Furthermore, regional differences do not allow for a joint transition on the planet. While in richer countries there are broad testing policies against Covid and a large offer of vaccination, in the southern hemisphere, there are places that have not vaccinated even 2% of their populations, such as Haiti.

Another factor that prevents the announcement of the end of the pandemic is the very novelty that Covid represents for the world, says Paulo Lotufo, an epidemiologist and professor at the USP School of Medicine.

“We can only talk about endemic when we know the historical trend of the disease well established, and we still don’t have that for Covid”, he explains.

Julio Croda, a researcher at Fiocruz, believes that the decrease in the lethality of the coronavirus, with an incidence today equivalent to one twentieth of what was observed during the wave of cases in 2021 with the gamma variant, is an indicator of how close we can be to the end of the pandemic.

“This does not mean being negligent with the virus, but that each year we will have to pay special attention to people at greater risk, the most vulnerable groups, which are the elderly and immunosuppressed, who need a booster vaccination, as is with the flu”, he says.

“As for young and healthy individuals, studies show that cellular protection induced by vaccines holds up well even against microns”, he adds.

Márcia Castro, demographer and head of the Department of Global Health and Population at Harvard University and columnist for sheet points out that we need to “question what the end of the pandemic is”.

“The end is not having more cases, not having more special attention for that disease? This happened with zika in 2015 and then we saw the consequences of microcephaly in babies”, he highlights.

“Who is the end for? There are many orphans of the pandemic, people who have lost income, starving, with Covid sequelae. What are the criteria to determine the end? Are they technical, public health, or are they social?”, she asks, stating that, despite the drop in deaths and hospitalizations, who declares the end of a pandemic is the WHO (World Health Organization), not a local government.

For Cláudio Maierovitch, a health doctor and former director of Anvisa, “thinking from a strictly technical point of view, it is not possible to speak of an endemic disease during a pandemic”.

“And there is another aspect: an endemic disease is not necessarily better than a pandemic. We can have endemic diseases that cause continuous damage to populations from a sanitary or financial point of view”, he recalls.

The very discussion of whether Covid would be a seasonal disease or would come in waves, like those recorded in the past, ended up making more global actions difficult, assesses Maierovitch.

“We have already seen a rise in hospitalizations and deaths in previous waves in Brazil and then a slow decline. In South Africa, the Ômicron rose like a wall, and the descent was in free fall. The United States continues with a very high,” he recalls.

“This all shows that mechanisms are still needed around the world to help this fall to be faster and more consistent, but not to lift restrictions”, he concludes.

Croda, however, sees that there is less and less impact on the public health system, as the indicators are falling. “The trend is, with the reduction in lethality and the drop in hospitalizations and deaths, to move towards this transition period, which does not mean zero impact, but a predictable impact”, she says.

Before the omicron, the moving average of deaths and daily cases in the country was decreasing, but the very arrival of the variant, more transmissible and with vaccine leakage, shows how this situation of apparent comfort can be disturbed.

For Ethel Maciel, an epidemiologist and professor at the Federal University of Espírito Santo, the very possibility of the virus mutating and new variants appearing makes this discussion premature.

“It became very clear that there was a big impact on the effectiveness of the vaccines, so we need to update them and, if this is done and they are effective, maybe we can consider a phase change”, he explains.

In this context, a case surveillance network, such as the sentinel structures set up for the influenza virus, are essential, combined with a comprehensive testing strategy, a plan that has never been properly implemented in Brazil.

“After two years we still haven’t been able to strengthen genomic surveillance, so saying that the Ômicron will be the ‘definitive variant’ is wrong. Nothing has been done to strengthen these and other public health measures, such as community agents and the use of self-tests as a policy public, with a focus on inequality”, says Castro.

Even with the recent epidemic of the H3N2 influenza virus, the sentinel failed in aspects such as the adoption of rapid containment measures in states with the best infrastructure, such as São Paulo, says Lotufo.

Annually, the flu causes about a thousand deaths in the country. For Covid, from January 1, 2022 until last Wednesday (23), more than 27 thousand deaths were recorded, according to data from the press consortium.

“The so-called ‘end’ of the pandemic, or the change from a pandemic to an endemic phase, means the amount of lost lives that it is acceptable to have as a society each year”, says Lorena Barberia, researcher and professor in the department of political science at USP. .

The withdrawal of the measures, therefore, is seen by her as a complicating and political factor, not of a technical nature.

In addition, says Barberia, the risks of long-term Covid and the public health consequences of the sequels are still immeasurable. “To arrive at an acceptable value [de casos e óbitos] means to say that future risks to the health of infected people are also acceptable, without even knowing them”, he highlights.

Also for Roberto Kraenkel, physicist and member of the Covid-19 BR Observatory, “we are not in this acceptable situation”.

“Despite the rapid drop in hospital admissions and deaths in some states, in the country we still have about 100,000 cases a day,” he recalls.