When disease burden is low, why COVID-19 continues to be a pandemic ?

Shobha Shukla, Bobby Ramakant *

On 30 January 2023, three years after the WHO had first declared COVID-19 as a public health emergency of international concern, the WHO announced that COVID-19 continues to be a public health emergency of international concern.

"While the virus is still circulating in our populations and the risk of mutations is there, the number of people with COVID-19 who need medical attention has gone down in countries like India. There is no rationale for inconveniencing people with COVID-pandemic related measures when neither its associated disease burden on hospitals nor untimely deaths warrants any of them," said Dr Ishwar Gilada, Secretary General of Organized Medicine Academic Guild (OMAG) - a pan-India network of professional associations of broader medical super-specialities.

According to the World Health Organization (WHO), globally, over 4.8 million new cases and over 39,000 deaths were reported in the last 28 days (30 January to 26 February 2023), a decrease of 76% and 66%, respectively, compared to the previous 28 days. Moreover, at the global level, during the past 28 days, a total of 42,258 new hospitalizations and 1619 new intensive care unit (ICU) admissions were reported.

This represents a reduction in both new hospitalizations and ICU admissions of 83% and 49%, respectively, (compared to the previous 28 days). Out of all the countries that report data on COVID-19 related ICU admissions to the World Health Organization (WHO), no country showed an increasing trend of ICU admissions compared to the previous 28 days period.

That is why OMAG calls upon the WHO to declare that COVID-19 is no longer a public health emergency of international concern, and the Indian government to officially announce end of the pandemic and withdraw the unnecessary pandemic-related measures in place.

"OMAG’s call to declare that COVID-19 is no lomger a pandemic, is not a call to stop being vigilant, or stop doing disease surveillance. Rather OMAG is calling to ensure that proper disease surveillance and reporting systems are in place, vaccine (and booster/ precautionary doses) is within reach of everyone eligible for it across the country, and globally, and pandemic preparedness is getting the attention it deserves. Infection prevention should indeed remain the mainstay," said Dr Ishwar Gilada, who is also the President of AIDS Society of India and Governing Council member of International AIDS Society (IAS).

OMAG also calls upon the government to give more attention to surveillance and study of long-COVID, and to update guidelines on its management on an ongoing basis, as scientific evidence evolves.

The annual meeting of OMAG was held in Chennai, India, at the offices of one of its partners, Association of Surgeons of India (ASI), where President-elect 2023 Dr Sanjay Jain (President of Association of Surgeons of India) took charge. The Association of Surgeons of India (ASI) will lead OMAG with its 15 constituent organisations and ASI President Dr Sanjay Jain will be the OMAG President for the year 2023-24.

Dr Sanjay Jain said that "OMAG can play a supportive role in public health policy making, which becomes more critical in times of public health emergencies. This will also go a long way towards pandemic preparedness and resilience."

Underlining the importance of different professional associations of medical super-specialists working together, OMAG President Dr KM Venkatagiri, who is also the President of Indian Society of Anaesthesiologists, said that OMAG constituent-associations consolidate feedback from the doctors of different specialities across the country, and aim to feed into the government-led responses to infectious diseases or other public health challenges. During a public health emergency, it is of paramount importance that optimal coordination exists between different medical specialities as well as other healthcare providers.

natural immunity provided more protection against reinfection than mRNA-based vaccines: Lancet

OMAG also puts spotlight on the recent The Lancet publication which showed that natural immunity acquired through COVID-19 infection provided more protection against reinfection from SARS-CoV-2 than mRNA-based vaccines. "Previous natural infection was associated with lower incidence of SARS-CoV-2 infection, regardless of the variant, than mRNA primary-series vaccination. Vaccination remains the safest and most optimal tool for protecting against infection and COVID-19-related hospitalisation and death, irrespective of previous infection status."

While eliminating this virus from human and animal reservoirs is highly unlikely, mitigation of its devastating impact on morbidity and mortality is achievable and should continue to be a prioritized goal.

Endemic, not pandemic anymore as of now, says Dr Gilada

Dr Gilada said that achieving higher levels of population immunity globally, either through infection and/or vaccination, may limit the impact of SARS-CoV-2 on morbidity and mortality, but there is little doubt that this virus will remain a permanently established pathogen in humans and animals for the foreseeable future - but not as pandemic rather endemic like other infections.

Government of India should continue to support research for improved COVID-19 vaccines that reduce transmission and have broad applicability, as well as research to understand the full spectrum, incidence and impact of post COVID-19 condition, and to develop relevant integrated care pathways.

As of 26 February 2023, over 758 million confirmed cases of COVID-19 and over 6.8 million deaths related to COVID-19 have been reported globally.