Prospect of treating Covid-19 as an endemic, rather than pandemic

2021.10.05

14 Deputy I. Gardiner of the Minister for Health and Social Services regarding the prospect of treating Covid-19 as an endemic, rather than pandemic (OQ.207/2021):

Will the Minister advise what consideration, if any, has been given to a move towards treating COVID as endemic as opposed to pandemic in Jersey; and if so, will he explain how this will be determined?

The Deputy of St. Ouen (The Minister for Health and Social Services):

I thank the Deputy for this interesting question. A pandemic is an outbreak of a disease affecting many populations over a wide geographical area. At present, of course, the COVID-19 pandemic has a vast global reach. Endemic refers to the normal circulation of a virus in a specified location over time. An endemic virus is relatively constant in a population with largely predictable patterns. For example, influenza is an endemic virus which is monitored globally for its epidemic and pandemic potential. Once we see a stable level of COVID transmission indicating a new baseline of COVID we might say the pandemic has ended and the virus is endemic. This will likely include minor seasonal trends, as we usually see with flu, but we are not yet in a position to treat COVID-19 as endemic in Jersey. We have not reached that stage of constancy and predictability. Furthermore, it would be unwise to treat COVID-19 as endemic in Jersey while there is ongoing epidemic or pandemic activity within neighbouring jurisdictions and common travel destinations. Our connectivity makes us vulnerable to further outbreaks.

1. Deputy I. Gardiner :

I am grateful to the Minister because it is exactly the explanation that I have personally seen for pandemic and endemic. Countries will not enter an endemic phase at the same time because of variable host environment virus factors, including vaccination rates. As our vaccination rate is higher than anywhere else, has the Minister considered what number of cases of COVID is acceptable as a level of endemic stability for Jersey? If so, what would the number be and is it hospital or community?

The Deputy of St. Ouen :

Thinking has not developed to that extent. I would be very cautious about fixing numbers, especially at this stage where we are certainly not in a position to start saying the pandemic is over. Because the issue perhaps will not be the number of infections, which might be capable of being treated within the community, but issues of concern might be the numbers being hospitalised or even, unfortunately, any numbers dying. I think this work will be carried out in due course and, as the Deputy says, it may be that around the world different countries will think they are in the endemic stage while others are in pandemic stage. I think we have to link ourselves with the U.K. and the Continent and see what is going on there. We cannot exist as an Island and pretend that we can manage entirely our own activity in this area.

2. Deputy R.J. Ward :

Can the Minister perhaps identify some of the features that would mean we are moving towards viewing it as endemic? For example, the removal of certain mitigations, the removal of testing at borders, the removal of any isolation requirements. Are they the sort of features we would see as we move towards treating this as an endemic disease rather than an epidemic?

The Deputy of St. Ouen :

The examples the Deputy gave may well be the case. Testing at borders for an infectious disease is an extraordinary step and one that we do not take lightly. So if we were in a position to remove that requirement that might be a sign we are moving towards an endemic situation. I think also when we have delivered a vaccination programme and been able to vaccinate all the eligible cohorts to the extent that is advised, then we will know that through vaccination we have delivered that to all those persons eligible and we know that vaccination provides significant protection, although not complete. That is another step, I think, we could look to.

3. Deputy R.J. Ward :

Is it not important that a clear message is given so that people understand precisely how this Government is viewing where we are with COVID? For example, if we are to remove testing at borders, which has been rumoured and proposed by the Assistant Chief Minister, would that not give the message to the population that we are now in an endemic phase. It may change people's behaviour? Is the message going to be clear is the question?

The Deputy of St. Ouen :

Yes, there will be a clear message and we are working at this time on a winter strategy, which will soon be released. We can expect that we will see different measures being applied from time to time, either relaxed or enhanced, depending on the degree of risk in the Island. The fact that we may do one thing does not mean that people should think we will suddenly be moving from pandemic to endemic. It is a case of managing over time and, as we move forward, I just do not know yet whether we would have a formal declaration of an end of the pandemic or whether we would just move into a different stage.

4. Deputy M.R. Higgins:

Could I ask the Minister, before we can even consider going into an endemic phase we need to be aware of what is happening in the rest of the world and the level of vaccination there, and also the number of variants that are coming out through unvaccinated people? Until the rest of the world is dealt with we cannot very well declare we have an endemic in this Island when travel around the world goes on all the time.

The Bailiff :

Is there a question there, Deputy ? Deputy M.R. Higgins:

Yes, the question was how can we declare that we have an endemic if the rest of the world has not sorted out the problem with vaccination or these other variants? Does the Minister not accept that it would be rather premature to declare an endemic in the Island when there is still a pandemic elsewhere in the world?

The Deputy of St. Ouen :

I accept at this stage, today, I would entirely agree with that, that what is happening around the world presents risks to the Island. I said in my first answer that we have to look to neighbouring jurisdictions and where there is pandemic activity there we are not in a position to declare ourselves endemic.

5. Deputy I. Gardiner :

As the word "endemic" is now regularly mentioned, especially among public health leaders and experts who are discussing how exactly COVID will be defined as an endemic, would the Minister advise if the public health officials in Jersey have started to consider this or, if not, when they will look into this?

The Deputy of St. Ouen :

My own feeling is that it is still too early to put a lot of resource into deciding whether, if and when we might declare an end to a pandemic. As Members will know, we have relied very greatly on advice coming through Public Health England, the J.C.V.I. (Joint Committee on Vaccination and Immunisation), the medical officers of health in the U.K., where they have substantial research and resource abilities. We will continue to draw on those. I know Dr. Muscat is in regular contact with the medical officers of health in those jurisdictions. I think as they begin to talk about these things we will also in Jersey. We are part of the conversation, I am pleased to say, and that time will come. I do not think we are planning this in any great deal at all very soon.