Is India entering the final pandemic stage?

With COVID infections in India steadily decreasing, epidemiologists and virologists are more optimistic that the Indian health system will be able to better manage caseloads moving forward.

In an interview with Indian media at the end of August, World Health Organization (WHO) chief scientist Soumya Swaminathan said India is at or approaching the endemic stage.

Last week, while reporting on the current state of the pandemic in India, Health Secretary Rajesh Bhushan said there was an overall decline being observed in most of the country

A virus is considered endemic when it is restricted to a specific population within a geographic area, which still causing outbreaks but with a manageable impact.

The spread of infection will eventually stabilize to a level where it will be present in the population, but at a relatively low and foreseeable rate.

Moreover, the number of people needing hospitalization will decline and severe cases will become rare.

Regional 'ups and downs' expected

Swaminathan told DW that as India enters the endemic stage, there will be "ups and downs" at regional levels and a possibility of local spikes in areas with low vaccine coverage.

"Eventually countries will enter the endemic phase, but because we are in a pandemic, things can change unexpectedly," she said.

The WHO chief added that mass blood sampling in India has shown 65% seroprevalence for coronavirus, which is an indication of the level of antibodies in a population.

That combined with increased vaccination coverage "should provide some protection against a severe third wave," Swaminathan said.

"However, the unknown variables here are the appearance of a new variant and the duration of protective efficacy of currently available vaccines. Continued surveillance is important," she added.

As India eases pandemic-related restrictions, health officials are monitoring the possibility of new variants emerging.

And localized outbreaks continue to be a problem in India. Although the pandemic is on the retreat overall, the southern state of Kerala has become a major exception.

One in every five samples tested for COVID in Kerala is turning out positive, a rise from one in eight samples reported in early August. The state alone now accounts for over 60% of new daily cases in India.

"Depending upon local seropositive status, vaccination coverage, adherence to masking and social distancing guidelines, some hotspots will emerge in the next few months certainly until vaccination coverage improves," Vineeta Bal, a scientist at the National Institute of Immunology, told DW.

Hope of avoiding a nationwide third wave

Officials are hopeful that India will not experience another overwhelming surge in infections, as data shows two-thirds of the population likely have antibodies against the coronavirus, according to a serological survey conducted by the Indian Council of Medical Research (ICMR).

The survey by India's top medical body was conducted nationwide in June and July and involved 29,000 participants.

It also for the first time included 8,691 children aged six to 17 years. Half of them were seropositive, meaning that they had been exposed to the virus.

"At the levels of seropositivity seen across much of India, mostly deriving from a prior infection, but now also from vaccinations, the chances for a strong third wave are quite small," Gautam Menon, a professor of biology at Ashoka University, told DW.

Serological surveys provide data on the proportion of a population exposed to the coronavirus, including asymptomatic individuals, through the presence of antibodies that typically start appearing about two weeks after the onset of infection.

"I am therefore at a loss to understand why government predictions have been so dire, in particular the one that said that 600,000 cases per day might be expected in September or just after," Menon said.

Another top disease control expert in India also said the pandemic is on the verge of turning endemic, pointing out that a third wave of infections won't come solely because of a new variant.

"This pandemic has defied most of our predictions, but in the next six months, we will approach endemic status," Sujeet Singh, the director of the National Center for Disease Control, told Indian news channel NDTV in an interview.

According to Singh, a new variant alone cannot cause a third wave, and other factors would need to be accounted for, such as human behavior, antibodies and the upcoming festival season.

India learns to live with coronavirus

After the delta variant ravaged India during April and May, health experts are now focusing on micro-level planning to ensure that India does not end up inviting a third wave.

"We need systems in place that can track early warnings and more importantly to quickly respond to any upticks or triggers," public health expert Vikas Bajpai told DW.

While health infrastructure has improved, especially in bigger cities, and treatment of COVID patients has progressed, constant surveillance could hold the key to preventing another flare-up.

The ICMR's chief, Balram Bhargava, warned that the upcoming festivals of Dussehra in October and Diwali in November could create a conducive environment for the virus to spread and urged prevention measures.

India's vaccination rollout has been picking up pace in the last month, with over 800 million doses administered.

According to Health Ministry figures, around 64% of the eligible population have received the first dose and over 200 million people have received both.