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Recently, the word "endemic" became a key buzzword in Singapore.

At the end of May 2021, Prime Minister Lee Hsien Loong said he did not expect Covid-19 to disappear, but rather to become endemic, and "remain with humankind".

Health minister Ong Ye Kung later echoed this view, stating that Covid-19 will likely become endemic, just like influenza.

Multi-Ministry Taskforce co-chair Gan Kim Yong also said that Singapore will be able to lift "practically all social and workplace restrictions" when Covid-19 becomes endemic in Singapore.

Basically, if you get a dollar for every time the word "endemic" has been in the news, you would get rich sooner rather than later.

But what does it actually mean for Covid-19 to be endemic in Singapore?

Pandemic vs endemic

On March 11, 2020, the World Health Organisation (WHO) officially declared Covid-19 a pandemic, after the virus spread to over 100 countries globally.

Like the word "endemic", the word "pandemic" also became a really popular word in 2020. So much so that it may come as no surprise that it became Merriam-Webster's Word of the Year for 2020.

To the layman, WHO's decision to label Covid-19 a pandemic probably sounded like a serious decision, although it is likely that many of us may not know what it really means for a disease to become a pandemic.

"Pandemic" = exponential growth over a wide area

According to Columbia University, a pandemic is declared when a disease's growth is exponential, and when a virus covers a wide area, affecting several countries and populations.

Unlike an epidemic (a pandemic's little brother), pandemics must also be contagious, as this is a key factor in the exponential growth of a disease.

Contrary to popular belief, what makes a pandemic has nothing to do with the severity of the virus, population immunity or the severity of the disease.

In other words, although many famous pandemics, such as the Spanish Flu or the Black Death took millions of lives, the lethality of a disease is not actually a requirement for it to be considered a pandemic.

In theory, a disease that simply gives you an itchy nose could perhaps be considered a pandemic, as long as its growth rate skyrockets and starts spreading all around the world.

"Endemic" = consistent presence in a particular region

On the other hand, an endemic (give yourself a dollar) disease is one that is consistently present but limited to a particular region.

An example of an endemic disease would be Malaria, which is consistently present in certain countries and regions like Africa.

A disease would often be considered endemic only if the rate of spread remains predictable.

In other words, this is what Singapore is aiming for: Not hoping for no Covid-19 cases at all, but being able to predict the number of cases over the long run — in other words, control it.

Dengue fever is considered endemic in Singapore

But what does it mean to live with an endemic disease in Singapore?

There are some who may criticise the government's new stance on Covid-19, preferring the government to focus on eradicating the virus altogether, rather than settling for its constant presence within the country.

However, many of us may not realise it, but we already live with a number of endemic diseases in Singapore.

For example, Singaporeans have been living with dengue fever for a long time.

While the government consistently makes an effort to keep the local mosquito population low, transmission still occurs regularly every year, and in 2021, there was even a spike in the number of new cases.

So how do Singaporeans deal with dengue fever?

By taking precautions, and developing a culture of cleaner living habits.

Members of the public are encouraged to prevent mosquito breeding by throwing out stagnant water, and using mosquito repellent, especially if they live in dengue cluster areas.

Those showing symptoms of dengue, such as a sudden onset of fever and skin rashes, are also advised to see a doctor early, in order to be diagnosed.

While there is no specific treatment for dengue fever, those who are infected receive supportive treatment such as painkillers, or electrolyte replacement and blood transfusions for severe cases.

An international example of an endemic disease would be HIV.

HIV (human immunodeficiency virus) is considered endemic in many parts of Sub-Saharan Africa; there's currently no vaccine available for the virus.

As such, personal responsibility is important for those living in regions where HIV is endemic: People are encouraged to avoid unprotected sex, and to be upfront about their condition to potential partners.

People with HIV receive treatment in the form of antiretrovirals which suppress (instead of treat) the disease. Those who are at higher risk of contracting the disease are encouraged to undergo frequent testing.

Looking at dengue and HIV, we can see how endemic diseases are kept under control: Through supportive medication and behavioural interventions.

Similarly, if Covid-19 becomes endemic in Singapore, Singaporeans would have to continue doing some things in order to prevent the spread of the virus.

For example, even if mask-wearing rules are removed in the future (one can hope!), we should wear a mask or refrain from going out if we display symptoms of Covid-19, just as a precaution.

We should also get tested immediately, to ensure that the spread of the virus is limited.

Companies might start adopting more flexible working arrangements (like remote working for instance) permanently to cater to workers who need to work from home if they're unwell.

In the long run, it's likely in the interests of employers to be more flexible. After all, a single Covid-19 case going to the workplace could cripple their manpower for weeks.

Vaccines would play a huge role

While vaccines are currently unavailable for both dengue fever and HIV, they are available for Covid-19.

Historically, mass vaccination campaigns have been pivotal in dealing with the spread of infectious diseases.

Tuberculosis (TB) used to be a huge public health threat in Singapore in the early 20th century, with overcrowded and unsanitary housing being a key factor for the spread of the disease.

After World War II, the increasing prevalence of TB among young children led the government to begin a mass vaccination campaign for those aged 18 and below.

It became part of the national childhood-immunisation program, and would be administered at birth.

Apart from the TB vaccine, young children in Singapore are also given various other vaccinations, including for Hepatitis B, MMR (measles, mumps, rubella) and even influenza.

With this in mind, if Covid-19 continues to be endemic in the future, it may not be surprising for Covid-19 vaccines to be part of Singapore's National Childhood Immunisation Schedule, in order to protect children from a young age — provided of course, that the vaccines are found to be safe for children.

For adults, regular booster shots may be on the menu, although it is currently unclear how often that may be.

However, one must remember that the path to making Covid-19 an endemic in Singapore is not a race.

Reaching an endemic status is not the end goal

After all, reaching the point where Covid-19 becomes endemic isn't even a destination, as endemic diseases can always turn back into pandemics.

Even if Singapore successfully reaches an endemic state, things can easily turn around, especially if other countries do not face the same success in dealing with the virus.

In addition, new strains of Covid-19 could cause new outbreaks, similar to how the Delta variant has caused massive spikes in cases in many countries around the world.

PM Lee previously described what the "new normal" may look like, with borders reopening with certain countries, and Singaporeans being able to go out without masks, at least outdoors.

While we may be tempted to race towards the endemic finish line at all costs, we must remember that it isn't the end goal.

In the near future, if Singaporeans do not continue vaccinating, and taking precautions seriously, stricter regulations may be reintroduced at a moment's notice.

And having been through all these restrictions already, having a taste of freedom just to have it taken away would honestly just suck.

Mothership Explains is a series where we dig deep into the important, interesting, and confusing going-ons in our world and try to, well, explain them.

This series aims to provide in-depth, easy-to-understand explanations to keep our readers up to date on not just what is going on in the world, but also the "why's".

Top image via Wikipedia.