Wednesday, 25 November 2020

Epidemiologists assure that we’ve reached the peak, but descent will be very slow

This pandemic ceiling is not shaped like a peak but rather like a plateau, from which it will gradually descend; but if the measures are neglected it can go back up

QCOSTARICA – At the end of June, the Pan American Health Organization (PAHO) revealed the projections of the Institute of Health Metrics and Evaluation (IHME) of the University of Washington on the behavior of COVID-19 for the countries in the region.

Masks are one of the measures to minimize the risk of contagion. These must be combined with other actions, such as hand washing and maintaining social distancing with people who are not from our family nucleus. Photography: Rafael Pacheco / LN

These projections indicated that Costa Rica would be one of the last countries to reach the top of the pandemic wave; I would do it in October and after that, it would start to go down.

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Today, at the end of the month, the questions arise: Was it fulfilled? How? What will happen now? Why do we feel like we’ve been at a peak for months?

In its report, La Nacion, spoke with three specialists in Epidemiology and Public Health to trace the dynamics of the virus in the country: Juan José Romero, coordinator of the Master’s Degree in Epidemiology at the National University (UNA); Luis Rosero, demographer, public health worker and researcher of the Central American Population Center of the University of Costa Rica (CCP-UCR); and Ronald Evans, physician, epidemiologist and researcher at the Hispano-American University.

All three agree on one thing we have already reached the crest of the wave, but this, unlike a pointed tip, has characteristics of a plateau, and the descent, far from looking like that of a slide or a roller coaster, has a very low descent, barely noticeable. And if measures to avoid or minimize transmission are neglected, this could be reversed.

The peak, they say, was reached before October.

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“We reached the peak on September 15, more or less,” Rosero said.

“It happened at a level where many other neighboring countries began to experience that peak, when they were close to 250 cases per million inhabitants. What is happening in Costa Rica is that we have become stagnant. We can say that there is a reduction in the contagion rate but it is very, very slow, in which we sometimes experience slight increases,” he added.

“The downside is very, very, poor. I would say that, generally speaking, we are stagnant. We have been “flattened” for a month and a half, on average we have very similar numbers of cases. We are in the highest part of the wave, a surfer would be happy there it has a crest to continue pulling,” Romero exemplified.

Evans is of the same opinion: “We are experiencing peaks and plains, but in a very mild way. It can be said, however, not with certainty, but with a certain level of security, that we have already reached the ceiling. As expected, we were one of the last countries in the region to reach it, but we arrived at it and began a very gradual decline.”

The peak of the COVID-19 wave in Costa Rica

Apparent stability

If the data on cases reported during the month of September are compared with the first 30 days of October, we can see a reduction in cases of 3.97%.

This decline became more evident as of October 11, when it began to fall a little more, and, a week later, the reduction was 6.2%. With the data available to date, it is expected that this week will close with an 8.4% reduction compared to the previous one.

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However, for Romero, this is an “apparent stability”, since no active case searches are carried out.

“We are seeing what cases are reaching health services. Many may not be arriving,” he stressed.

“The social and economic situation influences. If a person was out of work for five or six months and gets a form of income and begins to feel bad, it is possible that, for fear of losing their job, or not having a long disability that cuts their income. That person could ’empastillarse’ (taking an excess of drugs) to lower the temperature and take maximum care not to infect others, but eventually, they could infect,” he added.

Evans agrees: “in Costa Rica, we should already have about 300,000 to 500,000 cases, we only see those that are reported, but in reality, there are many more”.

The three interviewees agree that the country should carry out more testing and go out in search of cases instead of attending to those that arrive. However, they recognize the limitations of the health system.

Being in an active community transmission scenario also makes contact tracing difficult.

Second wave or the second phase of a first wave?

On June 8, the Minister of Health, Daniel Salas, stated that we were facing a second wave of the pandemic.

For the three interviewees, this is not the case. Rather, there was a first phase in which we were very stuck “to the ground” and in the middle of the year the real wave began, of which we are currently at the top.

“I think, in effect, that this is not a second wave, but rather the climax of the first,” Evans said.

Romero adds: “there was a first phase where the cases were very few and now is when we are really on a wave. Unlike other countries, we are maintaining super long waves.”

Rosero is even more forceful: “in March and April, there was no wave at all. It was an outbreak, not a wave as we are living it now. It’s like when we go to the sea, the waves don’t feel on the shore, stuck to the sand, they feel deeper when we see them rise.”

Of course, the three interviewees indicate that, as is normal in a pandemic, we will have a second wave after this first. What cannot be determined is its strength or aggressiveness.

Changes by regions

The specialists consulted point out that the virus has also changed its dynamics and there are places where transmission was rather lowered by a kind of herd immunity that we do not know for how long it will remain.

In some regions of some districts many people have already fallen ill and recovered. They can no longer be contagious and, for the next few months, they would not be contagious either, which reduces transmission in the area.

“This is being seen in areas such as La Uruca or Pavas, where the virus was strong in recent months, although contagion never occurs homogeneously throughout the district, human interactions are not homogeneous,” said Rosero.

Romero specifies: “What has happened in 18 districts of the Greater Metropolitan Area (GAM)? The number of cases dropped, in part because there is some immunity. Perhaps it is only 30% of the district’s population exposed to infection, but there are also ‘contact bags’, people do not go around the entire district, they usually always live with the same people. There will be areas of Pavas where there is already a kind of herd immunity and other areas where, in the event, one or another case has been seen in the pandemic so far.”

On the other hand, areas where such proliferation of the virus had not been seen so much before, such as Puntarenas, Limón, or some parts of Guanacaste are showing higher growth, because they had not previously been exposed.

The good news: hospitalizations

Among the good things that the interviewees point out is that even though now there are more freedoms, people have become more lax, and more is allowed than previously, the number of hospitalizations rather registers a drop.

This Thursday, for example, there were the lowest numbers of admissions since September 1 and the lowest numbers of people in intensive care since September 3.

“This is great news. Hospital morbidity and mortality has become much lower. We are seeing casualties both in the ward and in the ICU, this may respond to the type of people who are getting sick and who resist the virus better, but also to the fact that, after months of facing it, health professionals already know how to better deal with the cases so they don’t get complicated,” Evans said.

Concerns: Christmas and New Year’s Eve

The specialists consulted are concerned, however, that this downward trend will be affected by the upcoming Christmas and New Year celebrations. Especially since these are times when people are used to getting together and with different groups of people to share.

This begins before when people go out to public places to buy gifts or Christmas decorations.

“People are already fed up with the dynamics in which the virus has them,” Romero said.

Rosero adds: “very probably after Christmas, a ‘rebrote’ (new outbreak) will be seen unless we are very careful, but we must all work on this.”

Evans emphasizes that our attitude depends on how the post-December rebrote looks.

“There is no prospect that this will change to two months until Christmas. We will continue without a vaccine, without a definitive cure and without specific treatment. We will have the same weapons that we have now: hand washing, distancing, masks,” said the epidemiologist.

“We cannot expect to spend a Christmas like the one we did a few years ago, at least not on the level of big parties. This can be very expensive for us. It cannot and should not be an option,” he added.

Rosero thinks the same: “the key is to avoid family gatherings. A meeting of 10, 15 or 20 people can be a source of contagion. We must be careful and keep our get togethers as small as possible.”

“This (virus) is going to last, it is necessary to be patient. The masks will accompany us in 2021, but the more that is done now, the sooner we will be able to return to the big gatherings, for now, we must stay in small groups,” he concluded.

Source: La Nacion

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Q Costa Rica
Reports by QCR staff

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