QCOSTARICA – How has Costa Rica done during its first year in the fight against covid-19? If you ask the demographer Luis Rosero Bixby, he will say that the most important indicators to determine it are related to deaths.
“We can measure the severity of the pandemic if we see how deaths have behaved in different circumstances,” the researcher from the Central American Population Center of the University of Costa Rica (CCP-UCR) told La Nacion this Thursday.
There are two key values to understand the behavior of deaths.
The first is the fatality rate, which is the percentage of people who become infected with the virus and die. In Costa Rica, the fatality rate of covid-19 is 1.37%. That is, 1.37% of the people confirmed infected with covid-19, died.
The second is the mortality rate, which is defined as the number of deaths in a place in relation to its number of inhabitants. In Costa Rica, mortality from covid-19 during these 12 months has been 538 per million inhabitants.
What does this mean?
For example, Rosero compared the mortality of Costa Rica with that of the other Latin American countries: all the Spanish and Portuguese-speaking countries of the Americas and the Caribbean, as well as Spain and Portugal.
The analysis took into account 20 countries. Of these, Costa Rica ranked fifth among the five with the lowest mortality: Cuba, with 20 deaths per million inhabitants; Uruguay, with 150; the Dominican Republic, with 350; El Salvador, 370, and Costa Rica, with 538 per million inhabitants.
“Costa Rica is in the group of the five best with the lowest accumulated mortality. In short: in the country, the severity has been lower than in the rest of Latin America. We have done well, but we could have done better, as evidenced by the data from Cuba and Uruguay,” said the scientist.
Now, if we take into account only 2021, Costa Rica ranks third with the lowest mortality, after Cuba and Uruguay.
The situation is very different in the five with the highest mortality: Mexico, with 1,800 per million inhabitants; Peru, 1,620; Panama, 1,500; Colombia, 1,350, and Bolivia, 1,340.
“If we compare ourselves with Mexico, Peru or Panama, the mortality of Costa Rica is one third or less. It is an important achievement,” Rosero stressed.
Impact over time
Rosero highlights four moments in the behavior of deaths during this past year.
- From March 2020 to mid-June 2020: the pandemic was contained, the number of deaths was almost nil and weeks passed without any.
- From July 2020 to mid-October 2020: there is the greatest expansion of the pandemic measured by mortality. “The mortality curve rose rapidly,” Rosero observed.
- From mid-October 2020 to the end of January 2021: a period of maximum mortality with “some valleys”, when there were between 300 and 500 deaths per month, between 10 and 20 per day.
- February 2021 and today: contraction, deaths fall to less than eight a day.
Rosero explained: “Costa Rica was very successful until July (2020), while other countries (already) had high rates. When there was a rise in deaths, it was not as steep as in other countries.”
In terms of both fatality and mortality, the older by age, the higher the number of deaths.
“A person 90 years of age or older has more than a 30% probability of dying if they are diagnosed with covid-19. Those under 40 have almost zero fatality (…); the increase begins after the age of 70,” said Rosero.
For him, the problem with lethality is that not all covid-19 cases are taken into account because not all are reported. This is difficult with a person with mild symptoms and asymptomatic.
Regarding mortality, 2% of those over 90 years of age have died associated with covid-19. This also decreases according to age: below 50, it is less than 0.1%.
Of the deaths, 30% occur in people over 80 years of age; Only 10% are seen in those under 40.
“This is important: it tells us that when all people over the age of 58 are vaccinated, 80% of deaths could be prevented. Just by vaccinating everyone over 80 years of age, 30% could be avoided,” said Rosero.
This explains Costa Rica’s decision to use 58 as a start point for group 2 of the vaccination program.
Curve of reported cases
Costa Rica has had a particular evolution compared to other countries.
“If nothing had been done, and measures had not been taken, the curve would have risen very quickly and we would have had, in a matter of two or three months, 16,000 cases a day. This would have been catastrophic, we would have had about 20,000 deaths in three or four months,” exemplified Rosero.
“The curve that we really had, with all the measurements, peaked close to 1,500 cases in September,” he said
The wave here was characterized by an increase from June and a plateau that reached its peak in September. This maximum was in the form of a sustained plateau and fell sharply in January.
“ Costa Rica’s curve is peculiar. We have had only one wave, other countries have had two and three,” added Rosero.
The wave of infections in the country came late, a situation that the specialist describes as “very good” since it gave time to prepare medical services.
The contagion rate, or R rate, has had a fluctuating behavior.
This represents how many people a carrier of the virus could infect, on average. If it is equal to 1, the infections remain constant; if it is greater than 1, the cases will go up, and if it is less than 1 they will go down.
“It’s like the car’s speedometer; It doesn’t tell me how long I’ve been driving or how much further I have to go, but it does tell me the speed (at which I am going),” Rosero said.
Initially, the rate was above 2, but restrictions were quickly imposed and this managed to lower it below 1.
As measures were lifted and case traceability was lost, the R rate rose again. In May it rose again.
The recommendations for the use of masks lowered the index again at the end of June.
It rose again in September, but shortly after the mask became mandatory in all enclosed spaces. In October it fell again.
Finally, this January the biggest drop was recorded.
“Our problem was that we allowed the rate to stay above 1 for too long, because we lost traceability of cases and because we took too long to recommend the masks,” he stressed.
What will happen in this second year of the pandemic?
In the immediate future, Rosero foresees that the country will stabilize around 300 cases a day (slightly lower than the current cases) and will not decrease any further.
The specialist does not rule out waves during this 2021, but not with so much impact.
Will we get to her immunity this year?
This would be obtained if 80% of the population (four million) are immunized, either by vaccination or by natural infection.
Rosero remains cautious, as much depends on the speed of the vaccination process.
“If it is possible to have a good vaccination rate, if an enormous effort is made, in the second semester we should be vaccinating 150,000 weekly, with that we could have a herd immunity by the end of the year,” he concluded.
The numbers today
The Central American Population Center puts the R or contagion rate on March 3, 20201, at 0.94.
The Ministry of Health reports the accumulated confirmed cases (as of March 04, 2021) is 206,293, of which 180,829 are Costa Ricans and 25,464 foreigners.
A total of 186,093 (90%) people have recovered and 17,371 (8%) people continue actively infected.
The number of deaths is 2,829 of which 1,774 are men and 1,055 women, ranging in age from 2 to 101. Health authorities stopped providing publicly numbers of deaths by age.
Currently, 237 people are hospitalized, of which 133 are in an Intensive Care Unit (ICU).