Sunday 25 July 2021

The Chilean contradiction: Why doesn’t the success of the vaccination stop the pandemic?

The whole world is amazed at the speed of vaccination in Chile, but no one understands why the pandemic is on the rise, with records of infections and collapsed hospitals. What is behind this apparent contradiction?

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Q24N – Something does not add up. At an impressive rate since the beginning of February, Chile has inoculated almost 30% of its population with one dose and 15% with both. The achievement of reaching one of the first places in the world ranking of vaccinated people by population is celebrated by the government of Sebastián Piñera and highlighted by the international press.

The whole world is amazed at the speed of vaccination in Chile, but no one understands why the pandemic is on the rise

Chileans are excited about the idea of ​​starting to leave the coronavirus behind.

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Despite this success, the numbers of infections, hospitalizations and deaths show a completely different reality. The country not only has one of the highest death rates from COVID in Latin America – more than 1,500 deaths per million inhabitants, with a total of almost 30,000 deaths – but it also registers the highest number of active cases in what It goes from the pandemic and a worrying upward trend.

Last Saturday marked the record of daily infections – 7084 new cases – and every day an average of 100 people die: one deceased every 15 minutes. With hospitals overwhelmed, critical bed occupancy close to 95% and health personnel at the limit, the outlook is getting worse. In the last week, Chile was the third country with the highest number of new cases per inhabitant in Latin America, after Uruguay and Brazil, according to figures from Our World in Data.

“We have not yet reached the peak. There is an increase in hospitalized in ICU, many seriously ill. The number of deaths, which were relatively stable, began to rise in the last week and infections continue to rise”, says to DW Ernesto Laval, PhD engineer in education and specialist in data communication.

“We are experiencing the worst and this is going to continue,” warns Dr. Muriel Ramírez, a specialist in public health and epidemiology, and an academic at the Faculty of Medicine of the Universidad Católica del Norte, consulted by DW. Experts fear a collapse of the The current increase in infections could impact the health care network this week, according to the Health Minister, there would only be beds until Wednesday.

What’s happening in Chile?

New patients entering mechanical ventilation are getting younger and younger. This was also the case at the peak of the first wave and it is still too early to assume an effect of the vaccine, which began with health personnel, the elderly and patients with underlying diseases.

“Vaccine coverage so far is still partial,” warns Dr. Ramírez. The protection is not immediate either. The greatest immunity is achieved after two weeks of putting the second dose, which for the first inoculated is just happening now.

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But also success – and failure – has to do with the epidemiological situation and containment measures. “Vaccines are not the only tool to control the epidemic. They are one more tool, which prevents serious disease, but not transmission. Viruses continue to circulate,” says the expert.

“Experts and studies indicate that vaccination alone is not enough. It is a strategy that must be added to others. It is also very important to continue with measures to contain the pandemic”, corroborates Laval. An article in The magazine Lancet, with models for the United Kingdom, confirms that if the strategy is based only on vaccination, the pandemic will continue to expand.

Even before vaccination began, the government began to relax measures. Appealing to mental health and seeking to reactivate the economy, he gave vacation permits that left a trail of infections in the most visited areas. The shopping centers continued to operate, the casinos opened and in March the return to classes generated sources of contagion, to which was added the difficult distance in public transport.

Mass vaccination began when there was a very high level of contagion, a consequence of increasingly lax containment measures. The first wave was never completely lowered and, as a result of the holidays, the cases multiplied. And while Israel maintained containment measures alongside its successful vaccination, Chile did the opposite.

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The new variants also arrived, observes Dr. Ramírez: “Unfortunately, the government did not close the borders and this allowed the most dangerous variants from Europe and Brazil to enter, which could explain the rise in recent weeks.”

From overconfidence to triumphalism

Chile began vaccinating with a small batch of Pfizer-BioNTtech in December, but the massive campaign started with CoronaVac, from the Sinovac laboratory, with which it has an agreement for 10 million doses. The rapid acquisition was possible thanks to efforts by the Catholic University (PUC) to carry out the phase three study, to which the Confederation of Production and Commerce (CPC) contributed 1.6 billion pesos (1.8 million euros).

Chile authorized the emergency use of CoronaVac on January 20 and began inoculating on February 3. Before China even approved it for use in their own country. There, unlike Chile, it is only authorized for people under 60 years of age.

Thanks to the State’s primary health network, the country has been able to vaccinate at record speed. But success has put the need to maintain preventive measures in the background. “The strategy of having the vaccine has been spectacular, but let’s look at the results, at the number of people who are suffering and dying. We had all the signs, it should be said that this is serious, so that personal measures are taken. From a health point of view, it is totally counterproductive to convey a message of success, ”says Laval.

The vaccine would prevent a serious disease and with it the risk of dying, but not completely the contagions. The Sinovac laboratory has not yet published the final phase three study indicating the effectiveness of its vaccine. The most recent information provided by the PUC indicates that, after two doses, antibodies were found in 90% of those inoculated, but it is not known at what level. According to preliminary reports, in Brazil it would have registered an efficiency of 50% and in Turkey of 83%.

At the current rate, Chile should have 70% of its population fully vaccinated in 67 days, according to the Time to Herd site. But depending on the efficacy of the vaccine and current contagion levels, the long-awaited herd immunity could be delayed. “There are still unknowns about how the vaccine that we are applying in Chile is going to behave and there is a lack of surveillance for new variants,” Laval observes.

Chile has vaccinated 30 percent of its target population with one dose. But the impressive speed has not yet translated into a drop in infections.

Hospital collapse and elections in doubt

“We are with a very high ICU occupancy level, many patients under the age of 60 are arriving. At this rate critical patient units can become saturated and mortality increases,” warns Laval. These are the highest levels in the entire pandemic: 2,200 Covid-19 patients in the ICU and fewer than 200 critical beds remain available nationwide.

Doctors call for extreme care, because not only are the beds running out, but the human capacity for attention is reaching the limit.

The situation also jeopardizes the holding of the next elections on April 11, in which Chile elects members of the unprecedented Constituent Convention, mayors, councilors and governors. As a first measure, it was decided to carry out the process in two days, but voices arise calling for its postponement to ensure sanitary conditions and greater participation.

Elections in doubt.

Risk of a possible Chilean variant

Experts stress that there are no immediate effects and that today’s actions – confinement and vaccination – will be seen in weeks. For its part, the government is putting more communes in quarantine and finally ordered control and isolation measures for travelers entering from abroad. He also proposes to recruit health personnel from students and retired doctors.

“I am very concerned about the situation. At the same time that we are vaccinating, we have a very large increase in infections and that combination is not good, because it makes the viruses tend to defend themselves and mutate. I would not be surprised if the situation continues like this we can have a Chilean variant ”, alerts Dr. Ramírez.

“There is a great success that the vaccine is the only solution and it is not. This will be controlled with public health measures and even beyond, which have to do with an improvement in the quality of life of people, because it affects more those who live in overcrowding, poverty or malnutrition. There has to be a more social outlook on how to face the epidemic and not just biomedical “, proposes the specialist.

Asked by DW, Dr. Sandra Cortés, health worker and academic at the Faculty of Medicine of the Catholic University, agrees: “If we put all our hopes only in the vaccine, we are going to go through successive vaccination campaigns of very high cost. strategy cannot rest only on this pillar, it has to be based on cutting off the transmission chain and with comprehensive social and economic measures ”.

Data and public health experts warn that vaccination alone cannot control the pandemic and can give a dangerous sense of security.

The specialist calls attention to how the high number of deaths has been normalized and the need to take into account the impact on the population: “We are going to have people with sequelae, even disabling, and an aggravated mental health crisis, also in the families of the health teams. Many have gone months without seeing their parents or children. ”

“Our task is to educate, that they know what we have learned and what we have failed in. We are a country that has resources to spend on this, but an unequal country. Public health shows that prevention and containment is cheaper and safe. lives ”, emphasizes Dra. Cortés.

“The case of Chile will be in the sights of many countries that also have the hope that vaccination can be the silver bullet that allows us to get out of the crossroads we are at,” says Laval. Government progress and personal commitment will be key to amend the course.

Read the original article in Spanish at DW.com

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