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How and when could COVID-19 go from a pandemic to an endemic virus in Latin America?

A few months after the two-year anniversary of the World Health Organization (WHO) declaring the coronavirus a pandemic -with the consequent impact on our lives- the region is facing another challenge: the omicron variant.

The achievement of the expected herd immunity, which would close the way to COVID-19 by virtue of the vaccination of a large part of the population, seems to be far from being achieved due to various factors, including the behavior of vaccines, the unequal distribution of these and the new variants.

Therefore, everything indicates that the closest thing would be to bring the pandemic under control, which as a concept for the WHO, is declared when a contagious disease spreads rapidly in a certain population, simultaneously affecting a large number of people and countries during a period of time. specific time period. In the event of uncontrolled spread, an epidemic can collapse a healthcare system.

At a time of certain control, what was a pandemic becomes identified as an endemic disease, which means that the disease persists in a continuous or episodic way in a given area, without representing chaos for the health system.

Where we are?

The pandemic alert continues. In fact, the Pan American Health Organization has recommended prudence when it comes to celebrating Christmas and airlines in the United States they canceled dozens of trips this Friday due to the impact of omicron.

Infectious disease doctors consulted by the Voice of america they insist on complete vaccination schedules, including booster doses, to avoid new closures and waves that could impact, once again, daily life and avoid another collapse of health systems.

Experts insist that vaccination is the only option, both to save lives and to prevent the appearance of new variants.

“When they are vaccinated not only protect themselves, but protect those around them, call their friends, their family or people who may be in contact with them at a time,” he told the FLY Carlos Arturo Álvarez, infectious disease physician, epidemiologist, coordinator of COVID-19 studies at the World Health Organization in Colombia and advisor to President Iván Duque on this matter.

Álvarez points out that as long as there is a group of people that is not protected, there is “a risk that susceptible people become infected and when the person becomes infected it generates the possibility of the appearance of variants.”

Henry Mendoza Ramírez, infectious internist and general secretary of the Colombian Association of Infectious Diseases, said in an interview with the FLY that it is necessary to vaccinate adolescents, older adults with comorbidities and even children “to stop any appearance of variants”.

For the expert, it is essential to dispel myths such as those that indicate that vaccines introduce a chip, cause sterility or generate complications.

“This information that we all know as the infodemic is key that we control it,” says Mendoza, while calling for the population to inform itself with clear and truthful sources.

“The vaccination process is not a new process … it has existed for many years … We have already shown that, if we vaccinate (…) more than 70 percent of our population, it significantly reduces circulation,” reiterates the Secretary General of the Colombian Association of Infectology.

For Dr. Álvarez, the lessons learned in these almost two years of the pandemic have been many, including the demystification of measures that are not very useful. For him, complementary aspects of vaccines are the use of a mask, hand washing, good ventilation of closed spaces and social distancing.

Doctor Mendoza affirms that a key measure would be to demand the vaccination card among the community.

What to expect with omicron lurking?

Dr. Mendoza explained to the FLY that the new variant “omicron has not shown greater virulence with respect to the delta variant, the currently predominant”.

“There is no evidence of greater transmissibility. Yes, a greater ease of being infected, which alerts us very much, but a greater virulence, a greater mortality or a greater complication has not been demonstrated ”. However, he says that in patients who do have some comorbidities, complications are likely to occur.

Successes and mistakes in the region

Dr. Álvarez explains that we must be careful when comparing the countries, regarding the management of the pandemic, as he points out that the particular situation of each country depends and highlights “the resilience capacity of the region.”

For Álvarez, most countries are increasing vaccination coverage at a significant rate, which he classifies as one of “the achievements of the region.”

He explains that the expectation of vaccination in Argentina, Colombia and Brazil, even Peru, is similar. But Chile has the greatest advantage: “Its vaccination rate is an example in the world.” Dr. Mendoza agrees, and at the same time highlights in these countries the incentive to the population to achieve immunization.

Álvarez also highlights the effort to obtain an intensive care bed and diagnostic capacity in countries such as Argentina and Colombia.

“We cannot compare countries in our region with countries that have unlimited resources as happens in Europe, just to have the context, in the purchase of vaccines, for example,” clarifies the adviser to the presidency of Colombia.

Regarding health systems, Dr. Álvarez explains that the fragility of some of them and the strength of others have been shown. In this sense, the health systems such as the Colombian and Chilean ones stand out.

“In managing the pandemic, the strength of the health system, for example, has allowed people who get sick to really have very little out-of-pocket expenses. What is out-of-pocket expense? It is that both people have to pay for the care and in that, unfortunately in some countries of the region, that expense is very high as in the case of Peru, of Mexico ”, says Dr. Álvarez.

For the coordinator of COVID-19 studies before the WHO, when reviewing the work of the countries, it is necessary to take into account how many people have been infected and vaccinated.

In the case of Dr. Mendoza, although he highlights the free and intensive vaccination strategies in some countries of the region and the access to them, even at a time when immunization was barely being known in the world, the disadvantages are represented in “the disparity in accessing the vaccine ”and emphasizes the fact that some migrants were unable to access immunization from the beginning of the process, for example, in Colombia.

Public policies

Álvarez argues that leaders in the region should connect as much as possible to work together on regional and local solutions, where politics and science should go hand in hand.

“Unfortunately, in some countries in the region, the Minister of Health changed two, three, four or five times, for example. I think that this continuity and that closeness between the technical part and the political part make the difference, which I believe should be hand in hand for situations like these that we are seeing ”, says Dr. Álvarez.

For Dr. Mendoza, prevention measures can be continued without reaching closures: “We have to learn to live with COVID-19 because it is the new normal we have. Will not go away. Doing intensive enclosures of regions is not going to make this disappear ”.

The secretary general of the Colombian Association of Infectious Diseases also points out that “the pandemic must not be politicized, (nor) that it should be managed from political campaigns”, but it is an issue “that we must from the state of government.”

It suggests that governments maintain a dialogue with vaccine producers and thus take advantage of the possibilities of producing them in the region to make them more economical, make alliances between countries that have adequate fundamental technological advances with vaccine producers.

So what awaits us?

This virus will continue, it will not go away, doctors say. “What it is going to do is change us from an epidemic or pandemic situation to an endemic situation. What does this mean? That the virus continues, but it no longer impacts health systems in such a way that extreme measures such as confinements themselves have to be taken, ”Álvarez explains.

According to PAHO, more than 100 million cCOVID-19 cases were registered in the Americas since the beginning of the pandemic.

The omicron variant has already been notified in 18 American countries and territories: Argentina, Bermuda, Brazil, Canada, Chile, Colombia, Costa Rica, Cuba, Ecuador, Guadeloupe, French Guiana, Cayman Islands, Mexico, Panama, Peru, Puerto Rico, Saint Martin, and Trinidad and Tobago .

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