RIO DE JANEIRO, BRAZIL – 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 per population is celebrated by the government of Sebastián Piñera and highlighted by the international press. Chileans are excited about the idea of beginning to leave the coronavirus behind.
Despite this success, the figures for infections, hospitalizations and deaths show a completely different reality. The country not only has one of the highest COVID mortality rates in Latin America -more than 1,500 deaths per million inhabitants, with a total of almost 30,000 deaths-, but also registers the highest number of active cases so far in the pandemic and a worrying upward trend.
Last Saturday marked a record number of daily infections – 7,084 new cases – and every day an average of 100 people die: one death every 15 minutes. With hospitals overflowing, critical bed occupancy close to 95% and health personnel stretched to the limit, the outlook is worsening. In the last week, Chile was the country with the third 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 the number of people hospitalized in ICU, many of whom are seriously ill. The numbers of deaths, which were relatively stable, began to rise in the last week and infections continue to rise,” Ernesto Laval, an engineer with a doctorate in education and a specialist in data communication, tells DW.
“We are living the worst and this is going to continue,” warns Dr. Muriel Ramirez, a specialist in public health and epidemiology, and an academic at the Faculty of Medicine of the Catholic University of the North, consulted by DW. Experts fear a collapse of the health system. The current increase of contagions could impact the healthcare network this week. According to the Minister of Health there would only be beds until Wednesday.
What is happening in Chile?
New patients admitted to mechanical ventilation are increasingly younger. At the peak of the first wave this was also the case and it is still early to assume an effect of the vaccine, which started with health personnel, older adults and patients with underlying diseases.
“Vaccine coverage so far is still partial,” warns Dr. Ramirez. Protection is not immediate either. The greatest immunity is achieved two weeks after the second dose is administered, which for the first inoculants is only happening now.
But success – and failure – is also related to the epidemiological situation and containment measures. “Vaccines are not the only tool to control the epidemic. They are one more tool, preventing severe disease, but not transmission. The viruses are still circulating,” 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,” says Laval. An article in The Lancet, with models for the United Kingdom, confirms that if the strategy is based on vaccination alone, the pandemic will continue to expand.
Even before vaccination began, the government began to relax the measures. Appealing to mental health and seeking to reactivate the economy, it gave vacation permits that left a trail of contagions in the most visited areas. Shopping malls continued to operate, casinos opened and in March the return to school generated new sources of contagion, to which was added the difficult distancing 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 never completely subsided and, as a result of the vacations, cases multiplied. And while Israel maintained its containment measures alongside its successful vaccination, Chile did the opposite.
New variants also arrived, notes Dr. Ramirez: “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 of the last few 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 the efforts of 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 inoculation on February 3: even before China approved it for use in its own country. There, unlike in 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 the success has put the need to maintain prevention measures on the back burner. “The strategy of having the vaccine available 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 was appropriate to say 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 serious illness and thus the risk of death, but not completely prevent infection. The Sinovac laboratory has not yet published the final phase three study indicating the effectiveness of its vaccine. The most recent information provided by 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 registered an efficacy of 50% and in Turkey 83%.
At the current rate, Chile should have 70% of its population fully vaccinated in 67 days. But depending on vaccine efficacy and current infection levels, the desired herd immunity could be delayed. “There are still unknowns about how the vaccine we are applying in Chile will perform, and there is a lack of monitoring for new variants,” notes Laval.
Collapse in hospitals and elections in doubt
“We have a very high level of ICU occupancy; many patients under 60 years of age are arriving. At this rate, critical patient units could be saturated and mortality could increase,” warns Laval. These are the highest levels of the entire pandemic: 2,200 Covid-19 patients in ICU and fewer than 200 critical beds available nationwide.
Doctors are calling for extreme caution, as not only are beds running out, but the human capacity for care is reaching its limits.
The situation also jeopardizes the upcoming elections on April 11, when Chile will elect members of the unprecedented Constitutional Convention, as well as mayors, councilors and governors. As a first measure, it was decided to carry out the process in two days, but there are voices asking for its postponement to ensure sanitary conditions and greater participation.
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 placing more communities under quarantine and has finally established control and isolation measures for travelers entering from abroad. It is also proposing to recruit health personnel among students and retired doctors.
“I am very concerned about the situation. At the same time that vaccination is taking place, we have a very large increase in contagions and that combination is not good, because it makes the viruses tend to defend themselves and mutate. I would not be surprised that if the situation continues like this we could have a Chilean variant,” warns Dr. Ramirez.
“There is a great escapism (believing) that the vaccine is the only solution and that is not the case. This is going to be controlled with public health measures and even beyond that, which have to do with improving people’s quality of life, because it affects more those who live in overcrowded conditions, in poverty or with malnutrition. There has to be a more social approach in the way of facing the epidemic and not only biomedical,” proposes the specialist.
When consulted by DW, Dr. Sandra Cortés, a health specialist and academic at the Faculty of Medicine of the Catholic University, agrees: “If we place all our hopes only in the vaccine, we will go through successive vaccination campaigns at a very high cost. The strategy cannot rest only on this pillar, it has to be based on cutting the chain of transmission and with integral social and economic measures.”
The specialist draws 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 incapacitating ones, 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, to let them know what we have learned and where we have failed. We are a country that has resources to spend on this, but an unequal country. Public health shows that prevention and containment is more economical and saves lives,” stresses Dr. Cortés.
“The case of Chile will be in the sights of many countries that also hope that vaccination can be the silver bullet that will allow us to get out of the crossroads we are at,” notes Laval.
Will the measures implemented by the government and personal commitment be key to correcting the course?
Source: DW