What is the state of the pandemic in Chile? ICU Experts, urgency and infectology explain the conditions that the country is going through
With these figures, Are we coming out of the most critical phase, Until now, of the pandemic? Different experts agree that yes. From their respective areas urgenciologists, intensivists and infectologists point out that the virus is in a de-escalation, that the country is entering a stage of controlling the epidemic and foresee that, thanks to vaccines, infections remain at moderate levels throughout the winter,tending to a further decline towards spring, when the entire susceptible population – only those under the age of 12 are pending- have been immunized.
But they warn, yes, that an element could decompensate what has been gained so far: the action of new variants, in particular the delta, so they emphasize maintaining the closure of the borders.
"Looking at what happens in my service and the figures of the Minsal, the truth is that we are in a low of contagions. Now, I can't guarantee that it's not a pause and that we won't have a spike again because of the new variants of the virus that are appearing.", says Leonardo Ristori, head of the emergency of Clínica Indisa.
Ristori explains that the drop in infections has impacted the decline in patients hospitalized, what has allowed toplan the closure of some units intended exclusively for Covid-19 patients, emergency product, to restore its normal operation.
"Vaccination is definitely influencing, but we don't know how long the immunity will last.", the urgenciologist, who has also noticed an increase in hospitalization of patients over the age of 60: "I think this is showing that the booster dose is going to be necessary and hopefully it will be vaccinated around September.".
One threat that he sees on the horizon is the effect of variants and that they can evade the immune response. therefore, Emphasizes, "it is important to maintain a very effective border closure and high traceability of cases, to ensure that people are properly confined",
The head of the Critical Patients Center of the Barros Luco Hospital and coordinator of critical beds of the Minsal, Luis Castillo, states that the situation "is much more under control in terms of contagions and active cases. Cases arriving in ICU have been significantly reduced. Negative net income has been recorded in recent days., and to the extent that vaccination targets have been increased and met, cases of ventilated patients have been declining".
For Castillo, the pandemic is on its way to "better control" and "stabilization". In this scenario and considering the complex months that health personnel have faced., details that "we have given authorization for, in a progressive way, can make use of their holidays and administrative days, so they can rest. They have made a very large deployment to care for patients with a lot of effort and great quality".
The increase in the hospitalization of older adults that has been recorded in recent weeks - and that has ignited fears regarding a possible loss of effectiveness of the immunization schedule-, corresponds for the intensivist to the percentage that, according to studies, does not achieve a good immune response despite vaccines and that, in the case of CoronaVac, reaches 14% of people injected. He also attributes it to the phenomenon of immunosenescence, natural loss of immunity in older people.
"There is no vaccine that protects 100%, and all the more reason I believe that the authorities should aim for a third dose as soon as possible.. A decision has to be made, and I personally think it's best to vaccinate with a different mechanism of action to stimulate cellular immunity.". What's next for the next few months, assures Castillo, are relatively stabilized and declining figures. That's for sure., calls to be attentive with the action of variants and maintain a very strict sequencing of positive cases.
The head of the Emergency Unit of the Public Assistance Emergency Hospital (or ex-Posta Central), points out that in terms of numbers and inpatients, the drop reported by the Minsal coincides with the clinical scenario they have seen daily in the last week.
"The respiratory consultation has remained stable, but they are patients who do not even require hospitalization. And others with minimal support, oxygen therapy in different modalities, but not mechanical ventilation. That's the trend that's been going on.", details Jorge Ibáñez. However, points out that with quarantine openings and exits, tend to increase pictures not related to Covid as traumas, digestive bleeding, infarctions or aggravated chronic patients.
Why would this phenomenon of cases be occurring downwards, in the middle of winter, where respiratory conditions worsen? "Simply because of vaccination, it has no other explanation", assures the doctor. "Vaccination, according to the literature in international media, projective studies in relation to vaccinated patients and the protection that vaccines are giving, it is absolutely related to this loss".
Those who have been vaccinated with the CoronaVac, account, have a much lower chance of falling to mechanical ventilation, but not so to prevent contagion. And many times, vaccinated patients have respiratory symptoms that they consult, but of lesser severity.
On how stable the drop in cases is, Ibáñez projects that "we are going to have oscillations that have to do with the dynamic quarantines until September, and from there, with change of season and epidemiological profile of the other viruses that circulate, we will be able to move forward to the decrease in cases, along with the sustained increase in vaccination". Anyway the doctor believes that a third booster dose will be necessary, mainly in groups most vulnerable to the virus.
Inia Perez, Head of Infectology at Clínica Alemana
In clinical practice, Dr. Pérez confirms that "we are indeed with auspicious figures, a significant drop in cases. In the ICU that reflex is going to take a while: we must remember that the hospitalized patients are from two weeks ago. However, we have already seen a decrease in hospitalizations and consultations. We are just beginning to see the reflection of these better numbers and the wave has not yet passed, but we need the population to continue to help us so that this becomes a sustained decline".
However, explains that the virus is likely to remain circulating in the country for a long time, like other viruses such as influenza or common winter colds.
"It's not that the virus is any less infectious or deadly., rather, it tends to become endemic rather than pandemic.. Because when it's pandemic, we have a very large exposed population and everyone can get sick. When it becomes endemic, becomes part of the usual circulating viruses, like influenza, that we know that seasonally in winter it returns".
Like this, says Perez, the vaccine prevents more people from being susceptible to serious infection. "We avoid exposure based on vaccines, what are we trying to do with this virus. The significant number of vaccinated has been helping us, rather than avoiding contagion or infection, it's making cases less severe.", comments.
"We don't know what their final behavior will be over the years., it may end up being a virus like influenza and in the face of the possibility of mutations, we have to constantly revaccinate. As we have less viral circulation, we have less chance of reproducing. The better we control viral circulation, less chance that multiplying will produce mutations", concludes.
Jeannette Dabanch, infectologist of the Clinical Hospital of the University of Chile
Although cases have gone down, Dabanch is cautious about the evolution of the virus.
"I don't know if the time is going to come when the virus mutate into less harmful forms.. I don't like to call him a 'bad person', because I doubt I have the conscience. What yes, the virus is looking for a suitable reservoir to reproduce. While we manage to find the vaccines that help us, Antiviral, we must block the virus and prevent it from multiplying further", holds.
Catterina Ferreccio, epidemiologist U. Catholic and part of the Covid-19 Advisory Council
"The desire that we have worldwide is that this variant is the last and that the virus realizes that to survive it does not have to aggravate us and that it mutate to more 'benign' forms., but this just happens, the virus doesn't think", explains the epidemiologist of the Catholic University, Catterina Ferreccio.
The problem, details, is that "as there is so much multiplication of the virus in the rest of the world, continues to mutate and generate variants. When one of those mutations works for you and begins to prevail over the others, increases its predominance. And the human, In addition, it keeps moving around the world and carrying the virus back and forth.".
The latest news and concern for the scientific world? "Epsilon, that I see it worse than the delta, because in the U.S. USA. new mutations have been described for this variant that evade the response of messenger RNA vaccines, that so far have been effective in controlling transmission".
On the national situation, Ferreccio indicates that "here in Chile we are in a super good moment, with an effective R under 1. Patients infected in recent weeks, many of them, did not infect another person. When we're under that number it's because we're beating the virus.. But like that has happened to us before too., you have to be careful. For example, we already know that the P.1 caused us the outbreak that started in the summer and it was very late when the border was closed in April".