The third wave of COVID-19

The goal of managing any pandemic is to achieve a steady state of new cases or, viewed another way, to achieve a linear increase in total cases instead of the devastating exponential growth that has been seen in the rising parts of the waves.

It is not to give hair to the soup, which is very thick, but how did Iceland, New Zealand, Australia, Taiwan, South Korea and other countries do it to contain the pandemic? Politicians put aside their addictive role and were guided by those who know about science and health, especially public health.

And the strategies for managing the pandemic have been restrictions on entry from abroad, quarantines, mass examinations, traceability, isolation, with strict monitoring that allows the adoption of sanitary measures, such as sanitary residences, adequate and coherent communication policies, and financial aid. These measures contribute to lowering the number of daily cases to a level such that they are within the traceability possibilities of 90 +% of the close contacts of all positive PCR cases, thus applying the virtuous triad of test-traceability and isolation ( TTA). This experience, referring to this pandemic, was known in the middle of the first wave of 2020. The precarious application of TTA in our country and the lack of interest in preparing an epidemiological scenario of reduced infections that allow the feasibility and effectiveness of TTA, largely explain part of the current crisis in our country.

And could it have been made in Chile? Likewise, the resources necessary to maintain social assistance were spent, as well as individual pension savings, and the second or third wave of infections continues to be spent on this. Primary health care or local clinics, already diminished for economic reasons, was only activated in the middle of the first wave. Will it be possible now? Primary health care (Cesfam) is more than busy in the vaccination program, which has been relatively successful. What if practical activities in the field of students in the health area in their later years are incorporated into the traceability system? Something that has been done in other countries. Because this pandemic does not stop, especially when it is estimated that a significant percentage of infections would be due to the strain from Manaus (Brazil) that is very infectious, and for which we do not have specific PCR to know its penetration into our territory.

It is becoming increasingly clear that the five areas of measures associated with effective management of the pandemic (and any pandemic) appear to be, in addition to vaccination:

• Mandatory mask in public places with poor ventilation and ventilated places with people passing within two meters, frequent hand washing with soap or use of alcohol gel, and ventilation with clean air from closed places.
• Early and effective action to control borders and monitor traveler arrivals
• Testing, monitoring and location of all suspected cases of infection (TTA).
• Social assistance for those in quarantine to avoid increases in population density and risk of infection, and thus contain the virus
• Effective leadership and consistent and timely public messages.

Regarding vaccination, it is not clear that it contains the infections, although it does seem to be effective in reducing deaths⁵.

The goal of managing any pandemic is to achieve a steady state of new cases or, viewed another way, to achieve a linear increase in total cases instead of the devastating exponential growth that has been seen in the rising parts of the waves. New cases are almost inevitable due to escapes from control at airports and other entry points to the country, and escapes from the TTA system. That is why it is so important to improve the ability of the TTA system to contain the spread of infections, as the Medical College has said. Depending on the capacity of the TTA and the health system there will be a number of cases that will fluctuate around a value. And it is the political system that then has to decide what is the ethically acceptable value or if it improves the TTA to avoid unnecessary deaths and how much expense it is possible to do.

I don’t see the government making this strategic approach, or if they tried, it didn’t work for them. We have seen inconsistencies and absurd ideas, such as unsuccessful use of dynamic and incomplete quarantines, talking rashly about health passports and herd immunity, “talking about the virus, good person.” But also the discarding and not taking advantage of open spaces for art and sports, successful overvaluation of the vaccination plan, ignorance of the realities of poverty and overcrowding, discontinuity in aid policies -such as the delivery of food-, lack of transversal policies of support, and mediocre use of digital resources that facilitate crisis management.

All this has been the unsuccessful “fight” to contain the pandemic in Chile. And have there been adequate measures? Yes, that’s why the first wave fell, and the second wave was soft, but the hasty success, the prevalence of economic criteria and other mistakes such as universal vacation leave, opening of gyms and religious ceremonies in phase 2 and others, have us with the third wave over.

We will have a COVID-19 pandemic for a while if we mainly resort to confinement and increase in ICU beds, due to lack of epidemiological and political criteria! That works, but even more so in the context that I have mentioned, referring to the feasibility and effectiveness of the TTA.

And the five areas that I mentioned above have to be applied in a coordinated and intelligent way. A cocoon as an example: at least in Viña del Mar and Quilpué (and Santiago due to comments from social networks) there is little or no control of the quarantine since it was implemented last week.

If the government and politicians do not succeed, we will not only have waves, if not, “the Perfect Storm”.