Covid-19: cases rise, but they warn that there could be more, because there are fewer tests

Last week, after the publication of LA NACION, voices were added, including the official ones, to report that the infections of Covid-19 and what to do reinforce care to reduce risks in this cold season. But if these voices agree on something, it is in drawing attention to the underreporting of cases. The population, they warn, stopped going to test and the figures, therefore, they are limited to diagnoses in patients who are hospitalized, those who consult in hospitals or travellers.

“We are advancing in an epidemiological transition. This [por la pandemia] It’s not over,” he says. Hugo Pizzifull professor at the Faculty of Medicine of the National University of Cordoba (UNC). “The virus wants to continue to persist and is doing everything possible to adapt to overcome all the obstacles we put in front of it, such as prevention measures and vaccination,” he continues.

He was one of those voices that last week joined in confirming this new rise in infections. It was after the Buenos Aires Minister of Health, Fernan Quirosreferred in dialogue with THE NATION to the “transition terrain” in which the pandemic is, with expected increases in mild to moderate cases.

While cases rose in the last seven days for the second week in a row (11,443 accumulated between April 25 and last Sunday)testing decreased again after a 4.1% rebound in the last week of April according to official records that it monitors LNData. This last week, diagnostic tests fell by 16%, while positives rose by 7.9% until the last available official update of notifications and after the rebound of 35.3% the previous week.

“When we talk about underreporting –continues Pizzi– it is because there are people with similar, seasonal pathologies, such as the flu, who do not come to be tested. Many, who are vaccinated against Covid, take the infection in a very labile way and do not record it or those who pass it like a flu rest at home for a few days and simply go back to their tasks.

THE NATION tried to consult the Ministry of Health of the Nation in this regard, but until the closing of this note there was no response from their spokespersons.

The last wave, with the appearance of the variant omicron, had a peak of more than 150,000 positives in mid-January, already with the change in criteria for swabbing in December due to the long lines that formed at the testing points. This modification, which incorporated the epidemiological clinical diagnosis (by symptoms and close contact, without testing), also favored underreporting, as LA NACION demonstrated at the time.

“According to data from the national epidemiological surveillance system, the Covid-19 virus will circulate with other respiratory viruses. This implies the need to guarantee timely diagnosis and adequate care for the most vulnerable populations and risk groups. Prevention measures are the same for all agents that cause viral acute respiratory infections, such as influenza, respiratory syncytial virus and, of course, SARS-CoV-2 “, details Zulma Ortizvice president of PAIS Group (Argentine Pact for Inclusion in Health), which brings together one hundred health professionals.

To reduce uncertainty, Ortiz, who is also Director of Research for the Guest Foundation, explains that “the authorities must characterize the circulation of multiple agents and have a surveillance system capable of detecting changes in the trend patterns, severity and characteristics of the circulating agents, which includes genomic surveillance.” And, immediately, he points out: “Nothing indicates that omicron will be the last SARS-CoV-2 variant of concern.”

Jorge Geffnerdeputy director of Institute for Biomedical Research on Retroviruses and AIDS (Inbirs) and full professor of immunology at the Faculty of Medicine of the Buenos Aires’ University, describes a pandemic scenario “of much calmer” in the world and the country compared to the January peak. “The mistake would be to consider it the end of the pandemic. It is not like this. Neither in Argentina, nor in the world”, he maintains.

In the last two weeks he also noticed the rise in cases, although it is not possible to define the magnitude because the level of testing is “very low”. Per week, just over 7,000 tests are being done.

“Already among relatives, colleagues, teachers and students of the faculty we see that we are having infected acquaintances again. The positive thing is that this is not reflected, at least not yet, in more hospitalizations, largely due to vaccination, he says. The increase in cases is evident, although we do not have the certain data of how much, and it is due to the displacement of [los sublinajes] BA.1 y BA.2 of omicron.”

In the city and province of Buenos Aires, as revealed by Inbirs through the analysis of samples from both districts, the circulation of BA.2 is already the majority. The same, according to Pizzi, was detected by the UNC team that participates in the PAIS consortium for the genomic surveillance of SARS-CoV-2.

“BA.2 has 20-30% more transmissibility than BA.1, which contributes to this rise –continues Geffner–. So does the relaxation of very basic protection measures: the correct use of a mask in means of transport and in closed places with a large concentration of people.”

Faced with this scenario, the brake on the vaccination campaign with the application of the first booster activates alarms. “Vaccines are expiring and there are 3.4 million people without a second dose [del esquema inicial] and 10 million without the first reinforcement – ​​laments Pizzi-. Those who have at least three doses for Covid, the flu vaccine and wear a mask, are going to have a good winter.”

Geffner believes that the “defect” in the application of the first booster may complicate the course of the disease in some people. “We have 82% coverage with two doses, but 42% with the third dose and we are stuck in that percentage, beyond the fourth dose for the groups in which it is indicated. We have to move forward with the third dose and that is not happening: there are no public campaigns and there are vaccines, ”she maintains.

What could be expected in the coming weeks? There is, for Geffner, “high probability” that cases will continue to rise, “without a very significant increase” in hospitalizations, serious cases and deaths.

“Science had very important achievements during the pandemic and, also, failures. The achievements are the development of vaccines and specific drugs, antiretrovirals, to prevent severe forms [de Covid] that are not yet available in the country, such as the greater knowledge of the biology of the virus -he lists-. But in what we could not advance is in the predictive capacity of the course of the pandemic: there we continue in something like a black box.”

There are, for now, no indications that an omicron sublineage could once again complicate the epidemiological transition process. But the researcher points out: “We cannot rule out, although it is not most likely, that a variant may arise that defies the immunity conferred by previous infection or vaccinations. This coronavirus gave us so many surprises and behaves so differently from other viruses that precautions have to be taken, ”he maintains.

Along these lines, for Ortiz, new variants could arise that require maintaining individual and population care. “Given the uncertainty about the future behavior of SARS-CoV-2 (appearance of new variants or co-circulation with other viruses), the implementation of effective prevention measures must be sustained and strengthened to reduce the risk of transmission of all respiratory viruses – insists-. For example, if you have symptoms of respiratory infection, you should not go to public places, school or work to avoid contagion.”

Meanwhile, Geffner raises at least two “unfinished business” for health authorities in the short term. The first is to carry out “a great campaign” to explain to society why it is important to receive the first reinforcement of the anti-Covid vaccine. The second is to intensify the monitoring of the circulation of SARS-CoV-2 through tracking with tests and other types of studies, such as the analysis of wastewater, and sequencing studies of the “more massive” samples to have a closer look. to the actual evolution of the pandemic. “We have abandoned testing too much,” she ponders.

Hours after the Government releases the new weekly case report – there were about 11,000 detected per week in the last 14 days – the official data is also given while the provinces are integrating SARS-CoV-2 surveillance to that of the rest. of seasonal respiratory viruses in patients hospitalized in intensive care and those who consult with suspicious symptoms.

“We are in a different surveillance stage in relation to the Covid-19 pandemic in the country, with weekly notification and two weeks of increase in the number of cases, but it is low,” the Minister of Health said last Wednesday. , Carla Vizzotti, at a press conference at the Casa Rosada. Along with the Chief of Staff and former Minister of Health, John Manzuradded: “Getting vaccinated is going to be key.”

With the collaboration of Delfina Arambillet

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