European countries begin to treat COVID-19 as ‘endemic’. Can Ecuador reach that stage?

The United Kingdom, Denmark and Ireland have lifted the restrictions imposed by COVID-19 and speak of treating the virus as an “endemic” (a stage of a disease that is present on a regular basis, but there is no unusual increase in the number of cases ) and no longer as pandemic.

In fact, these countries have lifted basic measures such as the mandatory use of masks and the presentation of vaccination cards, with the exception of very crowded places. The sixth wave of the pandemic is coming down from its maximum contagion peak in all these nations and, given the certainty that the omicron variant is more contagious but less lethal, they have launched their plan to return to “normality”.

Although countries like Spain are not yet encouraged, for the moment, to completely remove the restrictions, they also speak of “flu” COVID-19, as does the United States. However, the World Health Organization (WHO) is cautious and has stated that declaring COVID endemic would not be such a positive thing, since it would only mean that the virus will always be there, like malaria or HIV, which continue to kill people. , and that no country should feel “victorious” at the present time.

In this context the question arises: Can Ecuador reach that stage? The country’s infection figures also show a decrease compared to the first weeks of January. Until Sunday, January 30, 3,824 new infections were registered and a cumulative 729,760 positive cases throughout the pandemic, according to the Ministry of Public Health (MSP). Omicron is the dominant strain.

In mortality, corresponding to the second epidemiological week of 2022 (January 9 to 15), 553 excess deaths were recorded, that is, 37 people per day. This figure had not been seen since the week of July 11 to 17, 2021. However, cities such as Guayaquil have begun to register a slight decrease in deaths associated with the virus and this has led to leaving alert status 3 to be on alert 2.

But to think of the term “endemia” in Ecuador, several requirements must be met and the existing protocols must be reviewed.says Jhonny Real, an epidemiologist at the Guayas College of Physicians.

“All those European countries understand that it is impossible to stay long doing massive tests, quarantines, looking for asymptomatic people, isolating the positive ones, because this brings us a social and economic problem. In addition, COVID-19 has changed and with the arrival of the omicron variant we see that although there is a huge spike in infections, it also collapses without producing the same number of deaths as those produced by the first variants, ”he says.

In addition, according to the specialist, like the European countries that are leading the change to endemicity, Ecuador has a high vaccination rate. As of January 29, the MSP indicates that 29,946,237 doses have been applied, of which 14,107,429 correspond to first doses, 13,290,852 to second doses and 2,547,956 reinforcement doses.

“So we need to get to a point where we stop tracking people who are healthy or who have minor symptoms, running tests, overwhelming the system. And we must focus on vulnerable groups such as people with pre-existing conditions, the immunocompromised, the elderly and children. Reinforce the self-care message. That is why we speak of endemic or hyperendemic“, it states.

In addition, he questions how the peak of infections experienced in January in the country has been reported, since “they implied that the intensive care hospital beds were full and raised fears of a situation similar to March and April 2020”, but “What they did not say is that the number of beds in both the public and private sectors had previously been reduced due to lack of patients.” Although he acknowledges that infections did increase.

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For José Rubén Ramírez, research professor at the Faculty of Health Sciences of the SEK International University, the change that European countries are making to endemic also means a shift in their public health policies and the way they deal with the virus, although the disease remains the same and the risk will remain present.

“We cannot compare the reality of these nations with Ecuador, as well as the behavior of societies. Each country must make decisions based on the state of its health systems and the reaction of its population to the virus. In addition, carry out specific analyzes of mild infections, hospitalizations, intensive care units and deaths”, he points out.

He agrees with Real that Ecuador must identify susceptible individuals, since they can cause a spike in infections: “They can be children, migrants and those with conditions such as diabetes, hypertension, HIV. They must be identified to adopt policies that lead us to treat COVID as endemic.” Added to this is that pharmaceutical companies already have drugs to treat the virus.

Meanwhile, María Fernanda Gutiérrez, a virologist, affirms that in Europe the pandemic has always been three or four months ahead of Latin America and has always shown what can happen in other continents. So, Europeans have already observed an epidemiological behavior where 80% of their populations are immunized, either by vaccines or by the virus infection itself.

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“The greatest importance for us (Latin Americans) is that they are showing us our future. We have done what they did three or four months later. So, it can be said that in this same period of time we are going to go through that stage (treating COVID-19 as endemic)“, He says.

Reduce the risk of new variants

The appearance of a new variant that, in addition to being contagious, is more lethal than omicron is a latent risk, specialists agree, since the virus’s ability to mutate is intrinsic to its nature. This would again put pressure on the health systems of nations.

To try to reduce this probability, it is necessary to cut the transmission chains, indicates Ramírez. Although this has been complex due to how infectious omicron has been, which has been compared to measles due to its level of transmission.

“Vaccination remains key to reducing the viral load of individuals. The vaccine has been the most cost-effective measure that health professionals have had to control infectious diseases and increase the average life in more than 70 years. Although vaccination does not prevent contagion, it does prevent a severe, fatal outcome and high viral loads,” he says.

Meanwhile, Gutiérrez maintains that the virus is no longer having room, due to vaccines and infections, to produce new variants, although this situation cannot be ruled out. Although coronaviruses have already caused three aggressive epidemiological processes in the last 30 years, including the current one, it is not the only organism that can do that, he says.

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“We live with bacteria, fungi and we have to know how to respond to them. It is very likely that another epidemic will occur again, we do not know how big it will be and when it will occur. This will be a behavior followed and more now that we are hitting nature more and more.“, Add.

Use of the mask

The United Kingdom and Denmark have lifted the mandatory use of masks in the endemic phase, but in countries like Ecuador, which has different customs from Europeans, the mask must continue to be used, especially in the winter season, says Real: “Here there was no custom before the pandemic that if you were sick, you wore a mask. People had the flu and sneezed without using their elbow, covering themselves, or at least wearing a tissue. So, until there is a strong and adequate orientation, the mask must continue.

Gutiérrez agrees with this and affirms that most Europeans already have the discipline of wearing face masks to avoid becoming infected or spreading a disease: “They are going to put on the mask voluntarily out of social commitment. We have to reach that moment and if we reach the endemic it is not that we are going to use the mask every day, but when we have symptoms of respiratory diseases”. (I)