Is Ecuador ready to classify COVID-19 as endemic and stop wearing masks? Specialists give their criteria

The removal of masks in open spaces is a decision that could be made in the following weeks in Ecuador, depending on the health situation due to COVID-19.

After a week of carnival, which was the first holiday with more relaxations in the last two years, the country maintains a downward trend in the parameters that are analyzed regarding the virus and if that trend is maintained in the following weeks could demarcate a panorama of new decisions regarding biosafety measures, according to government authorities.

“It makes us positive that we are going to be able to say that in approximately 15 days we can release certain biosecurity restrictions, such as the use of the mask in open places,” said the Minister of Health, Ximena Garzón, the previous Wednesday when exposing the actuality of the epidemiological situation and consider that there is probably no rebound in cases when the fifteen days after the holiday are completed.

Despite this encouraging context, specialists consider that at this time the removal of the mask would be a hasty step. That decision has already been made in several European countries such as Denmark and Ireland and localities in the region, including Bogotá and New York. Even in several locations on the Old Continent, the pandemic is beginning to be treated as endemic, that is, it occurs regularly or on certain dates.

To get to the point of leaving the mask mandatory, Garzón clarified that the pandemic could be considered “under control” when there is a percentage of less than 5% in viral positivity, which at the beginning of the year was 65% and now it is 14. %, in addition to a lower number of cases and that those infected with the delta variant are null. For now, the prevalence of variants is 99.5% in omicron and 0.5% in delta, and in two weeks infections with this last lineage of the virus are expected to disappear.

“There are some epidemiological indicators that we will sit down to analyze with the epidemiology directorate to make other decisions between April and May of this year, for now the indicators make us think that as we had said in previous weeks, we will soon remove the masks, initially in open places”, said the minister.

After the carnival holiday, the Ministry of Health considers that there will not be a rebound in COVID-19 cases

Wilson Tenorio, president of the Guayas College of Physicians, considered that the announcement made before the previous holiday by the Ecuadorian authorities about the possibility of removing the mandatory use of masks in open spaces led to the “riot” that was experienced in days off with crowds of people at public events, without respect for capacity. “We must be more cautious and wait a longer time,” he said.

“We must not neglect ourselves because we see the risk of ruining everything that has been achieved to date, of an excess of cases that could occur at any time. It should continue to be used a little more (the mask) until reaching that collective immunity goal that could be at the end of the year,” he added, mentioning that this will depend on the coverage of all doses in the determined population and the development of antibodies. in the population that has already been infected.

Like Tenorio, the epidemiologist Carlos Farhat, Health Advisor of the Municipality of Guayaquil, considered the decision to suggest the removal of masks in open spaces inappropriate, even more so if precisely in about two weeks the possible impact of contagion is expected due to the days of the carnival. and to this will be added the following month the upcoming Holy Week holiday, in which many take the opportunity to vacation and there may be new scenarios of imprudence in complying with biosecurity measures and therefore an increase in cases.

“It seems rushed to me. I believe that the Government can suggest, suggest, the non-use of masks, after passing these two risk factors (Carnival and Easter) so that, according to the epidemiological behavior subsequent to these two risk factors, decide whether to remove it or no, and decide to remove it or suggest avoiding the use of the mask or not using it, as long as there is a very low transmission rate, but after those events, not before, ”explained the epidemiologist.

For her part, Diana Ramos, president of the Infectology Society of Guayas, commented that although there is encouraging progress in the vaccination figures of the Ministry of Health, there is still a latent risk in the medium term since less than 30% of the Ecuadorian population at higher risk has received the booster dose.

In addition, he recalled that the main risk factor at the beginning of the pandemic for the increase in infections was the lack of use of masks as a public health measure, which later became mandatory. Given this, he emphasized that before thinking about the withdrawal of this biosafety element, it is imperative to work on reinforcing measures, such as five-day self-isolation and the use of a mandatory surgical mask in case of respiratory symptoms.

Likewise, the doctor added that it is vital that the epidemiological surveillance system be improved to detect cases of COVID-19 in the community early, given that outbreaks of COVID-19 usually occur in the patient’s immediate circle, and also proposes to improve ventilation of spaces (offices, homes, schools, among others), increase vaccination coverage, and formulate policies for the acquisition of proven medicines to treat COVID-19.

For his part, the representative of the College of Physicians of Guayas emphasized that for now the biosafety culture must continue to be insisted on, especially in adults, young and intermediate, so that they seek sanitary practices such as the use of a mask, hand washing and avoid as much as possible gatherings in closed spaces and in open places with prudent distancing, in order to prevent them from becoming infected and even bringing the virus to vulnerable people.

From pandemic to endemic

The epidemiologist Farhat considered that we are getting closer to having an endemic behavior of COVID-19. Without specifying deadlines, the doctor explained that in order to reach that phase, several factors are vital, such as the drop in transmission rates, infections, hospitalizations, and deaths.

“Remembering that these endemics may have recurrent peaks, that is, very low controlled cases, but there may be a factor that causes the cases to increase again, that is happening in Hong Kong, China and other countries. I think so, with patience and prudence, if we manage with these two parameters, we are getting closer to an endemic behavior of this pandemic that has caused so many problems, ”he indicated.

As a favorable factor towards this phase, he considered it important that the country is close to reaching the ideal coverage of 85% in the two doses of vaccination at the national level, in the case of Guayaquil in 81% to 82%. However, he specified, like Ramos, that the booster dose must still be strengthened to cut the transmissibility and presence of disease in our environment and, therefore, hospitalizations and deaths.

Similarly, Tenorio considered that the country is currently in a transition stage of COVID-19 from a pandemic to a hyperendemic, in which the population will later have to continue living with the virus and its variants in an endemic, once it is achieved. the goal of herd immunity.

Like the two specialists, Dr. Ramos sees the step closer to classifying COVID-19 as endemic, although she clarifies that this does not mean that we will not have COVID-19 infections, but that, as with other respiratory infections, there will be to a percentage of the population that will require timely care and the health system must be better prepared to deal with the cases.

For Tenorio, the transition to an endemic stage for COVID-19 is important to focus more attention on other diseases that continue to affect the population, such as dengue and other noncommunicable diseases (NCDs), in addition to the need to streamline the referral processes of patients from health centers to more specialized units and the provision of medicines.

The World Health Organization (WHO) has not adopted this term to refer to COVID-19 and last month considered it premature to consider declaring victory over the pandemic. Just this Friday the 11th marks two years since the WHO declared COVID-19 a pandemic.

In addition, he announced that they are preparing responses to three scenarios that could be presented in the future. The first, that the current situation with infections continue without having serious cases, the second, that the virus be controlled as is done annually with the flu season with the adaptation of the vaccine every certain period and a third, more complicated, presence of new variants.

“It will be a long time to live together (with the virus) until God forbid a supervariant appears…”, Tenorio added and suggested that in the event of this scenario, health controls on mobility should be maintained, especially at borders, and that health units are activated with all epidemiological surveillance systems and the proper supply of supplies and medicines to stop the situation in time.

Numbers of infections, deaths and occupation

The curve of confirmed cases in Ecuador went from almost 52,000 confirmed cases in epidemiological weeks 1 and 2, while now in week 9 there are 6,743 cases nationwide. “This will continue to decline,” according to the Minister of Health, who clarified that the situation will have to be evaluated when the fifteen post-carnival days are over.

Between the first weeks of January and March, with the spread of omicron cases, the mortality figure for COVID-19 stood at 232 and then dropped to 8 between confirmed and probable cases. The people who die the most are over 65 years of age who have incomplete doses of vaccines or have aggravating diseases, according to Garzón, who urged them to continue going to receive immunizations.

Likewise, the official revealed that there is a decrease in the number of patients who have come to care for COVID-19 in hospitals and health centers. “From 60,000 that we had in week 2 we have dropped to week 9 to 957”, he mentioned and attributed this success to epidemiological controls and the progress of the vaccination plan, which reaches 84.53% in second doses and 88.47 % in first doses. The reinforcement plan that was recently opened to the population over 18 years of age advances to 27.80%.

Currently, according to the figures released by the minister, the occupation of hospital beds in the ministerial health units is 11% of the 743 assigned and 20% of the 170 intensive care units (ICU). Meanwhile, in other Issfa, IESS and Isspol systems it is 22% in hospitalization, 20% in intermediate care and 50% in intensive care. Meanwhile, in the private complementary network there is an occupation of 18% in hospitalization, 20% in intermediate care and 27% in ICU.

The majority of infections are concentrated in people between 24 and 45 years old and who, in turn, being the economically active population, are more exposed and can spread the virus to other relatives. In many cases, those affected by COVID-19 may be asymptomatic and without the need for hospitalization.

From February 29, 2020 to March 8, 2022, Ecuador has recorded 843,760 accumulated confirmed cases and 35,316 deaths between confirmed and suspected cases of COVID-19. (I)