Since the World Health Organization (Who is the) Covid pandemic released, on March 11, 2020, it’s already 589 days. Diverse confrontation The effects of the health crisis It is continuous. In Brazil, with more than 603 thousand deaths from the disease, in recent times, fortunately, the reality has changed.
In Ceará, data from Integrasus shows that cases, hospitalizations and deaths continue to decline. But which one Objectives must be achieved to say so pandemic Reached the end? who determines How and when does it happen? what do you need in cities And in the states?
The answers to these questions in the Covid issue, in general, continue to intrigue scientists, government officials and health authorities. In general, the World Health Organization indicates that the epidemic will end when The disease is controlled in different regions of the world.
One of the motives for improving the epidemic scenario is vaccination. However, in addition to cases, such as in Brazil, where there are still a large number of Unprotected people, another obstacle is that, in general, it is not yet known precisely how long immunity.
In addition, the effect of vaccines against viral variants is investigated. This set of facts are real hurdles in calculating how much time is left to end the epidemic.
In Ceará, according to data from Integrasus, the state health department’s (Sesa) platform, there have so far been more than 942,000 confirmed cases of disease with 24300 deaths. But since the peak of the second wave in April, indicators have fallen.
At the height of the second wave, the state had more than 136,000 new cases in just one month. And now in October until Wednesday (20) there were 1.5 thousand new confirmations. Fortunately, Covid deaths also continue to decline, with 29 deaths confirmed this month. At the peak, there were 3,700 in one month.
NS Northeast Diary audiologists – physician and epidemiologist Ligia Kerr; infectious disease doctor Kenny Colaris; Professor in the Department of Community Health at the UFC School of Medicine, Carlos Henrique Alencar, collected information on the official websites of municipal and state departments, and made arguments to consider when determining When will the epidemic finally end?
When is it possible to determine that the epidemic is over?
Medical epidemiologist, researcher at the Federal University of Ceará (UFC) and Vice President of the Brazilian Association of Public Health (Abrasco), Ligia Kerr, explains that, for this, “the disease levels must be very low.”
“Every epidemic has a massive increase, then decreases, and when these cases stop happening completely or at very small levels, we can say that the epidemic will be over.”
Doctor, epidemiologist and Vice President of the Brazilian Association of Public Health (Abrasco)
But Ligia wonders, “In the case of Covid, the situation is a bit more sensitiveMany researchers, and so do I, believe that we are unlikely to get the Covid epidemic under control in a very short time. What could happen? One alternative is that we allow countries with few vaccines to develop the disease there and come back with the variables that “overcome.” On the vaccine, “and back to higher peaks. This is an opportunity to happen, but we hope it won’t,” he adds.
Another issue that has already been identified, the epidemiologist asserts, “is that the necessary levels of vaccination should be much higher than we could have imagined. The number of susceptible people is high and this is very dangerous.”
Kenny Colaris, MD, an infectious disease consultant at Ceará School of Public Health, adds that in the case of a new disease, “we can’t compare with the previous pattern. It’s essential, over the years, that that pattern be established.”
He stresses that it is necessary to observe the curves (mortality, hospitalization, mortality) to make a judgment that the epidemic is over. However, in the case of Covid, this criterion is not clearly defined by the health authorities.
Carlos Henrique Alencar, a professor in the Department of Community Health at the University of California School of Medicine, points out that every epidemic has the same indicator to measure its values: the coefficient of occurrence.
“The values of this indicator vary according to the size of the disease, and therefore, there is no way to say that there is a magic number that can be used to determine that an epidemic/pandemic is over, or has become endemic. This will only be achieved by assessing this disease over time.”
Carlos Henrique Alencar
Professor in the Department of Community Health at the University of California College of Medicine
In Ceará, is there any city without new cases and deaths recorded by Covid?
In the state, according to data from Integrasus, crossed by Diário do Nordeste with information revealed by city halls on official websites, at least 3 cities have not recorded deaths by Covid for more than 3 months, and they are:
- Sao Joao de Jaquarbi
Last death record: June 8, 2021
Total deaths: 9
Last death record: June 18, 2021
Total deaths: 5
- little baroque
Last death record: June 24, 2021
Total deaths: 25
In Fortaleza, according to the most recent Epidemiological Bulletin Issued by the city council on October 15, in the last two weeks (September 16 to October 14), the city has had 17 days without recording deaths from the disease.
With regard to cases, the cities of Ceará, in general, are still unable to tolerate periods of time, such as more than a month, without new cases of the disease, although, over time, the number of confirmations is increasingly less.
When everyone is vaccinated, will the epidemic end?
In Ceará, nine months after the start of the vaccination campaign against Covid, out of 9.2 million people, as of Wednesday (20), 4.3 million received two doses of the vaccine, i.e. 46% Of the population. The calculation shows the total population, however, the population under the age of 12 is still not immunized in Brazil.
In addition to the number of people who have already been vaccinated, it is necessary to take into account that no vaccine is able to guarantee 100% protection against diseases. With Covid, immunizing agents act as a mitigator, preventing severe forms of the disease, but even after immunization, regardless of the manufacturer of the vaccine, it is possible to have contamination, hospitalization and even death, and this is much less frequent than that. Enter Unvaccinated.
Physician and epidemiologist Ligia Kerr also notes that “the epidemic requires very high levels of vaccination. Countries that did not control vaccination ended up generating variants. These variants partially go beyond vaccination.” Another case is that when people stop vaccinating, they cause a “failure of vaccination”, so diseases that have been reduced in prevalence can return.
“Vaccination is an indirect factor. It is good to know that 60%, 70%, 80% of the population has been vaccinated, but this is not essential. We have seen that even people who are vaccinated get sick. The most important is the number of cases, hospitalizations and deaths. No. There is a percentage of vaccinated patients that we can say will bring us back to normal. So, our criterion is the behavior of the disease and not the vaccinated population.”
Physician and Consultant in Infectious Diseases at the College of Public Health in Ceará
How was the end of the H1N1 epidemic determined?
In the case of the epidemic caused by the H1N1 virus, which was officially recognized by the World Health Organization on June 11, 2009, its end was also set by the World Health Organization on August 10, 2010. But this does not mean the end of the circulation of the virus. It is still transmitted around the world, along with other seasonal viruses, and in each country the infection rate is different, but not with a large number of infections.
Another point is that when the end of this pandemic was announced, at that time, 2,100 people died of H1N1 in the health crisis in Brazil. In the case of Covid, in order to have dimensions, only in Ceará there were 24 thousand deaths.
When does an epidemic disease become endemic?
Professor in the Department of Community Health, FC University School of Medicine, Carlos Henrique Alencar, explains that it is necessary to understand the differences between some of the concepts he describes as follows:
- eruption: A sudden increase in the number of cases of a disease, but this increase has geographical limits, for example, the outbreak of swine fever that occurred in the municipalities in the northern region of Ceará a few years ago.
- endemic: The number of cases of disease within the expected pattern of the place and period of time. An example of an endemic disease is dengue fever, which is found every year in Ceará in expected patterns.
- EpidemicAn unexpected increase in the number of cases of endemic diseases. There are time periods when the number of cases exceeds the expected value, causing the disease, which was previously endemic, to appear in the current moments of the epidemic. An epidemic can also arise from an outbreak.
- Epidemic: It has a much wider geographical spread, and the disease can be recognized in many countries around the world. This has not only happened with Covid, but with other diseases, such as AIDS, and H1N1 influenza, among others.
According to Ligia Kerr, “Endemic levels are lower levels that can increase in certain periods. When (disease) falls and remains with much less spread. But he explains.
Dr. Kenny points out that in the case of Covid, “the expectation is for him to stay with us, and that we need to live with this virus, of course not causing as much trouble as it was in 2020 and 2021”. But he stresses that “when they say it’s no longer an epidemic, it could take a few months or years.”
Can countries and cities determine that the epidemic is over in that region?
In general, the World Health Organization monitors events in countries and says when the pandemic / epidemic will be brought under control, but according to epidemiologist Lígia Kerr, Covid is a completely atypical scenario, what “will most likely happen is that each country will decide with what level it wants to do so.” Dealing with her epidemic, how many deaths she will accept.”
According to her, one of the evidence of this decision for countries, states and cities is when the administration of this specific place decides to cancel the use of masks, even as the epidemic continues to spread.
Kenny adds that “the voice of the world’s health is the World Health Organization,” but he wonders, “We are at a very complex time in international politics, so the WHO is having a hard time implementing decisions.”
Professor Carlos Henrique reiterates that the WHO is responsible for determining the end of the epidemic, but according to the conditions of the disease in each country. He adds: “If the Covid virus continues globally at expected or normal levels according to the World Health Organization, the organization will classify it as an endemic disease.”
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