ICOVID: Specialists warn of new outbreak “that still does not impact the hospital level”

The ICOVID Chile team, an initiative led by the University of Chile, the Pontifical Catholic University of Chile and the University of Concepción, presented its 69th report with analysis and data of the proposed dimensions to monitor the pandemic in the country, with information obtained until Sunday, January 2, 2022, provided through an agreement with the Ministry of Health and the Ministry of Science, Technology, Knowledge and Innovation.
According to the new report, after having reached an intermediate risk level (orange between 1 and 5 per 100 thousand inhabitants), the load rose abruptly reaching 9.5 per 100 thousand inhabitants with a confidence interval over 10. As context, the researchers explain that “the outbreak of the delta variant had a maximum load of 11.2 per 100 thousand, so it is expected that in the coming days the current outbreak will surpass the delta outbreak.”
Looking at the situation in regions, the largest national burden was in Tarapacá (74.5), Arica and Parinacota (24.5), Aysén (22.0), Los Ríos (21.0) and Magallanes (20.2). While the lowest loads were recorded in O’Higgins (4.8), Metropolitana (5.1), and Maule (7.3).
On the other hand, the effective reproduction number R, which represents the average number of people who infect each case, shows that transmission was on the rise, turning red, with the average of 1.12. According to the document, the figure of this indicator is “rising rapidly to possibly reach in the coming days the maximum level of R effective in the outbreak of the delta variant, which reached 1.29 on October 13.”
Likewise, in regions, the highest transmission rates were in Tarapacá (2.9), Arica and Parinacota (1.8) and Magallanes (1.35), areas of high passenger exchange. Also noteworthy are the Metropolitan Region, Antofagasta, La Araucanía, Aysén and O’Higgins with levels between 1.24 and 1.21, all with growing infection. The lowest transmission rates occurred in Los Lagos (0.92) and Los Ríos (1.07).
Faced with the scenario, the epidemiologist and academic of the Faculty of Medicine of the Pontifical Catholic University of Chile, Catterina Ferreccio, said that “we are starting a new epidemic outbreak of covid-19 in the country, obviously the responsible is the new omnicron variant that infects the unvaccinated and also vaccinated with three doses and people who were previously infected with other variants.  Although the main origin of the cases are international travelers, community transmission is clear. You can only prevent a sharp rise in hospital demand by reducing the rate of contact between people, that is, to reduce the capacity both in indoor and outdoor activities.”
Regarding positivity at the national level, after several days in green, the indicator rose to 2.8% as an average for the week ending january 2. In fact, it exceeded 5% (red color) in the regions of Tarapacá and Los Ríos; and about 3% (orange) were La Araucanía, Biobío, Valparaíso, Los Lagos and Aysén with levels between 4.2 and 3.5.
The report also indicates that after a drop in the testing rate, in the last days of December it began to increase nationwide, reaching 16.0. Meanwhile, at the regional level, the highest testing rates were in the extreme north: Arica and Parinacota (27.8), Tarapacá (26.2), Atacama (25.3), and the extreme south: Magallanes (23.8), Aysén (22.5) and Los Lagos (22.0). The lowest rate was in O’Higgins (9.5).
Indeed, as the engineer and academic of the University of Chile, Marcelo Olivares, emphasizes, “Chile has managed to position itself as a leader in the vaccination campaign, with 58% of the population with a full vaccination campaign and booster doses, compared to 6.7% worldwide. However, the wave of infections observed in other countries should keep us alert to a possible new wave. We have a good testing capacity to detect new cases, but it is vital that the population is responsible for any sign of symptoms to consult, detect and isolate cases early. We must not let our guard down.”
In this line, on the traceability dimension, the early confirmation indicator, that is, the proportion of suspicious symptomatic people whose laboratory result is reported to the health authority within three days from the date of onset of symptoms, has been improving steadily, finding this last week in its best performance with 65%, increasing from 40% at the beginning of the day2021. “This increase is mainly due to the noticeable reduction in examination and laboratory times,” the report says.
This indicator is relatively homogeneous in all regions of Chile, in a range of 73% to 96%. The most deficient indicator is in Tarapacá, followed by Coquimbo with 75%. Atacama and Maule stand out with 96% of tests reported within 24 hours.
For its part, the indicator of early consultation, which calculates the proportion of people who had a medical consultation in two days or less since they started symptoms, has shown a stagnation in the range 50-60% throughout the year 2021, without presenting sustained improvements. The only regions that currently exceed 65% are O’Higgins, Maule, Tarapacá, Atacama and Arica and Parinacota, the latter with a good indicator of 79%. There are eight regions with the indicator of early consultation close to 55-57%, showing a deficient level (orange color).
“Since the peak viral load occurs around the time of symptom onset, infected people are highly infectious in the days leading up to symptom presentation and each day that their isolation accelerates is key to reducing transmission. Therefore, it is very important to continue working to improve this indicator, for which we alert the population to consult as soon as possible with a doctor when any symptoms indicative of disease occur (including mild symptoms such as nasal congestion, headache or muscle fatigue), whether or not they are vaccinated, “say the researchers.
As for the hospital dimension, around 27% of ICU beds are occupied by COVID-19 patients nationwide, a figure that has been decreasing since December, when it was 34% on average throughout the country. To put it in perspective, at the peak occupancy during 2021, 75% of ICU beds occupied by COVID-19 patients were reached, more than double the current level.
However, there are regions where ICU bed occupancy by COVID-19 patients is much higher, suggesting caution. The Aysén Region stands out, which from December to date has remained above 60%, although decreasing in the last two weeks. In the Los Lagos Region, occupancy has been on the rise since December to date, increasing from 30% at the beginning of December to 56% this last week (almost double in four weeks).
Likewise, the Biobío Region had been increasing its ICU occupancy of COVID-19 patients at a similar rate, reaching a peak in the week of December 12 and then showing a stabilization of around 47%. The Magallanes Region has also shown a significant increase, rising from 28% to 45% in the last two weeks. The rest of the regions are at relatively stable levels.
Critical COVID-19 patients generate a saturation of the critical bed system that can also affect the care of other pathologies. Therefore, “it is important to maintain continuous monitoring of ICU bed occupancy in its entirety. This indicator has remained stable between 85-90% from October to date, which corresponds to the red color, and is currently at 87.6%,” emphasize the researchers.
In addition, the report indicates that total ICU occupancy is particularly high in the Los Lagos Region, above 94% during the last three weeks, and in the Biobío and Metropolitan regions, where it has remained around 90% in the same period. The regions of Antofagasta and Valparaíso are at high levels (close to 88%), but have shown a decrease compared to the previous two weeks (when they were at approximately 95%).
When disaggregating the hospital occupancy data by age, it is observed that the variation in the occupation of ICU beds by COVID-19 patients is homogeneous between age groups: all decreased their occupation by 7-14% in the last week, an issue that managed to alleviate at least temporarily the increase in hospitalizations in all age groups that was observed between October and November 2021.
“It is possible that the increase in cases in the last two weeks will translate into an increase in hospitalizations, although in other countries the hospitalization rate of infected people has been lower than that observed in the period before the vaccination campaigns. For this reason, it is essential to maintain continuous monitoring of hospital occupancy to make decisions regarding mitigation measures and management of the health system,” the report states.
Regarding the vaccination plan, to date, 84% of the national population has received its complete vaccination schedule: 91.4% in those over 70 years of age, 94% for the group between 50 and 69 years, 85% in the group 18 and 49 years and 60% in the underage group (under 18 years). Local data mThere is a variation between regions, where O’Higgins, Ñuble and Aysén stand out with more than 90% of vaccinated (considering the entire population), and the Metropolitan and Tarapacá regions have the lowest levels, around 80%. It should be noted that 80% is still high, since countries with that level of vaccination rank within the top 15 worldwide.
Finally, “the most remarkable thing about the vaccination campaign in Chile is the progress with booster doses,” say the researchers. According to data from Our-World-In-Data, Chile has 58.5% of its population with a complete scheme and booster dose, compared to 6.7% worldwide. 11.4 million booster doses have already been administered, which corresponds to 69% of the population with a complete scheme.

Original source in Spanish