‘We cannot claim victory yet’ against COVID-19, epidemiologist says

By Pedro Correa Henry

Twitter: @pete_r_correa

Special to The Star

As a new phase of minimal restrictions and requirements to control the spread of the COVID-19 virus has begun, public health experts tell The STAR that the coronavirus pandemic is far from over.

In an interview with The STAR, Dr. Roberta Lugo Robles, who is a clinical epidemiologist, said Sunday that even if more than 70% of the adult population in Puerto Rico completes the COVID-19 vaccination, this does not mean that the island has fulfilled herd immunity against the disease caused by the coronavirus.

Lugo Robles told the newspaper that herd immunity, which she said is a suitable vaccination percentage calculated according to the transmission characteristics of a virus, must consider an entire population and keep track of how a disease develops in different communities.

“As the pandemic has been going on for more than a year, that percentage, given the new variants and the ease with which the coronavirus mutates and acquires new characteristics, that is to say, more transmissibility such as the Delta variant, has changed,” she said. “Press reports have already started to come out stating that 70% is obsolete, and now we have to be moving to 80, or even 92% of people vaccinated.”

“We will have to watch this as we go along and, with genomic surveillance, we will have to see which variants we have, what their characteristics are, and what the levels of transmission are in order to determine that percentage,” added Lugo Robles, while suggesting that the island Department of Health should update such calculations.

Meanwhile, the clinical epidemiologist said factors such as outbreaks, disease control and prevention, hospitalization, and deaths are considered to determine herd immunity.

“We have to look at other factors because it is not just about reaching 70% and that’s it, because we can have that percentage of people vaccinated, but the virus continues to circulate within our communities and continues to cause outbreaks, so we cannot claim victory yet,” she said.

Lugo Robles made that assertion amid an outbreak that took place at El Cuerpo de Cristo Church in Mayagüez, with 24 confirmed COVID cases of the Iota variant (formerly known as variant B.1.526), nine hospitalizations, and four deaths.

Lugo Robles told The STAR that even though the Department of Health had systems such as the COVID-19 Surveillance System and the Municipal Case Investigation and Contact Tracing System, it was important for the agency to develop a genomic surveillance system that works to its fullest potential, or well enough so that it reports COVID-19 cases with variants, detects current outbreaks and performs contact tracing “in 24 hours or less.”

The public health expert said further that it was important for the government to address the 74% of adults who have only received one vaccine dose in Puerto Rico in order to complete the vaccine campaign.

“There is not only one factor, but there are also many factors [to achieve control against the coronavirus], and to that, we must include the educational and cultural aspects within the pandemic,” Lugo Robles said. “The government has spread the word that once you’re fully vaccinated, there will be no risk, there’s no need to use face masks, and that is dangerous amid the variants that have developed.”

“I do recognize that transmission rates are low, that they have lessened, but there are still community transmissions happening, which can lead the way to new coronavirus variants and outbreaks,” she said.

Likewise, Lugo Robles said, “there is a lot of work left to do” with susceptible populations and islanders who have yet to inoculate against the coronavirus.

Therefore, she said, public health entities must execute different strategies to make the coronavirus vaccines accessible and appeal to communities with different values.

“The governor [Pedro Pierluisi] changed the way to respond to a public health emergency because he made Puerto Rico address the emergency on an individual level,” she said. “As both the governor and the Health secretary [Dr. Carlos Mellado], and other agency officials stated that people were now responsible for getting vaccinated in order to not use the mask, I do consider that the decision taken was a political decision because they thought that making such a decision would persuade people to get the vaccines, and that’s not the way to do it.”

Lugo Robles stressed that attention must be focused on specific populations such as 18-to-30-year-old residents, 65+ islanders who do not have transportation available, anti-vaxxers, citizens who may object to vaccination on religious grounds, and children.

“We have to learn how to evaluate risks in order for us to take the right prevention measures, and the government, with this new executive order, with the press conference [held last Thursday], ignored these factors and made residents choose between vaccinating or continue to use face masks,” Lugo Robles added. “The message should not be to either vaccinate or mask up, it should be to vaccinate and mask up; it’s important to spread that word.”

Meanwhile, Dr. Cruz María Nazario, a professor at the University of Puerto Rico’s Graduate School of Public Health, also raised concerns about the government’s behavior amid the coronavirus pandemic.

“We must look at the possibilities that a surveillance system does not cover us at 100%. For whatever reason, such systems are not capable of discovering every new variant, because they are ever-changing,” she said. “While the virus remains alive among different communities worldwide, not only Puerto Rico, it will be capable of mutating and changing.”

“I’m a little worried that we have that thought that Puerto Rico, let alone a municipality, will reach immunity against COVID-19 when the rest of the world still has no vaccines available; it’s absurd and dangerous,” Nazario added. “The only way we can say we defeated the coronavirus is when everyone in the world has fulfilled herd immunity, until now, we must take care of ourselves.”

Nazario also urged the Health Department to reveal the number of COVID-19 molecular tests performed during the emergency in order for public health experts to have more accurate data on the positivity rate on the island.

“If we want to be more transparent, in Puerto Rico, only 54% of the island population has been fully vaccinated,” she said. “The government must be clear on what they consider to be a vaccinated resident.”

At press time, the Department of Health confirmed the island has three COVID-19 cases with the Delta variant.

“The two additional cases were in unvaccinated people,” the agency reported in a written statement.

The agency said the cases involve a woman between the ages of 30 and 39 and a man between 40 and 49.

“The patients did not require hospitalization and one of them is under medical follow-up, while the other completed their isolation days,” the agency reported. “No other contacts were identified; both cases were in the metro area.”

According to the website Our World in Data, 24% of the world population has received at least one COVID-19 shot. Around 3.19 billion shots have been administered globally.

Nevertheless, according to BNO News, only 11% of the world population has been fully vaccinated.

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