What did the three pandemic waves leave in Argentina and what can be expected in the future

Argentina is following the end of the third wave of coronavirus (yesterday “only” 1842 positive cases were reported) that hit the country and which set the record for daily infections since the first infected was recorded in March 2020.

That record was set on January 14 of this year, when the country counted 139,853 new infections in just 24 hours. The previous record, in the middle of the second wave of the pandemic, was on May 27, when 41,080 were recorded in 24 hours, more than double those reported at the peak of the first wave on October 21 of last year in a single day, 18,326.

As of today, Argentina has 9,049,250 total confirmed cases, 43,755 confirmed active cases and 8,877,337 recovered patients: 8,877,337. Regarding deaths, yesterday there were 14 deaths in the last 24 hours, which totaled 128,158 since the beginning of the pandemic.

With regard to the coronavirus vaccination plan being carried out in Argentina, there are so far 97,181,658 total applications, with 40,646,311 people with an initiated vaccination schedule, 37,049,437 people with a complete schedule, 3,027,493 people with additional doses and 16,458,417 people with booster doses. Finally, the country has 105,003,764 doses distributed to jurisdictions and 5,083,000 doses donated to other countries.

Faced with these numbers, it is propitious to ask ourselves: how are we dealing with the coronavirus in Argentina today? Argentina is currently experiencing a favourable epidemiological situation with 11 consecutive weeks of decline in the number of COVID-19 cases and significant advances in the vaccination strategy, which has coverage levels of 89.4% in the general population with first dose, and 80.5% with complete schematics.

Yesterday, the Ministry of Health of the Nation reported that with 1,842 new infections and 25,775 tests carried out in the last 24 hours, the positivity rate recorded is 7.14%. This percentage is below the 10% recommended by WHO to consider the pandemic to be controlled.

According to the epidemiological part, at the moment in Argentina there are 428 people with COVID-19 hospitalized in intensive care. The percentage of bed occupancy at the national level is 37.6% and in the Buenos Aires Metropolitan Area (AMBA) 38.3%.

“It is at this point in the pandemic that the past, the present and the future are coexisting: the wave of infections, the variants and vaccines that work and the endemic COVID on the horizon. But we are neither in the past nor in the future. The present is complex but hopeful,” Dr. Ernesto Resnik, a scientist, molecular biologist, immunologist and biotechnologist based in Minnesota, United States, told Infobae. For him, “although it may not seem today, thanks to vaccines, he is moving to the endemic phase, the phase in which the virus will exist, there will be contagions, but it will not turn our lives upside down”.

For Ricardo Teijeiro, an infectiologist and member of the Argentine Society of Infectology, we are on the last route of the third wave. “Infections are declining sharply, except in some countries. In our region we have seen a sharp decrease in the circulation of the virus for several weeks. But for example countries such as Germany or the United Kingdom, are experiencing a sharp rise in cases due to one of the subvariants of Ómicron, such as BA.2. If you see the general context, we are in a frank fall in general,” said the specialist.

“The virus is likely to continue to circulate. It is necessary to see if it remains an endemic disease or if it makes annual outbreaks like the flu does. This would indicate that the vaccine remains in the National Vaccination Calendar, but surely only to risk groups, not the entire population. Likewise, we must emphasize that new waves do not bring major complications to health because they are processes of upper respiratory diseases where we do not have great health risks with many people who do not go into hospital or die. This is thanks to the extensive vaccination we have, which reaches more than 80% with two doses and also to the large number of infected people, who have natural immunity for a while because they have infected the virus,” said the infectiologist at Hospital Pirovano.

By endemicity, experts explain that it means that the virus will continue to circulate in parts of the world's population for years, but its prevalence and impact will be reduced to relatively manageable levels, so it will end up more like a flu than a disease that stops the world.

For an infectious disease to be classified in the endemic phase, the rate of infections must stabilize more or less over the years, rather than showing large and unexpected peaks as COVID-19 did during these two years. “A disease is endemic if the reproductive number is stable at one,” explained Eleanor Murray, an epidemiologist at Boston University. “That means that an infected person, on average, infects another person.” What the specialist refers to is R0, an indicator that is used to estimate how many people an infected person infects and, according to those in the know, “we are nowhere near that at the moment”. The highly contagious Omicron variant demonstrates that each infected person is infecting more than one person.

When does the pandemic end?

“While it is impossible to predict the next movements of SARS CoV2, leading experts say that the virus will transform into one more virus, like that of the common cold; others postulate that it will remain threatening, like influenza. The forces that drive antigenic changes will have the final say as they are strengthened or stopped,” Dr. Osvaldo Teglia, Adjunct Professor in charge of Infectious Diseases, from the Faculty of Biomedical Sciences, Universidad Austral, told Infobae.

“Relying on an optimistic viral evolution, several renowned scientists have opined in Nature as follows: 'The virus does not want to put someone to bed and make them sick enough that they do not meet other people. SARS CoV-2 will evolve to sustain infections for a longer period of time, increasing the number of new hosts exposed. If it maintains its low profile, SARS-CoV-2 could ensure its continued spread and part of the unvaccinated population would be contributing to plans for the virus, '” Teglia said.

He added: “A hopeful future for SARS-CoV-2, but surely less likely, would be to follow the measles path. Although infection or vaccination provides lifelong protection for measles, the virus continues to circulate largely among susceptible children and unvaccinated adults. Most people who contracted measles in recent years were not vaccinated. By this end of COVID, vaccines that generate immunity in a long time would be lacking, and high rates of inoculation would be necessary to ensure the herd immunity of the population, as was the case with the aforementioned childhood eruptive disease. However, even a virus such as measles, which essentially does not have the ability to evolve like coronaviruses to evade immunity, still persists and has caused serious inconvenience in recent years at the expense of declining vaccination rates.

According to Teglia, influenza or flu provides another scenario for forecasting the future of SARS CoV-2. “The influenza A virus drives global epidemics of seasonal influenza every year and is characterized by the rapid evolution and spread of new variants capable of escaping immunity caused by past strains. The result is seasonal epidemics, largely driven by the spread among adults, who can develop severe forms of the disease. The influenza vaccine reduces the incidence and especially the severity of the disease. A rapid evolution of influenza A, as happened with Ómicron; may mean that vaccines are not always adapted to circulating strains. How quickly SARS CoV-2 evolves in response to immunity will also determine whether and how often vaccines need to be updated. The current offers will probably have to be updated,” theorized the expert immunologist.

“On the other hand, there is uncertainty about whether the COVID-19 agent will not face new evolutionary challenges in the coming months and years, which will catapult it to gains in its transmissibility and/or virulence. The emergence of new variants has been helped by the uneven implementation of vaccines in low-income countries; these provide fertile ground for SARS CoV-2 to have been able to make surprising evolutionary leaps. The persistence of a large number of infected people over the long term, supported not only by low levels of vaccination in certain areas but also by the less minority anti-vaccine groups, will enable the virus to explore different combinations of mutations to find one that is successful, flourishing with changes deleterious more than with the indulgence of viruses of the common cold. In this latter context, SARS CoV-2 could also become more severe when combined with other coronaviruses and evading current vaccines,” Teglia said.

He concluded: “Despite a decrease in the severity of the disease, the hyper-transmissibility of the virus has generated tension in hospitals and society and negative economic repercussions. The inequity in the distribution of the COVID-19 vaccine and the rejection of it by the population are prolonging the pandemic and facilitating the emergence of new variants. The future of SARS-CoV-2 lies in the hands of humanity, a global vaccination drive may change the evolutionary landscape of the virus and determine what the end of this story will look like.”

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