Spanish – The coronavirus lockdown is wreaking havoc on many economies, and in several Latin American countries, the curve seems far from flattening out. What are the challenges of returning to normal in Colombia and Latin America? When will we see a vaccine? What challenges await Latin American countries during this pandemic? The PanAm Post spoke with Marcela Henao, professor, and researcher in the Department of Microbiology, Immunology, and Pathology at Colorado State University, to get her perspective on ending the lockdown in Colombia and Latin America.
What will the return to normal look like after the lockdown ends?
There is no normality at the moment, nor will there be any soon. We have to create a new normal, especially in developing countries like ours.
One thing is very clear to all epidemiologists and immunologists: this is a disease that will be controlled, but it will remain with us. So we will have to learn to live differently. It is clear that this virus is highly infectious. We know from both clinical and laboratory sources that with a very small viral load, it can infect a large population.
We will no longer be able to hug each other, nor greet each other with a kiss. We will have to keep our distance and create a new social etiquette. The more we are aware of the importance of this personal space, the better we can prevent possible infections.
This virus has two very serious things in its favor, it can be transmitted by people who do not have symptoms, and the response in a person can be so different that it is very difficult to treat and manage it efficiently.
In some regions of the country, the virus spread has been overwhelming, while in other places, it has not. How do you explain this behavior?
Several things could be having an influence. First, the overcrowding, many people living together, which is associated with limited economic resources and low educational level. So people might not fully grasp the severity of the issue. In our country, the displacement of people living in poor conditions on the streets worsens the situation since they are the most vulnerable population and undoubtedly a vector of contagion.
In the capital, Claudia Lopez started out managing things well, but there is a trade-off. In Bogota, there are too many people in a very small space. No matter how much they try to prevent and manage the situation, the virus is going to spread.
What alternatives do you think are feasible in the short term to contain the spread of the pandemic?
I think that the policy of infecting all young people, the so-called herd immunity, is a good idea. The problem is that there is no way of knowing the severity of the infection.
Pre-existing conditions are closely associated with a high mortality rate. And in Colombia, there are several risky conditions. If you see in the United States, Latino men are the group with the highest mortality.
The truth is that I am more concerned about mortality than morbidity. The fact that a population becomes infected and can control mortality is ideal. But what we have seen is that the virus has affected the population differently according to age group.
How feasible is it to lift the quarantine in municipalities that do not have COVID-19 cases or have the disease under control?
The quarantine should be lifted by avoiding the flow of people who are not from those communities and teach the community to live with the use of masks and extreme personal hygiene.
One example is how they are proposing to open universities. You have to start with a capacity of 30% to 40% of the staff, and you have to show that you can handle those levels, and keep going up.
It should be a monitored reopening. An evaluation committee can look at the pace of the reopening at the regional level. Everyone thinking individually about doing what they can is not enough.
We need sufficient testing capacity to properly monitor the spread of the virus. The other thing is to have a premeditated plan to close things once again in case the infection escalates. Everyone needs to know that if there is a spike or increase in cases, they should return to closure. Many things have to work at the same time- the health system, testing.
Finally, dedicated groups can be set up at the regional level to sew masks and provide them to all those who will start working. Another group can be in charge of keeping supplies of sanitizers, one group should be in charge of continuous and massive testing, and another group should be in charge of opening in phases.
How would such groups be created? Is there a need for highly specialized personnel?
These are not very complex tasks, and a person with a basic education can be trained. In the United States, the people doing this work are unemployed and young. I think the public sector could train these people and integrate them into these special groups. It is not complex training, but they will have to learn to operate under different conditions than they are used to.
One of the things you have to train them in is the correct use of gloves and masks. A lot of people can’t bear to wear them, and they feel like they are suffocating. Some people wear more masks than they need and have collapsed.
There is a theory circulating that this virus came out of a laboratory. Is that true?
I believe that the possibility of the virus being weaponized is basically zero because nothing is as effective as the evolutionary capacity of a virus. Any laboratory runs the risk of an infected employee, but these laboratories are highly specialized and with biosecurity supervision. I mean, I have been working with tuberculosis for 17 years, and I have never infected anyone. The first people who don’t want to be infected are those of us who work with highly infectious pathogens.
According to epidemiology, these diseases are zoonotic. They come from animals. They are highly transmissible, and both with this virus, and with past cases, it is believed to be transmitted by animals. The possibility of it being a zoonotic disease is very high, and the possibility of the virus coming out because of the negligence of a laboratory is very low.
Ultimately, these theories hinder rather than facilitate research into these pathogens. Rather, the theory that this virus is zoonotic is very easy to prove, and the other theory is not.
How far are we from a vaccine?
Before you release any vaccine, you have to have good safety tests. The cure can’t be worse than the disease. There are two possibilities: some institutions and countries are trying to implement a controlled infection. In other words, they are going to select groups or populations and infect them in a controlled way with the virus. In theory, the person is vaccinated and is allowed to roam freely on the streets. But since we have so many controls, the probability of infection is very low. This factor typically lengthens the clinical study.
It also raises many ethical questions. This population must be kept under surveillance, controlled, and monitored. Although it would a young group that is continuously monitored, there are great risks involved. This is a tough debate that the various Ethics Committees will have to settle.
If several countries get their controlled studies approved, we may see a vaccine in 8-10 months. If these studies are not approved for ethical reasons, we could wait up to a year and a half.
Making this vaccine widely available will cost billions depending on the cold chain, the method of administration, whether it will be injections or patches, etc. Many countries don’t have that kind of money to invest. The question is, how are we going to get the vaccine to the developing countries since they are going to face economic bankruptcy as a result of the quarantine.
Informal work in Latin America prevents an absolute quarantine. How should one deal with the dilemma of starving or going out and risking contagion?
People need to be made aware of the importance of washing their hands and putting on their masks properly. In Brazil, some communities are organizing themselves, where they are selecting homes to shelter the sick. Places must be set aside in the slums to isolate the patients with dignity, that is, with a bed and a roof over their heads.
One thing that has caught my attention is that the coronavirus is being stigmatized. The stigma has to be taken out of people’s heads because we are all eventually going to get infected if there is no vaccine soon. Stigmatizing this infection is one of the big mistakes we are making across the world. Many people are hiding their condition out of fear. For example, in the United States, many infected immigrants are not accessing healthcare out of fear of being deported.