Brazil forces reflection on strategies to vaccinate faster

The world is turning on the red flags for the Amazonian strain of coronavirus, more contagious, more deadly and able to avoid the immune response caused by previous infections, which in a few months spread throughout Brazil, leading this country to an even more serious health situation than during the first peak of the disease. This Tuesday a new record of more than 1,700 deaths in 24 hours was recorded there and in 19 of the country’s 26 states, intensive care unit occupancy exceeds 80 percent.

The Manaus variant has several characteristics that increase its contagiousness between 50 and 150 percent, according to two recent studies. It also means an increase in viral load, which makes it more prone to serious or fatal manifestations. But the most worrying is that has the E484K mutation, also detected in South Africa and the UK, which allows the virus to evade the immune response, making it more resistant to vaccines and able to re-infect people who have had the disease before.

In April of last year, Manaus was one of the Brazilian cities most affected by the coronavirus. Some antigen studies have shown that seven out of ten residents are infected, which is why some experts were quick to report that they had acquired herd immunity. In September, an increase in cases was detected again. In January, the new variant, which had been discovered in a traveler, was sequenced in Japan. A few days later, the health system has collapsed again.

By the end of February, all of Brazil had become Manaus. The greater contagiousness of these variants means that sooner or later they end up becoming the predominant strain. Two days ago, The latest infectious bulletin from the Fiocruz Observatory, one of the largest in the country, indicates that of the 26 states that make up the federation, out of 19, intensive care occupancy is greater than 80%.. In the previous report, released on February 22, there were only 12.

In Argentina, the presence of this variant has already been detected in two cases, one with a history of travel to Brazil and the other with close contact with a person who had stayed in this country.. However, due to the limited amount of genomic analysis performed on infected individuals, it cannot be excluded that there is already community circulation. We are in a time race between the new strain and vaccines, which have so far proven to be highly effective in preventing severe cases, hospitalizations and deaths.

The government plans to expand the vaccination operation to around five million per month. If this rate could be reached from now on, it would take until the end of May to complete the inoculation of the priority groups., as defined: just over 15 million people over the age of 60, adults with co-morbidities, health workers, military and security forces, teachers and non-teachers, and strategic staff. Only then can vaccination of the general population begin.

If before this time there were signs of regrowth caused by the new strain, the only way to avoid the collapse would be to resume restrictions on mobility and the performance of high-risk activities.. This would have a very high political and economic cost, but it is the path that several countries are taking, with success. The UK, one of the most advanced on vaccination, to deal with a similar (albeit milder) variant went into lockdown in mid-January and has no plans to lift restrictions until June .

The alternative is to vaccinate faster. Given the difficulties, common to almost every country in the world, of obtaining a greater number of injections in the short term, the existing resources must be managed intelligently. In this direction, The decision of the Argentine government to close the possibility of giving a single dose of the vaccine to people already infected is not explained, when several scientific studies around the world, including one in Argentina, demonstrate the effectiveness of this practice..

The government itself had published this morning the results of an antibody study on people inoculated with Sputnik in the province of Buenos Aires who found that “the increase in the total titre of IgG antibodies against Spike and neutralizing in individuals who had already been exposed to the virus having received one dose of the vaccine was greater than that observed in naive individuals with both doses”. That is to say one dose applied to infected people generates more defenses than two doses in healthy people.

However, a little later, from the Presidency of the Nation, it was reported that this work is “only a technical report” which is “very important from a scientific point of view” but “It is not being evaluated at the Ministry of Health not to administer the second dose of Sputnik V to people with covid-19”. The Uncover was able to verify that at least two officials from this region have not only assessed the possibility, but also consider it appropriate to advance this health strategy.

This is the second time that a reversal has been observed in this direction. In January, the then Deputy Minister (and current Head of the Portfolio) of Health Carla Vizotti had expressed in an interview the possibility of applying a greater number of first doses before starting the second instance vaccination. After a series of harsh media questions, recourse to this regime, applied in several countries of the European Union, was ruled out, although it was rejected in the United States.