¿Cómo hará Nueva Zelanda para mantener los casos de COVID-19 en cero?

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Dos de los epidemiólogos que trabajaron en la estrategia de eliminación del virus en Nueva Zelanda explicaron los desafíos por delante

Nueva Zelanda regresó el martes pasado a la práctica normalidad después de que la nación oceánica informara que ya no tiene ningún infectado en su territorio, anunció este lunes su primera ministra, Jacinda Ardern.

El Gobierno neozelandés anunció la relajación de medidas al nivel más bajo, lo que en la práctica implica que los ciudadanos pueden retornar a sus puestos de trabajo y reanudar sus actividades cotidianas. “Hoy, 75 días después (de declarar el máximo nivel de alerta), estamos listos para la vuelta a la normalidad”, declaró la mandataria, cuya gestión de la pandemia ha sido alabada internacionalmente.

Nueva Zelanda, que hasta la fecha ha confirmado 1.154 infectados, incluidos 22 fallecidos, entró en “emergencia nacional” el 25 de marzo, con tan solo 50 contagiados. Las medidas de restricción, unas de las más estrictas implementadas en el mundo, han permitido al país controlar la propagación del virus y las autoridades sanitarias neozelandesas esperan declararlo erradicado de su territorio el próximo 15 de junio.

“El Ministerio de Salud se complace en informar que no hay casos activos de COVID-19 en Nueva Zelanda. El Ministerio de Salud Pública Regional de Auckland notificó al Ministerio que su caso restante no ha tenido síntomas durante 48 horas y se considera recuperado. La persona ahora ha sido liberada del aislamiento. No hay nadie en Nueva Zelanda que reciba atención hospitalaria para COVID-19”, aseguraron en un comunicado desde el organismo.

“Este es un hito importante y un momento para celebrar. Pero a medida que continuamos reconstruyendo la economía, hay varios desafíos por delante si Nueva Zelanda quiere mantener su estatus libre de COVID-19 mientras la pandemia continúa en otros lugares”. Así lo indicaron Michael Baker y Nick Wilson, profesores de salud pública en la Universidad de Otago en Dunedin, Nueva Zelanda, y autores del modelo que demostró que era muy probable (muy por encima de una probabilidad del 95%) que Nueva Zelanda hubiera eliminado por completo el virus.

"El objetivo real de la eliminación es detener los casos invisibles que se extienden silenciosamente en la comunidad. Es por eso que necesitamos modelos matemáticos para decirnos que es probable la eliminación” (REUTERS)

“El objetivo real de la eliminación es detener los casos invisibles que se extienden silenciosamente en la comunidad. Es por eso que necesitamos modelos matemáticos para decirnos que es probable la eliminación” (REUTERS)

Para los especialistas, sigue siendo importante que la buena ciencia respalde la evaluación y gestión de riesgos. “Argumentamos que Nueva Zelanda necesita una revisión urgente del sistema de salud, incluido el establecimiento de una nueva agencia nacional de salud pública para la prevención y el control de enfermedades”, dijeron en diálogo con The Conversation.

¿Qué significa la eliminación?

La eliminación se define como la ausencia de una enfermedad a nivel nacional o regional. La erradicación se refiere a su extinción global (como con la viruela). Requiere un sistema de vigilancia de alto rendimiento para garantizar que, si falla el control fronterizo, se encontrarán rápidamente nuevos casos. Las definiciones acordadas son importantes para la tranquilidad pública y como base para expandir los vínculos de viaje con otros países que también han logrado la eliminación.

“Es importante recordarnos que los casos activos no son de los que debemos preocuparnos. Por definición, todos han sido identificados y colocados en aislamiento y es muy poco probable que infecten a otros. El objetivo real de la eliminación es detener los casos invisibles que se extienden silenciosamente en la comunidad. Es por eso que necesitamos modelos matemáticos para decirnos que es probable la eliminación”, advirtieron.

Evitar la complacencia y nuevos brotes

La estrategia decisiva de eliminación de Nueva Zelanda parece haber tenido éxito, pero es fácil volverse complaciente. Muchos otros países que siguen un enfoque de contención han tenido nuevos brotes, en particular Singapur, Corea y Australia.

Según los expertos, Nueva Zelanda ha pasado meses ampliando sus capacidades para eliminar COVID-19. Pero mantener la eliminación será un desafío. Los aeropuertos, los puertos marítimos y las instalaciones de cuarentena siguen siendo posibles sitios de transmisión desde el extranjero, particularmente dada la presión para aumentar el número de llegadas.

El paso de Nueva Zelanda al nivel de alerta 1 terminará con todas las restricciones de distanciamiento físico. Si se reintroduce el virus, esto crea el potencial de brotes derivados de reuniones sociales en interiores. Nueva Zelanda también se está moviendo hacia el invierno cuando los virus respiratorios pueden propagarse más fácilmente, como se ve con los coronavirus altamente estacionales que causan el resfriado común.

5 formas clave para proteger la salud a largo plazo de Nueva Zelanda

“Con el fin del distanciamiento físico, recomendamos que el gobierno considere seriamente hacer obligatorio el uso de máscaras en el transporte público, en los aviones y en las instalaciones de control fronterizo y cuarentena" (REUTERS)

“Con el fin del distanciamiento físico, recomendamos que el gobierno considere seriamente hacer obligatorio el uso de máscaras en el transporte público, en los aviones y en las instalaciones de control fronterizo y cuarentena” (REUTERS)

Al igual que Nueva Zelanda se preparó para la pandemia, el período posterior a la eliminación requiere “máxima proactividad”. Cinco enfoques clave de gestión de riesgos para lograr una protección duradera para Nueva Zelanda contra COVID-19 y otras amenazas graves para la salud pública según los especialistas

1. Establecer el uso público de máscaras faciales de tela en entornos específicos

La protección de la salud se basa en múltiples barreras para la infección o la contaminación. Esta es la piedra angular para proteger el agua potable, la seguridad alimentaria y las fronteras de las incursiones de agentes biológicos.

“Con el fin del distanciamiento físico, recomendamos que el gobierno considere seriamente hacer obligatorio el uso de máscaras en el transporte público, en los aviones y en las instalaciones de control fronterizo y cuarentena. Otras medidas de higiene personal (quedarse en casa si está enfermo, lavarse las manos, toser en los codos) son insuficientes cuando la transmisión es a menudo de personas que parecen estar bien y pueden transmitir el virus simplemente al respirar y hablar”, indicaron.

La base de evidencia para la efectividad de incluso máscaras faciales de tela simples ahora es sólida, según una revisión sistemática reciente publicada en The Lancet. La Organización Mundial de la Salud también ha actualizado sus pautas para recomendar que todos usen máscaras faciales de tela en áreas públicas donde existe riesgo de transmisión. Establecer una cultura de uso de máscaras faciales en entornos específicos en Nueva Zelanda facilitará la expansión de su uso si es necesario en futuros brotes.

2. Mejorar la efectividad del rastreo de contactos con herramientas digitales adecuadas

El sistema nacional de Nueva Zelanda para el rastreo de contactos sigue siendo una medida crítica para controlar los brotes, en caso de que fallen los controles fronterizos. Pero existe un potencial significativo para que las nuevas herramientas digitales mejoren los procesos actuales, aunque con las protecciones de privacidad apropiadas incorporadas. Para ser efectivas, tales soluciones digitales deben tener una gran aceptación y soportar un rastreo de contactos muy rápido. Las aplicaciones descargables parecen insuficientes y tanto Nueva Zelanda como Singapur están investigando dispositivos con Bluetooth que parecen funcionar mejor y podrían distribuirse a todos los residentes.

Una expansión potencial es la entrada libre de cuarentena, que será más segura en países que cumplan objetivos de eliminación similares (REUTERS)

Una expansión potencial es la entrada libre de cuarentena, que será más segura en países que cumplan objetivos de eliminación similares (REUTERS)

3. Aplicar un enfoque basado en la ciencia a la gestión de fronteras

“Un retorno prudente a niveles más altos de viajes de entrada y salida es importante por razones económicas y humanitarias, pero debemos evaluar el riesgo cuidadosamente”, explicaron. Esta apertura incluye dos procesos muy diferentes. Una es la ampliación de las categorías actuales de personas a las que se les permite ingresar a Nueva Zelanda más allá de los residentes, sus familias y un pequeño número de personas. Esto normalmente requerirá la continuación de la cuarentena de rutina de 14 días, hasta que se desarrollen métodos mejorados.

La otra expansión potencial es la entrada libre de cuarentena, que será más segura en países que cumplan objetivos de eliminación similares. Este proceso podría comenzar con las naciones de las islas del Pacífico libres de COVID-19, especialmente Samoa y Tonga. Debería ser posible extender este acuerdo a varios estados australianos y otras jurisdicciones como Fiji y Taiwán cuando confirman su estado de eliminación.

4. Establecer una agencia nacional dedicada a la salud pública

“Incluso antes de que COVID-19 llegara a Nueva Zelanda -advirtieron- estaba claro que nuestra infraestructura nacional de salud pública estaba fallando después de décadas de abandono, fragmentación y erosión”. Entre los ejemplos más destacados de fallas del sistema se incluyen el brote de campylobacter de Havelock North en 2016 y la epidemia prolongada de sarampión en 2019. El informe completo de revisión del sistema de salud y discapacidad se entregó al Ministro de Salud en marzo y se esperaba ampliamente que recomendara una mejora significativa de la capacidad de salud pública.

También recomiendan una evaluación provisional de la respuesta de salud pública a COVID-19 ahora, en lugar de después de la pandemia. Estas revisiones informarían la mejora necesaria de la capacidad de salud pública de Nueva Zelanda para gestionar la respuesta a la pandemia en curso y preparar al país para otras amenazas graves para la salud. Una mejora clave sería una agencia de salud pública nacional dedicada a liderar el control y la prevención de enfermedades. Dicha agencia podría ayudar a evitar la necesidad de bloqueos mediante la detección temprana y la acción en respuesta a las amenazas de enfermedades infecciosas emergentes, como lo logró Taiwán durante la pandemia actual.

5. Comprometerse con un cambio transformador para evitar las principales amenazas globales.

COVID-19 está teniendo efectos devastadores en la salud y la sociedad a nivel mundial. Incluso si se pone bajo control con una vacuna o antivirales, quedan otras amenazas importantes para la salud, incluido el cambio climático, la pérdida de diversidad biológica y las amenazas existenciales (por ejemplo, pandemias derivadas de desarrollos en biología sintética). Estas amenazas necesitan atención urgente. “La recuperación del encierro brinda una oportunidad para una transformación sostenida de nuestra economía que aborda objetivos sociales, ambientales y de salud más amplios”, conlcuyeron.

Ambito

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