Progression of COVID-19 Under the Highly Restrictive Measures Imposed in Argentina
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Progression of COVID-19 under the highly restrictive measures imposed in Argentina Dr. Jose-Luis Sagripanti ( [email protected] ) US FDA and US Army (RETIRED) https://orcid.org/0000-0002-3952-5838 Dr. Daniel R. Aquilano Laboratorio de Análisis Bioquímicos Dr. Daniel R. Aquilano, La Plata, Buenos Aires, Argentina Research Article Keywords: COVID-19, SARS-Co V-2, pandemic, lockdown, curfew, vaccination, germicidal sun light, economic impact Posted Date: August 9th, 2021 DOI: https://doi.org/10.21203/rs.3.rs-789729/v1 License: This work is licensed under a Creative Commons Attribution 4.0 International License. Read Full License Page 1/18 Abstract The variety and extent of non-pharmaceutical measures implemented by the government to control COVID-19 in Argentina were exceptional, making this country the best example to analyze the evolution of COVID-19 under the most stringent and longer-lasting restrictive policies- which up to May 31st 2021 included 119 days of strict nation-wide lock-down, 304 days of less restrictive lock-downs, and 35 days of curfews. Two of the three peaks of infection correlated with the germicidal solar ux received in Argentina, suggesting a seasonal component and a role for the virus persisting in the environment. A massive public gathering crowding the presidential square in Buenos Aires, during which nearly half of those present were without face masks, did not alter the infection curve in that city. Comparative epidemiological data (standardized per million inhabitants) shows that COVID-19 in Uruguay, a neighboring country whose capital is at a similar latitude than Buenos Aires and who did not mandate lock-downs or curfews, progressed much slower (until vaccination started) than in Argentina. The number of yearly deaths caused by respiratory diseases and inuenza in Argentina before the pandemic was similar to the total number of deaths attributed to COVID-19 cumulated on April 25, 2021, more than a year after the pandemic started. The failure to detect any benet on ameliorating COVID-19 by the long and strict nation-wide lock-downs in Argentina should raise world-wide concerns about mandating costly and ineffective restrictive measures during ongoing or future pandemics Signicance For Public Health Epidemiological data released by the Ministry of Health of Argentina was compared with the public health policies instituted by that country that have resulted among the longest, most restrictive, and more strictly enforced measures in the world intended to control COVID-19. Analysis of the data failed to detect a benet of the public health measures instituted in Argentina when compared to a neighboring country with opposing policies. The ndings reported here should be considered by Argentina as well as by other countries mandating or planning to implement long lasting stay-at-home orders and lock-downs to control COVID-19 or during future pandemics to come. Introduction Computer modeling simulations, mainly from the Imperial College of London, predicted that 7 billion infections and 40 million deaths would occur during 2020 alone if quarantine, lock-downs and other highly restrictive measures were not enforced.1,2 These measures published by leading scientic journals and disseminated widely by the press were considered instrumental3 in justifying 1168 quarantine and lock-down policies mandated by the governments of 165 countries4 which resulted, by the rst week of April 2020, in 3.9 billion people (more than half of the world's population) in quarantine or under in-house lock-downs.5 Paralleling world-wide predictions1,2, a local simulation study also predicted much worse consequences of the pandemic in Argentina if lock down and other restrictions were not implemented, with infection Page 2/18 rates sharply decreasing if the number of quarantined individuals increased.6 In contrast, an earlier study of the effect of traveling (to workplace, to the pharmacy, to buy groceries or to other places) on infection by SARS-Co V-2 reported that lock-down in Argentina could be effective in reducing mobility short term but should not be effective in reducing contagion long-term.7 Argentina was among the countries instituting early (March 19, 2020) nation-wide and strictly enforced stay-home orders while its neighbor Uruguay chose not to mandate lock-down nor quarantine, allowing free mobility.8 The measures mandated in Argentina may have not been unique but the extent and variety of restrictions imposed on the population (as detailed below) were exceptional, making this country the best example to analyze the evolution of COVID-19 under the most stringent and longer-lasting restrictive policies taken by any country. The starting assumption of the present study was that any benecial effect of lock-downs, quarantines and curfews should be amply evident in Argentina, if such effect exists. Design And Methods The policies implemented in Argentina to control COVID-19 were those published periodically in the Argentinean Government Ocial Bulletin (Boletin Ocial del Gobierno).9 The present analysis comprised COVID-19 epidemiological data released daily by the Ministry of Health of Argentina from March 3rd 2020 to May 31st 2021.10 Total infections per million inhabitants, and deaths attributed to COVID-19 per million inhabitants, were calculated using a population gure of 44.5 million.11 The compliance of mask wearing at the largest public gathering in Argentina during COVID-19 was estimated from ninety eight different photographs taken at the funeral of ex-soccer star Diego Maradona and posted in the internet by various sources. On these photographs we could score accurately 329 persons as either wearing face mask or not. Epidemiological data for Uruguay was obtained from the country's government daily updates.12 The epidemiological data corresponding to COVID-19 for Argentina and Uruguay were conrmed by the compilation made by the John's Hopkins' Center for System Sciences and Engineering.13 The germicidal solar ux received in Argentina (Buenos Aires) through the year and its virucidal effect on SARS-Co V-2 has been previously published elsewhere.14 Causes of death pre- pandemic were obtained from statistics released in 2018 by the government of Argentina.11 Results COVID-19 policies in Argentina. The rst case of COVID-19 in Argentina was reported on March 3, 2020. The federal government responded to COVID-19 with a Resolution by Need and Urgency (Decreto de Necesidad y Urgencia, DNU # 297/2020) published in the Government Ocial Bulletin (Boletin Ocial del Gobierno) on March 19, 20209, when there were 97 cases and 3 death attributed to COVID-19.10,13 This DNU declared obligatory nation-wide quarantine (Aislamiento Social Preventivo y Obligatorio or ASPO), whereby restricting the population of the whole country to their homes (known in Argentina as Phase I and indicated as region B Page 3/18 in Fig. 1) with the exceptions of essential personnel, like police. Curiously, personnel in public and private transportation (buses and taxis) were considered essential and allowed to circulate despite their main customers quarantined at home. Government agencies suspended in-person customer service. Social, cultural and sporting activities were cancelled and commerce closed all day. Exceptions to this policy included public and private clinics and hospitals, veterinary clinics, supermarkets and hardware stores serving to persons with documented addresses nearby (it is mandatory to carry identication documents at all times in Argentina). Persons considered at risk, including obese persons (with Grade II, body mass index < 35-39.9 kg/m2), were not allowed to return to work even to perform in the exempted occupations listed above (Resolution of Ministry of Labor #207/2020). Essential workers must carry a written or digital permit while non-essential individuals may request a temporary circulation permit for going to the doctor, hospital or caring for a sick relative. This circulation permit (called CUIDAR) holds personal data and a QR code to control legitimacy. Persons detained without proper identication or circulation permit were ned or jailed (varying with the Province or circumstances) and their vehicles impounded. In addition, face masks, hand washing and social distancing of 1.5-2 meters (5–7 feet) was also required. The Argentinean Minister of Health declared on July 8, 2020 that “all bad colds are coronavirus until proven the contrary”15, and recommended not to laugh, sing or speak loudly to reduce contagion.16 In addition, The Ministry of Health of Argentina released on April 2020, "Recomendaciones para sexo seguro" (Recommendations for safe sex) stating that to prevent COVID-19 close contacts, including sex should be avoided.17 The measures mandated in the 1st DNU (297/2020) were prorogated every 15 days, remaining in force until July 18, 2020 when a new decree (DNU# 605/2020) partially relaxed restrictions.18 Under the measures mandated by DNU#605/2020 (called by the government Distanciamiento Social Preventivo Obligatorio, DISPO or generally known as Phase II, depicted as Region C in Fig. 1) industrial, commercial, or services activities were allowed as long as they had an operational permit approved by the provincial sanitary authority within the guidelines mandated by the national sanitary authority. Among other restrictions, the national sanitary authority limited operation of working activities to no more than 50% of the covered area of the installation. It was left to provincial sanitary authorities to rule particular days and hours for the performing of sporting, artistic or social activities as long as (by national guidelines) the number of participants remained below 10 individuals. In addition, the occupational density in close quarters (oces, restaurants, changing rooms, etc.) was limited to one worker per 2.25 square meters. These measures excluded personnel at risk, including obese individuals, from returning to work as decreed on March 19, 2020 (see above). Cinemas, theaters, cultural gatherings, and sports involving more than 10 persons or that could not preclude more than 2 meters separation between players remained prohibited.