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. 2020 Aug 17:44:e99.
doi: 10.26633/RPSP.2020.99. eCollection 2020.

Epidemic trends, public health response and health system capacity: the Chilean experience in four months of the COVID-19 pandemic

Mauricio Canals  1 , Cristóbal Cuadrado  1 , Andrea Canals  1 , Karla Yohannessen  1 , Luis A Lefio  1 , Maria P Bertoglia  1 , Pamela Eguiguren  1 , Izkia Siches  2 , Verónica Iglesias  1 , Oscar Arteaga  1
Affiliations

Epidemic trends, public health response and health system capacity: the Chilean experience in four months of the COVID-19 pandemic

Mauricio Canals et al. Rev Panam Salud Publica. .

Abstract
in English, Spanish

Objectives: To report the surveillance of COVID-19 pandemic in Chile and analyse the response to public health interventions implemented from 3 March to 30 June 2020 and to assess the risks of collapse of the health care system.

Methods: We analysed the effective reproductive number, underreporting of cases, burden of critical beds, case fatality ratio and number of diagnostic RT-PCR for SARS-CoV-2.

Results: After an accelerated onset, the COVID-19 pandemic seemed to be relatively controlled in Chile (late April 2020), with reproductive numbers close to 1.00. However, at this time, the load of infected patients was high, with an important number of underreported cases; the diagnostic effort was still limited and heterogeneous across regions. After 1 May up to 30 June a marked exponential increase in the number of cases was observed with a peak on June 14. In this last period the occupation of intensive care unit beds increased to saturation level (89% nationally; 95% in the Metropolitan Region).

Conclusions: Our findings suggest that the implemented public health interventions have been initially effective in decreasing the spread of the pandemic. Premature decisions to relax these interventions may have resulted in a rebound in cases with a rapid saturation of the health care system.

Objetivos: Informar sobre la vigilancia de la pandemia por COVID-19 en Chile, analizar la respuesta a las intervenciones de salud pública implementadas desde el 3 de marzo hasta el 30 de junio de 2020 y evaluar los riesgos de colapso del sistema de salud.

Métodos: Se analizó el número reproductivo efectivo, el subregistro de casos, la carga sobre las camas de cuidados intensivos disponibles, la tasa de letalidad y el número de pruebas diagnósticas de RT-PCR efectuadas para el SARS-CoV-2.

Resultados: Tras un inicio acelerado, la pandemia por COVID-19 parecía estar relativamente controlada en Chile a finales de abril de 2020, con números reproductivos cercanos a 1,00. Sin embargo, en ese momento, la carga de pacientes infectados activos era elevada, con un número importante de casos no notificados; la capacidad diagnóstica era todavía limitada y heterogénea entre las regiones del país. Desde el 1 de mayo hasta el 30 de junio se observó un marcado incremento exponencial en el número de casos, con un pico el 14 de junio. En este último período la ocupación de camas en las unidades de cuidados intensivos aumentó hasta el nivel de saturación (89% a nivel nacional; 95% en la Región Metropolitana).

Conclusiones: Nuestros hallazgos sugieren que las intervenciones de salud pública implementadas parecen haber sido efectivas inicialmente para disminuir la propagación de la pandemia. Las decisiones prematuras de relajar estas intervenciones pueden haber ocasionado un rebote en los casos con una rápida saturación del sistema de atención de salud.

Keywords: Chile; Coronavirus infections; health policy; health systems; pandemics; public health.

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Figures

FIGURE 1.
FIGURE 1.. Evolution of new COVID-19 confirmed cases in Chile and intervention strategies implemented, 3 March-30 June 2020
FIGURE 2.
FIGURE 2.. Case fatality ratio and underreporting estimates for COVID-19 in Chile, April-June 2020. A) Crude and corrected case fatality ratio. B) Under-reporting estimates, with 95% confidence intervals
FIGURE 3.
FIGURE 3.. Evolution of the reproductive number for COVID-19 epidemic in Chile, March-June 2020
See this image and copyright information in PMC

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