uan Sierra, un habitante de San José de Guaviare, uno de los cuatro municipios que hacen parte del departamento del Guaviare, región Amazónica Colombiana.

Two and a half years after the pandemic, of the 1,103 municipalities that Colombia has, 419 still do not comply with 70 percent of complete schemes.

By: Juan Carlos Diaz, San José del Guaviare, Colombia.

Wearing a white hat on his head, a polished and abundant mustache, a blue plaid shirt, a poncho that rests on one of his shoulders, and in the midst of a suffocating heat, a cloudless sky and without a hint of breeze to cool In the morning, Juan Sierra, an inhabitant of San José de Guaviare, one of the four municipalities that are part of the department of Guaviare, in the Colombian Amazon region, is next to a table waiting for an orange juice to be served.

Juan Sierra, 81, is one of the residents of this area of Colombia, who has only applied a dose against covid-19, not for fear of the virus. but because he needed the card to be able to move around without problems. Juan does not remember which biological method was applied.

“That covid what they say out there. I had a vaccine applied, because I needed the card to travel through any part of Colombia, or else I would not have done it, because I have my poisons. I prepare them myself and take them, and with that encourages me, and with that I have encouraged quite a few people”, says Juan Sierra, jokingly.

For Juan, who wears a silver ring on one of the fingers of his left hand, he asserts that no more doses were applied against covid-19, because in that remote area the myth has spread that biologicals are to kill people.

“Vulgarly what is heard in the squares and in the huddles is that they give him that injection to kill people and they pay him 30 million pesos, and I am not going to do it. I continue with my poisons that I have and I give to people, and I have encouraged several people with that, «he assured.

The poisons

Juan, who travels in a green van, says that the poisons with which he cures people of covid are based on plants that leave them feeling discouraged.

“They have to go to the sidewalk. I crush their plants; they drink the juice and another juice and they are encouraged”, says Juan with great confidence.

Juan Sierra says that, despite the fact that he has seen several friends and neighbors die, he does not apply more doses.

“More than one has died from that pod. I have had to accompany the funeral, but never, ever have I not applied more doses, because I am encouraged. I am 81 years old and I am going to be 82. Wherever I walk, very few walk,” he said.

The status of the vaccination plan in Guaviare

Juan Sierra, who insists on having the remedy to face covid-19, lives in San José del Guaviare, one of the 419 municipalities, of the 1,103 that Colombia has, that have not managed to complete 70 percent of vaccinated people, in first and second doses, two and a half years after the arrival of the pandemic in this country.

San José del Guaviare, together with the municipalities of Calamar, El Retorno and Miraflores, are part of the department of Guaviare, which have not achieved the vaccination goal by September 2022.

Despite the fact that this vaccination goal has not been achieved and the health authorities have not yet lifted biosecurity measures, in these four towns in the department of Guaviare, its inhabitants no longer use face masks, do not observe distancing measures, and The vaccination card with the complete schedule of the three doses and boosters is not required anywhere.

In San José de Guaviare, capital of Guaviare and one of the 32 departments that Colombia has, and which can be reached by air from Bogotá in less than an hour and by land in more than six hours on an inter-municipal transport bus, the difficulty in achieving the goal of vaccination against covid-19, is that the inhabitants of this population lost their fear of the virus, since the mortality rate is very low.

So far, 105 people have died from the virus, mostly from San José de Guaviare and El Retorno. The last case was reported in February 2022. The highest peak of deaths from the virus was recorded between July and August 2021.

For example, parents of minors between the ages of three and 11 are not taking their children to be vaccinated, despite the days being held in schools and colleges by the health authorities so that young people can apply for the dose.

The vaccine lag

Only 0.1 percent of the population of the department of Guaviare is vaccinated weekly; that is, between 400 and 500 people. In San José de Guaviare the weekly average is between 250 and 300 inhabitants. As of October 19, 2022, 92,633 doses have been applied, and the total population vaccinated with a complete schedule in the department of Guaviare is 54,736 people.

This lack of interest in getting vaccinated, or completing the complete scheme against this deadly virus, has led to the loss of more than two thousand vaccines in that population of the Colombian Amazon, of the 870 thousand biologicals that are about to expire throughout Colombia. .

As of August 31, 2022, in this South American country, the National Plan for Vaccination against Coronavirus is at 83.3 percent for first dose, 71.5 percent for second dose, 41.3 percent for first boosters and 12 percent for second boosters.

It should be remembered that the second booster doses are required according to the protocols established by the Pfizer, Moderna, Sinovac and Jansen vaccines.

“We were the last department in Colombia, where cases of covid-19 were identified. Bearing in mind that we do not have an ultra-freezer to preserve the biologicals, then they are sending us the vaccines little by little,” assured Farly Santoya, departmental vaccination coordinator for the health secretary.

Only until June 2021, that is, after a year and a half of spreading the virus in Colombia, in the municipality of San José de Guaviare, the entire population, both urban and rural, began to be vaccinated, regardless of age. .

“This year 2022, vaccination has decreased due to the difficulties surrounding the entry of the vaccine due to the lack of ultra-freezers, where the Ministry of Health sends us the amount we request, especially from Pfizer and Moderna, which limits availability. Of the biological, because we must be asking for it constantly, because we cannot have it saved”, the official stressed.

To this problem, the lack of special equipment to store vaccines, is added to the population, seeing that the number of hospitalized and deceased has decreased, people have relaxed.

“The inhabitants of San José de Guaviare do not perceive the risks of the disease. Biosafety measures have been lowered; vaccination coverage has been lowered, ”warns Farly Santoya, departmental vaccination coordinator for the health secretary.

Vaccinated population

In the department of Guaviare, in relation to the population over 18 years of age, there is coverage of around 89 percent; but in minors it is where there is low vaccination coverage.

“The groups with low vaccination coverage in Guaviare are between 3 and 11 years old, from 11 to 18 years old with medium coverage, and those over 18 years old with higher coverage. We have been doing the exercise, in coordination with educational institutions, to campaign with students, a strategy that has served us well. One difficulty is that several parents do not sign the consent to vaccinate minors,» revealed Farly Santoya, Coordinator of the San José de Guaviare departmental vaccination plan, who also mentions that «the fear of the disease has already been lost.»

And he added: “It is not the fact that the disease does not exist, but that exercise is working. That is, people no longer consider vaccination important. They say: why should I vaccinate, otherwise it won’t hit me so hard, which reduces the perception of risk and reduces the need for the population to be vaccinated”.

Of the four municipalities in the department of Guaviare, the population of San José is the closest to achieving vaccination coverage against covid-19.

“At the departmental level, coverage is 61.2 percent with complete vaccination schedules and 31.2 percent with reinforcement. If we measure it by municipalities with complete vaccination schedules, San José de Guaviare is at 68.8 percent, Calamar with 45.5 percent, El Retorno with 56 percent and Miraflores with 35.5%. Because it is a department and municipalities with categories 7 and 8, it does not have the necessary resources to carry out vaccination days at the rural level, added to the difficulty of traveling to these areas,” said Farly Santoya, coordinator of the Expanded Immunization Program.

Vaccine losses

Given the warning of the imminent expiration of 870,000 biologics in Colombia, in the department of Guaviare, 1,950 from Pfizer, 1,000 from Moderna and 4,472 from Sinovac are about to expire, for a total of 7,422.

It should be noted that the doses of Sinovac are aimed at the population aged 3 to 11 years, which is the population that has not been vaccinated.

“We try to ensure that the doses requested are in accordance with the vaccination rhythm to mitigate the risk of loss. In Guaviare, when the Pfizer and Moderna vaccines arrive, you have a month to apply them, since they have periods after thawing.” Farly Santoya stressed.

In this department of the Amazon, 122,015 doses have been applied to 68,817 people with one dose and 54,188 residents of Guaviare with complete regimens.

«The goal for the population over 3 years of age is 88,490 people, of whom 54,188 have been vaccinated with complete vaccine schedules, which represents 61.2% of the population.»

Urgent call

An urgent call to the Ministry of Health and Social Protection to urgently implement the necessary and conducive strategies to guarantee and protect the health of Colombians in the face of the appearance of new cases of covid-19 and the non-use of vaccines against the virus. , specifically, the booster doses, made by the Ombudsman, Carlos Camargo.

“The gap must be closed so that Colombians complete their vaccination schedules, taking into account that they have the necessary stock of vaccines and 870,000 biologicals are about to expire, which puts the health of people in the territory at high risk. Colombian, specifically, the second doses of reinforcements that are required according to the protocols established for the Pfizer, Moderna, Sinovac and Jansen vaccines,” said the Ombudsman.

Carlos Camargo recommended that the Ministry of Health reinforce educational campaigns to encourage vaccination and to resume measures such as hand washing and the use of face masks.

In the same way, it required health secretariats to develop actions that induced the demand for vaccines. It is urgent to increase coverage not only for people over 50 years of age with chronic pathologies, but also for children from 12 years of age and older.

“Acute respiratory diseases continue to be one of the main causes of hospitalization and mortality from infectious diseases that can be caused by different bacteria or viruses, and vaccination against covid-19 continues to be the most cost-effective measure to control the pandemic, and reduce its impact on health, the economy and society”, pointed out the Ombudsman.

Outlook in Colombia

Colombia began its preparations for surveillance and response to possible cases in the country, after the confirmation of the outbreak in China of covid 19, and the National Public Health Surveillance System (Sivigila) captured the first case on March 6, 2020, in Bogota. With the confirmation of this case, the National Institute of Health activated its Public Health Emergency Operations Center and began the Containment Stage of the epidemic.

Since April 2020, Colombia began the Mitigation Phase, in which it was necessary to strengthen co-responsibility on the part of individuals with self-care measures, communities and the government to selectively isolate positive cases and their contacts, reduce the speed of transmission, increase the health offer in the territories and begin the gradual economic reopening, in which we continue to date.

To achieve this, the actions and interventions that make up the PRASS Program – Testing, Tracking and Sustainable Selective Isolation have been implemented and strengthened.

Among the prevention provisions adopted by Colombia in August 2020, the Ministry of the Interior regulates the Selective Isolation Phase in municipalities highly affected by covid-19 and responsible individual distancing, in which all people are urged to remain in the territory must comply with the biosafety protocols for behavior in public spaces and promote self-isolation through the Decree of October 30, 2020, the measures are extended until December 1, 2020.

The Government of then President Iván Duque, imparts non-pharmacological measures that seek to slow down the course of the epidemic with the aim of minimizing the saturation of health services.

This is how, in February 2021, the National Vaccination Plan against COVID-19 began in five stages distributed in two phases, initially prioritizing risk groups; Subsequently, vaccination began in children between 3 and 16 years of age and from November 2021 the booster dose was included.

On April 28, 2022, based on the behavior of the virus in the national territory, the Presidency of the Republic extended the state of health emergency until June 30, 2022.

Downward trend

Currently, the country presents an epidemiological situation with a tendency to decrease in the number of infections and confirmed deaths, with an average of 220 cases per day and 6 deaths per day.

These figures had not been recorded since the start of the pandemic in April 2020. Likewise, a decrease in the occupancy of ICU beds has been reported, remaining below 55 percent in the last month.

Due to the above, the National Government has been implementing the de-escalation of non-pharmacological measures in municipalities that comply with 70 percent of complete schemes and 40 percent of reinforcements.

The cities with the greatest impact from the pandemic per 100,000 inhabitants are: Bogotá; Bucaramanga, Santander); Buriticá (Antioquia); Rionegro (Antioquia) and Barranquilla.

20,557,437 tr-PCR samples and 13,907,615 covid-19 antigen samples have been processed, of which 6,960,956 have a positive result for a cumulative total positivity of 22.8 % for tr-PCR and 16.4% for antigen.

At this time, regarding the transmission of SARS-CoV2, the country is in a security zone, but it has not been there for very long to be able to ascertain whether it is in an endemic phase or not.

As of October 20, 2022, according to the National Institute of Health, confirmed cases of covid-19 in Colombia total 6,309,168; active cases 1082; recovered, 6,137,351; and the deceased, 141,827.

According to the health authorities, the observation should continue for a period of at least 20 weeks. If it remains there, during this time range, and although there would still be uncertainty regarding the possibility of the emergence of new variants with a higher percentage of immune escape, the probability of already being in a stable endemic phase increases.

While all this is happening, Juan Sierra, who lives with his three children and his wife in the village of Caño Blanco Tres, two hours by car from San José de Guaviare, along a road in poor condition, is a faithful visitor on weekends. Week to one of the corners of the main park of this municipality, where he enjoys the natural juices sold by his friend Navis Flórez, a recognized leader, who came to this job after having a lot of money and being penniless, all for a woman who abandoned him, leaving him broke.



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