Uruguay, once seen as the global model for responding to the COVID-19 pandemic, has lost control of the SARS-CoV-2 coronavirus in recent months. It is now one of several countries in South America struggling to contain a wave of infections.
Uruguayan scientists say a mix of complacency – fueled by the country’s early success in controlling the virus – and the challenges posed by a particularly transmissible variant of SARS-CoV-2.
“We were a role model in 2020,” says Rafael Radi, biochemist at the University of the Republic in Montevideo. “Unfortunately it won’t work like that in 2021 anymore.”
For all of last year, the country with a population of 3.5 million recorded only about 19,100 cases of COVID-19 and 180 deaths from the disease. However, more than 341,000 infections and 5,100 deaths have been reported this year, according to the online publication Our World in Data, which is maintained by researchers from the University of Oxford, UK (see “Uruguay’s surge”). It recorded the highest number of COVID-19 deaths per capita in the world several times in May and June.
In the past week, however, new infections and deaths have declined thanks to the country’s rapid vaccine introduction, says Radi – which gives hope that the country can contain the virus again.
Uruguayan scientists and officials blamed the country’s early success in containing the pandemic to government officials who followed the advice of the Honorary Scientific Advisory Group (GACH), a team of 55 multidisciplinary science experts led by Radi. After the country confirmed its first COVID-19 cases in March 2020, based on the group’s recommendations, the government quickly closed shops and schools and restricted travel at the borders.
“We did a lot of things right,” says Radi. “The coupling of health, science, state and society in 2020 was almost perfect.”
At the same time, scientists – including Gonzalo Moratorio, a virologist at the Pasteur Institute and the University of the Republic, both in Montevideo – realized that Uruguay needed COVID-19 tests to identify and then isolate infected people, and that the country could get away do not rely on buying these kits from other nations. So the researchers developed their own and eventually got one of the highest testing rates per capita in Latin America – second only to Chile. Thanks to widespread testing and an aggressive contact tracing system from the Uruguayan Ministry of Health, the country was able to break chains of transmission before they could grow exponentially. In 2020, Uruguay reported no daily new infections several times.
But that all changed in 2021. COVID-19 cases began to rise in December. The GACH again recommended restrictions such as border closings, but government officials did not implement all of them. For example, they didn’t close any restaurants because that would have hurt the economy, says Radi.
As the number of infections continued to rise, Uruguay’s test, trace, isolate program (Tetris) stalled. Once more than 4% of the tests are positive, Tetris cannot identify and isolate COVID-19 cases quickly enough to contain the virus, Moratorio says.
“This really persistent first wave that we are suffering from goes way beyond the Tetris strategy,” says Radi. “We have lost sight of a large part of the cases.”
Stuck in the middle
Another reason for Uruguay’s recent surge is the country’s geography, researchers say.
Although COVID-19 has declined in some parts of the world, it is raging in South America. The continent currently reports the five highest weekly COVID-19 death rates per capita in the world.
Uruguay lies between two of the region’s hotspots – Argentina and Brazil – where infections were in part driven by a highly transmissible variant of SARS-CoV-2 called P.1 or Gamma. Some Uruguayan cities, such as Rivera, push against the border with Brazil and make travel restrictions between the countries ineffective.
In February, less than 15% of all viruses sequenced in Uruguay were the gamma variant – but in Rivera it was 80%, says Rodney Colina, director of the Laboratory of Molecular Virology at the University of the Republic in Salto, Uruguay.
The leakage of the gamma variant to Uruguay was especially bad during the summer vacation earlier in the year, when family and friends got together instead of staying socially aloof. Scientists have now proven the variant nationwide in nine out of ten sequenced virus samples, says Radi.
But the gamma variant is only part of the equation, say Uruguay’s scientists. Paradoxically, the country’s early success in containing the pandemic may have contributed to the loss of control in 2021.
“National authorities claimed victory too early,” says Moratorio. “Fear of the virus was lost because of all the good things we’d done before.”
As case numbers rose, Uruguay should have locked them up to bring them back to manageable levels, says Zaida Arteta, secretary of the Uruguayan Medical Union and a member of the Uruguayan COVID-19 Interdisciplinary Data Analysis Group that is monitoring the pandemic.
“We had several options to get our epidemiological tracing back on track, but instead we opened up further and moved from a containment strategy to a containment strategy,” she says.
The Uruguayan President’s office and the Ministry of Health did not respond nature‘s questions as to why they chose not to follow GACH’s recommendations on introducing restrictions the second time around.
Government officials weren’t the only ones on guard over COVID-19. Researchers say compliance with social distancing recommendations waned in 2021 because people of Uruguay were confident about how the pandemic and COVID-19 vaccines were being handled. The first shots were fired in Uruguay on March 1.
A study published by GACH earlier this month found that while the majority of Uruguayans think COVID-19 was a serious illness, only one in three thought they would become self-infected within the next six months.
“Although the infections were increasing, there was a general feeling that things were under control or were getting better,” says Radi. “In fact, they got worse and worse.”
To date, around 43% of Uruguayans have been fully vaccinated and 63% have received at least one dose of a COVID-19 vaccine. The country has the second fastest vaccination program in South America and began vaccinating people ages 12-17 on June 9.
Positive COVID-19 cases have decreased by more than a third in the past week. According to a study by the Uruguayan Ministry of Health, admissions to intensive care units have fallen by more than 92% and the number of deaths has fallen by more than 95%.
So experts remain cautiously hopeful. “It’s not over yet, we still have dozens of serious cases and we expect more deaths,” says Arteta. “But the introduction of vaccines is one of Uruguay’s strengths. They are effective and we vaccinate very well and quickly. I hope the trend continues. “
This article is reproduced with permission and was first published on June 25, 2021.