As of January 21, Guanacaste reports 2,472 active cases of COVID-19, making it the province with the lowest number of cases in the entire country. It also has the lowest population, according to data from the Institute of Statistics and Censuses (INEC). Even so, the province remains vulnerable, since almost 70% of the cases to date are concentrated in two cantons: Liberia and Santa Cruz, and hospital capacity there is at risk.
The presence of more cases in Santa Cruz can be attributed, among other factors, to breaking pandemic protocols at year-end celebrations, according to the canton’s epidemiological surveillance coordinator, Luis Alonso Matarrita.
We have been feeling the effect of this increase steadily since December. We began to see an exponential increase in cases since the end of December, and in January, these first weeks, we maintain an incidence of increased infection,” the doctor said.
Matarrita affirmed that the behavior of cases varies constantly. For example, the Health Area reported a drop in positive COVID-19 patients last week, but cases increased again in the middle of this week.
Ministry of Health data analyzed by Agustin Gomez, statistical coordinator for the Development Observatory of the University of Costa Rica (UCR), back up his statements. In Santa Cruz, the R rate, which determines the average number of people who will be infected by each person who is infected, dropped from being 0.96 during the second week of January to 0.45 in the past week. In total, for every 1,000 inhabitants of the canton, 25 are infected.
On January 20, the Ministry of Health recorded 13 new cases in Santa Cruz, when the canton had been reporting between three to four cases in the previous days.
The situation in Liberia is even more serious: the R rate has remained between 0.8 and 0.6 since December 25, more similar to the behavior found in cantons within the Greater Metropolitan Area, where there is a greater number of cases in the nation.
These increases and decreases are a reflection of the behaviors that could have occurred in certain cantons. They are a reflection of the population’s behavior… We must remember that the data presented by the Ministry presents a delay. It doesn’t necessarily correspond to people who were infected a week or fifteen days ago,” said the statistician.
So how is hospital capacity? At this time, Santa Cruz has a unit to care for patients with symptoms of respiratory illnesses in the canton’s central clinic. This health area has treated at least 3,000 patients suspected of having contracted the virus since the beginning of the pandemic.
Matarrita, the canton’s epidemiologist, remarked that as COVID cases have increased in the canton, the unit’s personnel have also presented a greater number of infections.
We have had many colleagues affected by the sickness, that is to say, infected [by COVID-19]. Cases of doctors, nurses, cleaning personnel and in some cases, even ambulance drivers. Because it is a staff that is very focused on the patient, that faces the sickness every day. The more cases that arrive, the more risk they take,” the coordinator related.
That office’s staff can only evaluate, examine and diagnose potential patients, but they don’t have the capacity to hospitalize anyone there. In other words, if there is an increase in serious COVID-19 cases in Santa Cruz, patients have to be transferred to the La Anexión Hospital in Nicoya or the Enrique Baltodano Briceño Hospital in Liberia, depending on each patient’s risk level.
As of January 21, La Anexión has 17 out of 21 COVID-19 beds available for mild and moderate cases. In Liberia, the hospital has five free beds for critical and severe patients and 17 for moderate and mild cases. The hospital also has two beds for pediatrics and four for gynecology. This data can change from minute to minute.
Due to the increase in cases in the region, the Enrique Baltonado Hospital has transferred people to the Rafael Angel Calderon Guardia Hospital and the Mexico Hospital to maintain the hospitalization services’ capacity.
So far in January, the Liberia hospital has transferred nine COVID-19 patients to San Jose, according to data from the Costa Rican Social Security Fund (CCSS).
A Different Strain?
Virologist Eugenia Corrales indicated that the virus statistics reflect what life is like for people in each region. The increase in cases in some cantons speaks to the general state of the population living there, the overcrowding that exists and the behavioral practices of people who live there, she explained.
There is no difference in strain or in virus. The difference in spread is made by people by how we behave. The difference is in where we live, in our health system and the health inequalities that exist in each region,” Corrales stated.
In other words, the increase or decrease in cases in a canton will depend on how people comply with Ministry of Health measures, as well as on the conditions in which they live and how quickly health personnel can respond to possible cases.
Santa Cruz, for example, doesn’t have the ability to hospitalize a COVID-19 patient immediately. Dr. Matarrita affirmed that, depending on the availability of beds in hospitals, patients can be hospitalized in a matter of minutes, or it can take hours when it’s necessary to take them to hospitals in the Greater Metropolitan Area.
Corrales considers areas like Guanacaste to be in even greater danger in the face of large-scale spread since there is no way to care for dozens of patients in serious condition with the equipment available at this time.
The number of ICU beds in Liberia isn’t the same, nor is the level of critical[-condition beds] that Liberia has, [compared] with the level of criticall[-condition beds] that the San Juan or Mexico [hospitals] have. That is why we see transfers from rural areas, because there isn’t the same capacity,” the virologist explained.
Distance and care must continue
Corrales emphasized that people have to take into account that despite a decrease in cases or the arrival of vaccines, they must still take the same health measures to avoid infection. “People think this is already over, but by doing that, we’re giving the virus room to develop into something more dangerous. You see Santa Cruz or other parties that they have and 2021 could be even worse than 2020,” she emphasized.
Dr. Matarrita believes that cases due to the celebrations during the second week of January will hit the Santa Cruz health system “very hard.” For this reason, he requested that people continue to follow the necessary cleaning and distancing protocols to avoid reaching hospital capacity.
“Hopefully everyone can understand that we are living in different times, that the fiestas can be held later on, but right now, to the extent possible, and please, let’s cooperate with health authorities and avoid every kind of festivities,” he emphasized.