New York City. The pandemic has been exacerbated by recent hurricanes in Central America, as a result of outbreaks in overcrowded emergency shelters, as well as travel during the American Thanksgiving season, health leaders said at a Pan American Health Organization (PAHO) press conference.

Last week, saw an increase of 1.5 million cases reported in the WHO “Americas” region, mostly in the USA where new cases are now averaging close to 180,000 a day, but also with climbing numbers in vulnerable populations and among indigenous communities in Central America, who are especially vulnerable due to their remote location and the challenge of access to the health infrastructure.

“Since the start of the pandemic, there have been more than 25 million cases and more than 700,000 deaths due to COVID-19 in the Americas,” said Dr. Jarbas Barbosa, Assistant Director at PAHO.

Back-to-Back Hurricanes Impact Pandemic Response in Central America

Central America’s pandemic surveillance system has been greatly impacted by recent hurricanes Eta and Iota. The number of cases reported has dropped dramatically in Honduras and Nicaragua, which have seen approximately 640 testing centres and other facilities hit by the hurricanes, which have affected more than 8 million people, also leading to widespread evacuations to hurricane shelters. 653,000 people have been evacuated in the region. The Caribbean, Guatemala, and El Salvador have also been similarly impacted.

“Shelters organized to host thousands of people in these countries do not necessarily have the conditions to prevent transmission from COVID-19,” said Dr Ciro Ugarte, Director of Health Emergencies. “This creates a very challenging situation.”

In Central America, hospitals and shelters have reported a lack of care personnel and capacity – increasing the risk of transmission of disease – as already vulnerable populations, like the elderly, have been left with limited or no access to healthcare. The region has also seen decreased water and sanitation services, making it difficult to maintain infection, prevention, and control efforts: all important in preventing the spread of waterborne and other communicable diseases like COVID-19. Collapsed roads have also prevented timely humanitarian response.

Ugarte noted at the PAHO conference that the health sector, supported by PAHO and other international NGOS, have been assisting assessment as well as emergency response.

Holiday Season Brings Good News of Promising COVID Vaccines but also Increased Transmission Risk

While Central America is facing increased transmission from a damaged healthcare infrastructure, there is another source also driving increased disease transmission and that is traveling and family gatherings during the holiday season, which began with Thanksgiving celebrations in Canada and this weekend in the United States.

“During an epidemic there is no such thing as a risk free holiday season. Every gathering, every shopping trip, every travel plan, you increase the chance of spreading the virus,” Dr Barbosa warned, advising against large social gatherings, especially indoors. He recommended that any gatherings be held in well-ventilated areas, with masks, or outdoors, and if that is not feasible postponed entirely.

The US CDC also has issued stiff warnings against travel and mixing between households. But on Thursday the United States Supreme Court also issued a stiff blow to authorities’ attempts to curb religious mass gatherings that can be superspreader events. The Court on Thursday ruled that limits which had been imposed by the City of New York on the number of people gathering in churches, mosques and synagogues – were unconstitutional because they impinged on people’s freedom of worship.

Travel Not Risk-Free Even With a COVID Test

Speakers also flagged that many people falsely assume that being tested means safe travels, free of infection. Testing often leads travelers into a false sense of security, as it does not guarantee risk of infection is eliminated. Countries must continually use data on the spread of the virus to reassess their travel guidance to make travel safer, they said.

Although November saw announcements of the very positive interim efficacy results of several potential vaccine candidates announced, with vaccine candidates produced by Pfizer and possibly Moderna, in line for emergency use approval by the US FDA by mid- or end of December, PAHO officials warned that vaccines are still some months off, in terms of reaching the general public.

“Unfortunately, we will not have enough vaccines to vaccinate everyone and stop the transmission,” Barbosa said. Once the vaccine is released, however, its use is still recommended in order to save lives. Achieving herd immunity, in theory, would only be possible if a population reached a threshold of 60-70% immunity, either through natural infection or vaccination.

Even in the US, which has amassed the largest stock in the world of pre-purchased vaccine supplies from Pfizer, Moderna and others, it is yet to be determined who will be vaccinated first. In addition, officials are concerned about public resistance to vaccines. The most recent US poll showed 51% of people were inclined to be vaccinated, and while that is an increase from previously, it is still far lower than the 90% levels that would need to be achieved.

A much stronger public information effort needs to be undertaken to inform people about the personal and community-level benefits of vaccination against COVID-19, PAHO officials said. And more awareness raising needs to be done to inform the public of how the virus can be transmitted, particularly during the holidays.

Barbosa noted: “The individual decisions we make this holiday season affect the people closest to us. They will also impact our communities. Solidarity has been our region’s response to COVID-19. [Solidarity] is more important than ever, during the holidays.”

Image Credits: PAHO, Duke Global Health Innovation Center.