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Confinamientos por COVID-19

Durante las primeras etapas de la pandemia de COVID-19 , se implementaron varias intervenciones no farmacéuticas , en particular confinamientos (que abarcaron órdenes de quedarse en casa , toques de queda , cuarentenas , cordones sanitarios y restricciones sociales similares), en numerosos países y territorios de todo el mundo. [1] Estas restricciones se establecieron con la intención de reducir la propagación del SARS-CoV-2 , el virus que causa la COVID-19 . [2] En abril de 2020, aproximadamente la mitad de la población mundial estaba bajo algún tipo de confinamiento, y más de 3.900 millones de personas en más de 90 países o territorios habían recibido la orden o el pedido de sus gobiernos de quedarse en casa. [3] Aunque se han utilizado medidas similares de control de enfermedades durante cientos de años, se cree que la escala de las implementadas en la década de 2020 no tiene precedentes. [4] [ verificación fallida ]

Las investigaciones y los estudios de casos han demostrado que los confinamientos fueron generalmente eficaces para reducir la propagación de la COVID-19, aplanando así la curva . [5] [6] [ contradictorio ] [7] La ​​recomendación de la Organización Mundial de la Salud sobre los confinamientos es que deben ser medidas muy breves y de corto plazo para reorganizar, reagrupar, reequilibrar los recursos y proteger a los trabajadores de la salud que están agotados. [ cita requerida ] Para lograr un equilibrio entre las restricciones y la vida normal, la OMS recomienda una respuesta a la pandemia que consista en una estricta higiene personal, un rastreo de contactos eficaz y el aislamiento en caso de enfermedad. [8] [ se necesita una mejor fuente ]

Además de los efectos sobre la salud de las restricciones del confinamiento, [9] los investigadores han descubierto que los confinamientos han reducido el crimen y la violencia por parte de actores armados no estatales, como el Estado Islámico y otros grupos terroristas . [10] También han tenido profundos impactos económicos negativos y se han enfrentado con protestas en algunos territorios.

Eficacia

Varios investigadores, a partir de modelos y ejemplos demostrados, han llegado a la conclusión de que los confinamientos fueron algo eficaces para reducir la propagación y las muertes causadas por la COVID-19. [5] [6] [11] [7 ] [12] [13] [14] [15] [16] Se cree que los confinamientos son más eficaces para contener o prevenir la transmisión comunitaria de la COVID-19, los costos de atención médica y las muertes cuando se implementan antes, con mayor rigurosidad y cuando no se levantan demasiado pronto. [17] [18] [19] [20] [21]

Un estudio que investigó la propagación basándose en estudios de los síntomas más comunes, como la pérdida del gusto y el olfato, en Francia, Italia y el Reino Unido mostró una marcada disminución de los nuevos síntomas solo unos días después del inicio del confinamiento en los países ( Italia y Francia) con los cierres más fuertes. [22] El modelo de la pandemia de los Estados Unidos sugirió que "la pandemia se habría suprimido casi por completo para que no despegara significativamente si las medidas de cierre se hubieran implementado dos semanas antes" y que la segunda ola habría sido menos severa si el cierre hubiera durado otras dos semanas. [17]

El estricto confinamiento en Hubei a principios de 2020 resultó eficaz para controlar el brote de COVID-19 en China . [15] [23] Se cree que el número relativamente alto de casos y muertes en Suecia , que ha mantenido abierta gran parte de su sociedad durante la pandemia, en comparación con sus vecinos con demografías comparables Noruega , Dinamarca y Finlandia que sí aplicaron confinamientos, es al menos en parte atribuible a esta diferencia en la política. [24] [25] [26] [27] [28] [29] [30] De manera similar, la modelización sobre datos australianos concluyó que lograr una transmisión comunitaria cero a través de un confinamiento estricto reduce los costos sanitarios y económicos en comparación con medidas menos estrictas que permiten que la transmisión continúe, y advirtió que la relajación temprana de las restricciones tiene mayores costos. [19] [20] Este enfoque de " transmisión comunitaria cero " se adoptó en Australia, y un estricto confinamiento de cuatro meses en el estado de Victoria durante un brote en Melbourne, combinado con otras medidas, evitó un brote más amplio en el país en 2020. [31] Nueva Zelanda y Vietnam también adoptaron una estrategia de "COVID cero" a lo largo de 2020 que incluyó confinamientos selectivos. [32] [33]

La aparición en 2021 de la variante Delta del SARS-CoV-2, altamente transmisible , ha llevado a algunos analistas a sugerir que, si bien los confinamientos siguen reduciendo la propagación de la COVID-19, se han vuelto menos eficaces para contenerla. Los confinamientos en Australia y Vietnam en respuesta a los brotes de la variante Delta resultaron menos eficaces para contenerla que los confinamientos anteriores contra la propagación de otras variantes . [34] [35] [36]

Restricciones voluntarias versus obligatorias

Un miembro del Ejército peruano con un perro policía hace cumplir el toque de queda el 31 de marzo de 2020 durante la pandemia de COVID-19 en Perú .

Un estudio dirigido por un economista de la Universidad de Chicago concluyó que los confinamientos involuntarios tuvieron poco impacto, y que el distanciamiento voluntario representó casi el 90% de la caída en el tráfico de consumidores, ya que la gente temía al virus en sí. [37] De manera similar, un estudio de la Oficina Nacional de Investigación Económica concluyó que las órdenes de quedarse en casa aumentaron el confinamiento en solo un 5-10%. [38] Otro estudio de la Universidad de Yale concluyó que la mayor parte del distanciamiento social fue voluntario, impulsado principalmente por la "cobertura mediática de la morbilidad y la mortalidad". [39]

Por otra parte, algunos estudios han sostenido [14] [40] que las medidas coercitivas probablemente redujeron las interacciones, aunque aceptan que la mayor parte de la reducción puede haber sido voluntaria. Uno de esos dos estudios, de Flaxman et al., ha sido criticado, entre otras cosas, por tener un factor de ajuste específico para cada país, sin el cual el modelo predeciría una cantidad masiva de muertes para Suecia. [41] Sin embargo, una simulación económica ampliamente citada que afirma que las órdenes de quedarse en casa redujeron el total de casos al triple mantuvo constante el distanciamiento voluntario. [42] Otro estudio encontró una diferencia del 30% entre los condados fronterizos donde se impusieron órdenes de quedarse en casa. [43]

Otro estudio que comparó el impacto de las "intervenciones menos restrictivas" en la propagación de la COVID-19 en Suecia y Corea del Sur , con las órdenes obligatorias de quedarse en casa en otros 8 países, como Francia y España , no encontró evidencia de un mayor control de la enfermedad en los países con más restricciones. [44] Sin embargo, los hallazgos del estudio han sido cuestionados debido a sus numerosas limitaciones, incluido el pequeño tamaño de la muestra de países. [45] [46]

Algunas investigaciones también han demostrado que un enfoque de “consejo” no es suficiente para controlar los brotes de COVID-19. Un análisis de un brote en el norte de Italia concluyó que se produjo una reducción efectiva de la transmisión comunitaria durante un estricto confinamiento nacional, y que las medidas anteriores menos estrictas no fueron efectivas para reducir la movilidad a un nivel lo suficientemente bajo como para reducir la propagación de COVID-19. [18]

Desde el comienzo de la pandemia, Google ha recopilado constantemente datos sobre los movimientos, mostrando una rápida disminución de la actividad pública mucho antes de que se impusieran restricciones legales. [47] Una encuesta de abril de 2020 encontró que el 93% de los estadounidenses eligieron voluntariamente salir de casa solo cuando fuera necesario, independientemente de las restricciones legales. [48]

Recepción

Una revisión de 348 artículos realizada en febrero de 2021 concluyó que se reconocía la importancia de las intervenciones no farmacéuticas para controlar la propagación de la COVID-19. [7] Sin embargo, investigaciones posteriores también reconocen los altos costos sociales, aunque en algunas circunstancias son menores que los costos de permitir que la pandemia se propague sin mitigación. [6] [5] [7]

Relacionado con la epidemiología

La evidencia epidemiológica respalda intervenciones no farmacéuticas generalizadas para frenar la propagación de la COVID-19. [7] [49] [50] [51]

Durante las primeras etapas de la pandemia en Europa y Estados Unidos , se utilizaron como base para los confinamientos modelos estadísticos que sugerían que las restricciones eran útiles para prevenir un gran número de muertes. [16] Esto incluye una proyección del Imperial College , dirigida por el epidemiólogo Neil Ferguson . [52] A pesar de algunas críticas, los académicos defendieron la proyección del Imperial College como fundamentalmente sólida, al tiempo que admitieron que el código era "un desastre lleno de errores". [53] La evaluación retrospectiva de los confinamientos y los modelos informáticos han verificado que han contribuido significativamente a reducir la mortalidad y la morbilidad por COVID-19. [54]

Un notable oponente de los confinamientos ha incluido al epidemiólogo estatal de Suecia , Anders Tegnell , quien ha criticado con frecuencia la estrategia. [55] [56] El enfoque del gobierno sueco ha incluido restricciones mínimas y ha sido controvertido en parte debido al número relativamente alto de muertes debido a la transmisión generalizada. [57] [58] Sin embargo, el gobierno sueco comenzó a considerar la implementación de un confinamiento a principios de 2021. [59] [60]

En agosto de 2020, los médicos Ranu Dhillon y Abraar Karan , al defender la necesidad de imponer más confinamientos en Estados Unidos, abogaron por "confinamientos más inteligentes" que impongan restricciones en zonas con altos niveles de transmisión y aumenten el apoyo a las poblaciones vulnerables en esos lugares para compensar los costos económicos. [61]

En octubre de 2020, varios expertos médicos firmaron la Declaración de Great Barrington , en la que se pedía una "protección centrada" en los grupos de alto riesgo y restricciones mínimas para la población general con el fin de lograr la inmunidad colectiva frente a la infección por COVID-19. Sin embargo, la mayoría de los expertos médicos y la OMS han criticado enérgicamente esta estrategia propuesta por su falta de base científica y por ser poco ética. [50] [62] [63] La declaración también ha suscitado controversias sobre su financiación y la autenticidad de sus firmas. [49] [64]

Relacionado con los impactos sociales

Los confinamientos tuvieron múltiples efectos en la vida cotidiana de las personas. Algunos de estos fueron efectos directos, como la cancelación o el aplazamiento de un evento social, y otros tuvieron efectos indirectos, como la pérdida del sentido de identidad. [65] Por ejemplo, los profesores a menudo derivan significado y un sentido de propósito de vida de la enseñanza, pero las escuelas estaban cerradas, lo que provocó que muchos de ellos se sintieran desconectados de su identidad como profesores. [65] Muchas personas también sintieron que no podían confiar en que las cosas (por ejemplo, los pomos de las puertas) y las personas que las rodeaban estuvieran seguras. [ 65] Las personas también perdieron la noción del tiempo, y los sentimientos de imprevisibilidad se convirtieron en lo opuesto a la seguridad ontológica humana normal . [65] En lugar de saber qué hacer, en qué confiar y qué esperar en el futuro, las personas se sintieron desconectadas y perdidas. [65] También hizo que las personas fueran más conscientes de los problemas preexistentes a los que se enfrentaban, como el abuso, la adicción y el racismo. [65] La socióloga Ann Swidler comparó los cambios sociales con la anomia , una ausencia de normas sociales que se describió por primera vez al final de la Revolución Industrial , cuando el sistema previo, acordado socialmente, de conexiones interpersonales, valores, interdependencia e ideas sobre el comportamiento normal fue dejado de lado y aún no había surgido un nuevo sistema. [65]

Algunos comentaristas han sugerido que el uso de poderes de emergencia por parte de los estados para limitar la libertad de reunión y movimiento es autoritario y puede resultar en un retroceso democrático a largo plazo . [66] La centralización del poder por parte del liderazgo político en Hungría , Polonia , China y Camboya en respuesta a la pandemia de COVID-19 se ha citado como ejemplos. [67] [68] [69]

Algunos investigadores han señalado que las restricciones por la pandemia de COVID-19 han tenido costos para la salud mental , agravados por los causados ​​por la propia pandemia de COVID-19. [7] [70] [71] [72] [73]

Debido al cierre, las instituciones educativas de todo el mundo pasaron al aprendizaje en línea. Los profesores y el personal docente tuvieron que aprender nuevas formas de interactuar con los estudiantes durante la pandemia de COVID-19. Algunos ejemplos de herramientas de enseñanza en línea son los podcasts, los videos y las aulas virtuales. [74] [ Se necesita una mejor fuente ]

En un informe de abril de 2020, ONU Mujeres advirtió que las restricciones por la pandemia de COVID-19 exacerban las desigualdades de género y han provocado un aumento de la violencia doméstica . [75] Muchas mujeres se vieron obligadas a "confinarse" en casa con sus abusadores al mismo tiempo que los servicios de apoyo a las sobrevivientes se interrumpían o se volvían inaccesibles. [76] Por ejemplo, en Francia hubo un aumento de alrededor del 30% en los casos de violencia contra las mujeres desde el confinamiento en marzo de 2020. [75]

La telesalud cumplió una función importante para que los médicos no perdieran el seguimiento de pacientes con diferentes enfermedades crónicas y potencialmente ayudó a contener la propagación del SARS-CoV-2 entre pacientes y proveedores de atención médica [77]. Durante la pandemia de COVID-19, las comunicaciones por video se convirtieron en una herramienta fácil de usar y de rápido aprendizaje para muchas personas, y la ansiedad por contraer COVID-19 podría haber contrarrestado el bajo nivel de confianza de algunos pacientes en la tecnología. Por estas razones, la mayoría de los pacientes aceptaron recibir una videoconsulta a pesar de la visita tradicional en persona y la telemedicina confiable. [78]

Relacionado con los impactos económicos

Una protesta contra el confinamiento en el Capitolio del estado de Ohio en abril de 2020 en medio de la pandemia de COVID-19 en el estado.
Presencia policial en Melbourne en una protesta contra el confinamiento

Algunos economistas apoyaron un aumento de la financiación gubernamental para las medidas de mitigación, incluso a costa de tolerar una contracción económica muy grande. [79] Coincidieron en que los confinamientos deberían continuar hasta que la amenaza de un resurgimiento haya disminuido, incluso considerando únicamente el impacto económico. [80] Hubo un acuerdo general, al menos en algunos círculos económicos, en que "los confinamientos severos -incluido el cierre de negocios no esenciales y limitaciones estrictas al movimiento de las personas- probablemente sean mejores para la economía a mediano plazo que medidas menos agresivas". [81]

Tanto el Programa Mundial de Alimentos (PMA) como la Organización Mundial de la Salud (OMS) han publicado declaraciones en las que señalan el impacto de los confinamientos en los medios de vida y la seguridad alimentaria , y David Nabarro , enviado especial de la OMS para la COVID-19, declaró en octubre de 2020 que "los confinamientos solo tienen una consecuencia que nunca se debe menospreciar, y es que los pobres son muchísimo más pobres". [82] [83] [84]

Protestas

También ha habido una serie de protestas en todo el mundo en contra de los confinamientos, incluso en el Reino Unido , Estados Unidos , Australia , Alemania , Países Bajos , Canadá y Nueva Zelanda . Las motivaciones y los tamaños de estas protestas han variado. Algunas han sido impulsadas por los impactos económicos y sociales de los confinamientos, pero también se han asociado con desinformación relacionada con la pandemia , teorías conspirativas y antivacunación . [85] [86]

Tabla de confinamientos por pandemia


En la tabla, los confinamientos pandémicos se definen como el cierre de partes de la economía, [521] debido a medidas antipandémicas no farmacéuticas y exigibles por ley, como:

Estas medidas provocaron la recesión por COVID-19 en 2020. [522] El cuadro no contiene:

La pandemia dio lugar a la mayor cantidad de cierres en todo el mundo en un mismo momento en la historia. [523] Para el 26 de marzo, 1.700 millones de personas en todo el mundo estaban bajo alguna forma de confinamiento, [524] que aumentó a 3.900 millones de personas en la primera semana de abril, más de la mitad de la población mundial . [525] [526] Los confinamientos afectaron al 93% de los trabajadores en todo el mundo. El 30% vivía en países con cierres totales de lugares de trabajo, salvo en el caso de empresas críticas, y el 42% en países con cierres parciales. Casi el 20% vivía en países con cierres de lugares de trabajo recomendados pero no obligatorios. [527]

Las restricciones más importantes comenzaron primero en China [528] , y otros países del este de Asia, como Vietnam, pronto implementaron medidas de contención generalizadas. Gran parte de Europa , América del Norte y África tardaron mucho más en implementar medidas estrictas. Las restricciones a los viajes y las actividades dentro de las naciones fueron de distinta rigurosidad [529] .

A mediados de abril, casi 300 millones de personas, o aproximadamente el 90% de la población, estaban bajo algún tipo de confinamiento en los Estados Unidos , [530] con alrededor de 100 millones en Filipinas [531] y alrededor de 59 millones en Sudáfrica , [532] mientras que alrededor de 1.300 millones estaban bajo confinamiento en la India , que fue el mayor de todos los confinamientos. [533] [534]

A fines de abril, alrededor de 300 millones de personas estaban confinadas en varios países de Europa, incluidos, entre otros, Italia , España , Francia y el Reino Unido ; mientras que alrededor de 200 millones de personas estaban confinadas en América Latina. [531] En Alemania, el 35% de los trabajadores trabajaban desde casa además de sus tareas habituales en el lugar de trabajo, mientras que el 26% trabajaba desde casa exclusivamente. [535]

Variación por países y territorios

Un sitio de pruebas de COVID-19 en Corea del Sur en febrero de 2020. Corea del Sur no implementó ninguna medida de confinamiento; su estrategia de cuarentena K incluyó el rápido desarrollo de infraestructura y capacidad para realizar pruebas masivas.

Países y territorios de todo el mundo impusieron medidas de confinamiento de distinta rigurosidad en respuesta a la pandemia de COVID-19 .

Algunas incluyen un control total del movimiento, mientras que otras han impuesto restricciones basadas en el tiempo. En muchos casos, solo se permite que permanezcan abiertos los negocios esenciales. Las escuelas, universidades y colegios han cerrado a nivel nacional o local en 63 países, lo que afecta aproximadamente al 47 por ciento de la población estudiantil del mundo. [536] [537]

A partir del primer confinamiento en la provincia china de Hubei [538] y a nivel nacional en Italia en marzo de 2020, los confinamientos continuaron implementándose en muchos países a lo largo de 2020 y 2021. El 24 de marzo de 2020, se ordenó a toda la población de 1.300 millones de la India que se quedara en casa durante su confinamiento , lo que lo convirtió en el más grande de la pandemia. [539] El confinamiento continuo más largo del mundo, que duró 234 días, tuvo lugar en Buenos Aires, Argentina , en 2020. A octubre de 2021, la ciudad de Melbourne, Australia , y ciertas ciudades de Perú y Chile pasaron la mayor cantidad de días acumulados en confinamiento durante períodos separados, aunque las medidas variaron entre estos países. [540] [541]

Unos pocos países y territorios no utilizaron la estrategia, entre ellos Japón , Bielorrusia , Nicaragua , Suecia , Corea del Sur , Hong Kong , Taiwán , Tanzania , Uruguay, dos estados de Brasil y ciertos estados de los Estados Unidos .

Véase también

Wikimedia Commons tiene medios relacionados con Toques de queda y confinamientos por COVID-19 .

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