A eficácia das vacinas – e porque máscaras e o distanciamento social ainda são importantes contra o COVID-19
Quase um ano após a pandemia acometer mais de 200 países, com 97 milhões de infectados pelo mundo e mais de 2 milhões de vítimas fatais do novo coronavírus, finalmente iniciamos no Brasil a campanha de vacinação contra a COVID-19, um verdadeiro sopro de esperança para um mundo cansado de quarentenas, caos na saúde pública e mortes.
As diversas vacinas desenvolvidas (de vírus inativado, vetor viral não-replicante ou RNA modificado) apresentam perfis de eficácia, efeitos colaterais, custos de produção e aquisição além de demandas logísticas diferentes que deverão ser analisadas pelas autoridades de saúde de cada país, para definir aquela (ou aquelas) que mais se adequa à realidade local.
É tentador achar que uma vacina com 90% de eficácia seja muito melhor que outra com 50%, mas os fatores acima citados devem ser considerados, pois os custos e as dificuldades para obtenção, armazenamento, transporte e administração reduzem a efetividade das vacinas na vida real.
Mas por que devemos manter as medidas de distanciamento social e continuar a usar máscaras por um mais um bom tempo, se agora temos vacinas contra o COVID-19?
Para entender melhor, precisamos conhecer as diferenças entre contágio, infecção e doença. De modo sucinto, contágio é a transmissão de um patógeno biológico, seja um vírus, bactéria ou parasita. Se este agente se instalar e se multiplicar num organismo, se torna uma infecção. Quando a infecção desencadeia manifestações clínicas, se torna uma doença.
É possível sofrer contágio, sem progredir para uma infecção, assim como uma infecção pode não evoluir para doença, permanecendo assintomática. Como exemplo, temos o vírus HIV, cujos infectados podem permanecer por anos assintomáticos (soropositivos) para mais tarde desenvolver a doença, a AIDS. O novo coronavírus já provou ter altíssima taxa de contágio, e permanecer, na maioria dos casos, como uma infecção assintomática, dificultando sua detecção e facilitando sua disseminação na população.
Quando um fabricante alega que sua vacina tem 95% de eficácia, não significa que o indivíduo vacinado tenha somente 5% de risco de contrair o vírus, e portanto pode dar adeus às máscaras e voltar à vida “normal”, para festas e eventos com aglomeração social.
A eficácia de uma vacinada é calculada ao analisar quantos voluntários desenvolveram a doença no grupo dos vacinados em relação aos do grupo dos não-vacinados (placebo). Uma eficácia de 70% significa, a grosso modo, que haverá quase 3,5 vezes mais doentes no grupo não-vacinado quando comparado ao grupo vacinado.
Nenhum dos estudos populacionais realizou coletas sistemáticas de RT-PCR mais sorologias pré e pós-vacinação nos dois subgrupos para identificar os portadores assintomáticos. Somente os voluntários com sintomas gripais, os que já tiveram histórico de COVID ou exames prévios positivos foram considerados, dentre outros critérios, inelegíveis para os testes, de forma que é impossível determinar: I – quantos já haviam contraído o vírus antes da vacinação? ou II – a presença de anticorpos foi induzida pela vacina ou por infecção prévia?
As principais vacinas disponíveis requerem uma segunda dose para alcançar a eficácia anunciada; não garantem imunidade total contra o vírus e nenhuma vacina evitará o contágio. Também é desconhecido por quanto tempo durará a imunidade induzida, e a imunidade coletiva só será atingida quando uma grande parcela da população já estiver vacinada. Além disto o coronavírus tem sofrido mutações e novas variantes tem sido detectadas, como podemos constatar em casos comprovados de reinfecção. A eficácia das vacinas perante as variantes mutantes ainda precisa ser avaliada.
Concluindo, tenham eficácia de 50%, 70% ou 90%, as vacinas são ferramentas fundamentais para o combate à pandemia e para a redução da morbidade e mortalidade. Relevante é o fato delas reduzirem com sucesso a incidência de casos graves e mortes nos voluntários vacinados. Uma vacina hipotética que reduzisse em apenas 30% a mortalidade do vírus já teria salvado pelo menos 60.000 vidas no Brasil.
Portanto é fundamental mantermos os cuidados para a redução do contágio. Com medidas de higienização adequadas, manutenção do distanciamento social e uso de máscaras para reduzir o risco de transmissão do vírus, conseguiremos conter o vírus até que as vacinas estejam disponíveis e aplicadas à população em larga escala, e a imunidade coletiva se torne uma realidade concreta em nossas vidas. Só assim poderemos, finalmente, retornar ao “novo normal”.
Por: Dr. Hyun Seung Yoon, gerente médico do ClubSaúde
Sobre o ClubSaúde:
O ClubSaúde é um completo clube de benefícios, que oferece a você e sua família acesso à consultas e exames por preços reduzidos, além de um super desconto em medicamentos sem cobrança por dependentes.


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