We reached the December bridge and, once again, the covid-19 threatens to complicate the Christmas holidays. Christmas is not made up of dinner on the 24th, lunch on the 25th and the party on the 31st. It is not just three days, but several weeks of numerous contacts with our families, friends, work colleagues or students. Also with people we do not know and with whom we meet in places of worship, at parties, at events or anywhere else.
We increased contacts with relatives (a word that gave so much to talk about last year), with less close friends and with strangers. Vaccinated and leaving an autumn with relatively low transmission, we seem anxious to recover what we gave up last year (which, all said and despite the subjective feeling, it should not have been so much since last December caused one of the worst waves we’ve been through).
Those contacts that we long for are the fuel for the transmission of SARS-CoV-2.
Where are we right now?
This question cannot be answered simply or without some speculation. But some data offers us (in white, in black and in many shades of gray) various clues:
- After a successful vaccination campaign, Spain is among the countries with the highest proportion of people with a “complete” vaccination schedule (> 80% of the total population). Probably the largest among countries with more than 10 million inhabitants.
- Spain also has percentages of people with a complete guideline close to 100% among those over 60 years of age. A critical aspect because this population group is the origin of most of the serious cases. This is an essential difference with some countries of the European Union that maintain important pockets of unvaccinated in these age groups that lead to high rates of hospitalizations.
- Although the protection offered by vaccines against the risk of developing severe COVID-19 remains quite high, protection against transmission has been declining over time since vaccination. And with the Delta variant, which currently predominates in Spain and, moreover, throughout the world. The variant that we should not underestimate despite the appearance of omicron.
- The third doses (boosters, reinforcements) seem to regain a good part of the protection against infection, even with the delta variant. But the administration campaign of boosters It seems to unfold without too much haste. Starting in December, a third of those over 70 years of age and two-thirds of those who were vaccinated with the Janssen single-dose are pending a third dose. For the 60-70 group, statistics are not even offered.
- Spain shows a sustained growth in transmission since the beginning of October that seems to accelerate in recent weeks. The accumulated incidence in 14 days (IA14d) at the beginning of December is close to 250 cases / 100,000 inhab (approaching 9,000 daily cases). However, some more Communities double these rates by approximating, say, European figures. The highest incidence occurs in those under 12 years of age (IA14d> 400/100 000) but those over 60 also have high rates (IA14d> 100/100 000).
- Despite the increase in the incidence of cases, Spain is far –very far– from the incidence figures of the Eastern European and Central European countries. But we cannot ignore that a good part of our neighbors have very high transmission figures and that we have a great interaction with them.
- We are also very far from the previous waves in our country. Thanks to vaccination, the numbers of hospitalized, people in ICU and deaths are much lower than those we have seen so far. Especially in vaccinated, since around half of the cases of severe covid-19 come from that 9% of people still unvaccinated.
- The potential omicron threat is there too. Let’s underline the potential. We do not know how much more transmissible it will be in a much more vaccinated environment than South Africa, nor its ability to cause reinfections in vaccinated or in people who have passed COVID-19. Or if the third doses will maintain the protection they offer against Delta. Nor if it will be less serious, as some point out, in an environment such as Europe, with a much older population than that of South Africa.
- In the present moment, Spain is one of the countries with the least restrictions. They are practically limited to the formal mandatory use of a mask indoors (with a more than relaxed interpretation of the concept of “mandatory” in hospitality and nightlife) and the use of the Covid “certificate” in several Autonomous Communities (a measure that although it can give a boost to vaccinating reluctants, it will have little impact on transmission).
Taken together, the situation suggests that transmission rates, accelerated by bridges and pre-Christmas mobility, will continue to increase. With this sustained rise, and even to a lesser extent than in other waves, severe cases will also rise. The omicron unknown could further complicate this scenario, although in the immediate future it is Delta and our own behaviors that should concern us.
In a complex context to interpret and with important unknowns, recommending solutions also has a lot of speculation. Hard not to overreact, hard not to fall short.
Perhaps that is why it is convenient to be open to applying any measure that the real evolution of the incidence of hospitalizations indicates as necessary. Avoid basing public health strategies on assumptions that our high vaccination rates will be enough to stem the current wave or any other preconceived idea. Rely on the data. Mainly in the incidence in people over 60 years of age and in the incidence of new hospitalizations.
In any case, there are actions to take that seem obvious:
- Accelerate the third doses, especially in those over 60 years of age. The fewer serious cases we have, the better. And this age group causes the majority of severe cases.
- Strengthen primary care. In the current situation, it is who is bearing most of the weight of the transmission growth (vaccinations, tests, case monitoring, tracing … and the burden of supporting documents and sick leave that it entails), including the increase in non-covid respiratory infections and many decompensations from chronic conditions. Strengthen it, expand it and keep it operational during the holiday periods that we have above us.
- Maintain, and reinforce, preventive measures in all interior spaces. Especially if there are a lot of people. The main measure, obviously, is to avoid these spaces whenever possible (for example, by reintroducing teleworking). Ventilation, the use of masks and interpersonal distance are essential when being indoors cannot be avoided.
- Reduce contacts with non-partners. Especially in closed spaces. One thing is a dinner on Christmas Eve, a meal on Christmas (with “relatives” if you like). And a very different one, a rosary of meals, dinners, be late and drinks with different groups for three weeks. The rule: the fewer the merrier.
- The Covid certificate or antigen tests can reduce transmission somewhat. They can help. But not so much as to forget the rest of the measurements indoors. Those vaccinated can and can infect. And they can infect other vaccinated people including elderly people (our parents, our grandparents, those of our acquaintances and those of our strangers) who could develop serious Covid. No matter how much it is repeated and no matter how many certificates are issued and requested, there are no “safe” interiors. Even with “certified”, even with antigens, you have to maintain ventilation and masks in these spaces.
- Monitor the evolution of omicron and be prepared to adopt new measures if some of the threats that concern this variant the most begin to materialize. Expect the best, without overreacting, but be prepared for the worst. And that implies that the measures should be already being prepared and approved in the coming days.
I believe it was William H. Welch (I have not been able to confirm the quote, and may the author forgive me if I am wrong), first dean of the then Johns Hopkins School of Hygiene and Public Health, who said that in an epidemic, more important than to know the disease is to know the society that suffers from it. From March 2020 until now we have learned a lot from pandemics and a lot from ourselves. And we have done it at the cost of many losses.
We are not where we were and, probably, we will not return to situations like the ones we have been through. Nor have we reached that “light at the end of the tunnel” that so many times seemed to be at the fingertips.
And, now, again, Christmas. Complicated Christmas. With new uncertainties. More tired. Sometimes so frustrated with a step back that we disparage what we have advanced. But here and now, as a society, we have to keep moving forward. Try that this Christmas the losses are lower, much less, than last. Like other times, we depend on ourselves as a society.
Salvador Peiró, Researcher, Health Services Research Area, FISABIO SALUD PÚBLICA, Fisabio
This article was originally published on The Conversation. Read the original.
George Holan is chief editor at Plainsmen Post and has articles published in many notable publications in the last decade.