Should we be alarmed by the increase in covid infections?

The seventh wave advances in Catalonia coinciding with the start of the summer holidays for health personnel

4 min
Tourist groups at the Rambla la Boqueria in Barcelona.

BarcelonaContagions are on the rise and Catalonia is once again experiencing a wave of covid, the seventh in just over two years. Most of the cases are not recorded because, by protocol, tests are only carried out on the over-60 and results from tests carried out at home are no longer counted. This means knowing how the pandemic is evolving is now more difficult than ever, but there is one indisputable way to identify a significant increase in infections: an increase in the number of patients seen by primary care centres and hospitals. And this is precisely what is happening. Catalan Health minister Josep Maria Argimon doubts the impact of this wave will be similar to those experienced in previous waves, but the rise in cases coincides with staff holidays, especially nurses, who are usually the most difficult positions to fill. In addition, according to primary care and hospital workers, there is limited information on the variants now in circulation, which have a greater capacity for transmission. There is no doubt, however, that the more infections there are, the more overloaded the system will be.

The main cause of the spike in infections in recent weeks is to be found in the spread of the BA.5 omicron subvariant, which is more contagious than its predecessors. This mutation already accounts for 60% of the total number of sequenced samples and is expected to become the predominant mutation in a matter of days. However, Argimon does not believe that it will lead to more severe cases per se and, therefore, despite the fact that infections and admissions are rising (in three weeks the number of people admitted to the ICU has doubled), the health authorities do not foresee any measures or restrictions in the short or medium term that could change the recent return to normality. "Contagions have increased, but for the moment we have to wait and see," said Argimon, who did admit "concern" about how the health system may be affected by the new wave coinciding with health workers' holidays.

Despite the fact that this year's conditions are slightly different to other years', old problems are reappearing. In addition to holidays, there is also sick leave. The virus is transmitted very easily and healthcare personnel also become infected and have to stay off work for five to seven days to avoid becoming a source of contagion in healthcare centres. "There is not enough substitute staff, and workers are very tired and honestly cannot do many more additional efforts," Hospital Clínic epidemiologist Antoni Trilla tells ARA.

Stop testing

Primary care has noticed an increase in consultations over respiratory infections over the past weeks. According to the latest data from the Infection Surveillance System of Catalonia, which will be updated this Tuesday, the coronavirus accounts for half of the diagnoses in the last week (about 22,000, 19% more than the previous week) in all age groups. "We foresee added pressure between the months of June and September due to vacations. With reduced staff and no reinforcements, if we have a significant increase in covid cases, we expect a tense scenario ," explains Jordi Mestres, a doctor of Rambla de Sant Feliu de Llobregat Health Centre and a member of the Catalan Society of Family and Community Medicine (CAMFiC).

The physician acknowledges that the increase in visits for suspected covid is not as big as last year at the same time, but warns of the increase occurring among those over 60, which is worrying and is forcing Health Centres to monitor patients more closely. Fortunately, most of the cases being treated, says Mestres, are mild and he attributes this precisely to the BA.5 variant, but he warns that the more community transmission there is, the greater the risk of vulnerable people becoming seriously ill.

The trickle of infections is already translating, inevitably, into an increase in hospitalisations. Trilla warned the impact of coronavirus is being felt on hospital wards, mostly in cases of elderly people with other illnesses whose state worsens due to covid. Conventional hospitalisation areas for covid have 1,383 patients. Many of these were unaware they had covid and only found out when tested on their arrival to hospital for a different procedure. On the other hand, in intensive care units (ICU) the Health Department only registers patients admitted for covid and data shows that the number of critically ill patients has almost doubled in the past three weeks: at the beginning of June there were 26, while today there are already 46.

However, Argimon has stressed the need to normalise the circulation of the virus and has limited himself to recommending a more rigorous use of masks in closed spaces by vulnerable people (either because of their age or because they suffer from a serious underlying disease). The Department asks the rest of the population who may suffer symptoms to apply common sense (avoid contact with people who are at risk and wear a mask when meeting others), but also to avoid saturating the health system. That is to say, they should not go to health centres but stay at home until they recover. He also stressed that it is important not to take tests at home to confirm or rule out positives. "It's very difficult not to take them because we've been taking them for two years and we have been recommending it. But probably, if you have fever, fatigue and a headache, it is covid. Fifty percent of the viruses circulating today are SARS-CoV-2," he concludes.

Severity and vaccines: what do we know about the BA.5 subvariant?

The Omicron subvariants BA.4 and BA.5, the second of which is expected to become predominant in a few days, have very high capacity to infect people who have already had covid, even if it was with other Omicron subvariants and they were fully vaccinated. Studies suggest that these mutations, which began circulating in Europe last March, are more contagious than their predecessors because they have suffered changes to the Spike protein (the key to accessing cells and infecting them without being recognised). Yet nothing indicates that they may cause more serious diseases. For the moment, data collected in South Africa (where it was first detected) on their severity indicate that they would be even less aggressive than the original Omicron or stealth Omicron.