Spain dodges sixth wave of covid for now
Contagions are accelerating across Europe as WHO gives governments that relax restrictions a wake-up call
BarcelonaThe transmission of coronavirus is accelerating throughout Europe and no country is unaffected by the threat of a new wave, not even those with low infection rates, such as Spain. So says the World Health Organization (WHO) regional director for Europe, Hans Kluge, who has warned that the continent is reliving the "most critical point" of the pandemic: some countries where vaccination remains low are suffering a boom in cases which can put their health systems at risk and could also increase the spread of the virus in neighbouring countries. "Europe is once again at the global epicentre [of the pandemic]," said Kluge, visibly concerned, who attributed this to the unequal vaccination rates between countries and the fact that some governments have continued to relax containment measures despite the epidemiological instability.
The head of preventive medicine at Hospital Clínic, Antoni Trilla, stresses that Europe is now the main focus of covid infection in the world, but with different intensities depending on each country, its restrictive anti-covid policy and the vaccination rate they have achieved. For example, for now, epidemiological and health care indicators indicate that Spain is avoiding the sixth wave. With 80% of the total population vaccinated, it is the only European country where cumulative incidence for the last seven days remains under 30 cases per 100,000 inhabitants (25.4) and there are under 1,800 covid related hospitalisation throughout Spain.
"The situation in Spain is very good, but we must be cautious. Nothing shields us and it may be that we are disappointed later," Trilla warns, referring to the increase in cases in neighbouring countries such as France (61 cases per 100,000 inhabitants) and Portugal (50). The trend is similar in Catalonia, with 74.3% of the entire population fully vaccinated, it has registered an incidence of 28 cases and 327 hospital admissions (79 in intensive care). The Secretary of Public Health, Carmen Cabezas, predicts that in the next few days there will be an increase in the number of covid infections.
"In Europe there are very high cumulative incidences and this warns us that the virus is still there", said Spanish Minister of Health Carolina Darias, who has called on the unvaccinated to get a jab in the face of the growth of cases of coronavirus across Europe. Indeed, for the moment it is indisputable that the situation in Catalonia and the rest of the State is very different from the Baltics and Central and Eastern Europe. Estonia, Georgia, Croatia and Slovenia have some of the worst epidemiological indicators (see graph) and none of them has managed to exceed 60% vaccination rates. Neither has Russia, which in a single day has recorded 1,195 deaths, exceeded a third of those immunized. "There is a direct relationship between the vaccination coverage rate and the rate of infections", says Trilla, also a researcher at the Barcelona Institute for Global Health (ISGlobal)
The doctor and researcher at the University of Leicester Salvador Macip agrees that the vaccine has made "a major difference", especially in hospital admissions and deaths, between western and eastern Europe. But it has also reduced the circulation of the virus, as evidenced by the map of cumulative incidence. "However, we must not forget that a pandemic is global and as long as the virus circulates, if it affects one country, it will affect the rest," he reminds us. And he adds: "The colours of a map are volatile and depend a lot on issues such as containment measures, such as mask use, or control, such as diagnostic tests to confirm that those who enter the country freely are not infected".
"Saw-toothed" curves
But if vaccines are effective, how can we explain that countries where at least 70% of the population has been vaccinated are also gradually turning red on the European contagion map? "We are witnessing an acceleration of infections and, therefore, a growth of cases, but the serious consequences are not triggered because the vaccines, although they are not perfect, are very effective," insists Trilla, who says that the key test to make decisions is hospitalisations. Germany, which is facing its fourth wave with a new record of daily infections, about 34,000, is considering reintroducing restrictions such as the use of face masks indoors before there is an increase in hospital admissions.
"The situation is very different to before the vaccination campaigns, especially in terms of mortality. Far fewer people die," says Macip, who explains that Spain can "learn from what happens in Europe" to avoid repeating the mistake from now on. "The fact that a country achieves good indicators does not mean that it can turn the page and live as if it did not exist. For mental health's sake we must recover normality, but with some control. The virus does not stop circulating no matter how much its transmission is reduced to a minimum with the help of vaccines. If we relax, contagions will rise," he sums up. In fact, he warns that having a curve of contagions "with saw teeth" will be the trend in most countries thanks to vaccines. That is, contagions will go up and then down.
The Minister of Health has stated that, taking into account the levels of vaccination, Spain is in an "optimal" situation to reach herd immunity. "We are in optimal conditions to put an end to covid, but we cannot lower our guard," he said. The influential journal The Lancet, specifically its section on respiratory medicine, raises the possibility that Spain "is on the verge of achieving" this desired immunity. "After lifting most control measures, the rate of infections (and particularly hospital admissions) has been falling, and this is the opposite of what has happened in previous waves. The only plausible explanation is the high vaccination rates in this country," the study stresses.
But the experts consulted are more sceptical. Trilla stresses that herd immunity would imply that we can stop the transmission of the virus only with vaccines. "And as long as there are elements that can affect its effectiveness, whether variants or a long-term loss of protection, measures to control the virus will continue to be necessary," he says. Macip also believes that it is "premature" to talk about herd immunity knowing that vaccines are not sterilising (they do not prevent contagion despite reducing it). "This does not mean that we can't get there. In fact, I am confident that it will be possible. However, to do so, we will have to vaccinate all those who have not wanted to get vaccinated or have not been able to, including children," he says
Catalonia wants to continue with the easing of restrictions in response to the epidemiological improvement, and one of the Government's priorities is to remove masks in school playgrounds, where children must still wear them. The covid scientific advisory committee, which has studied this proposal, agreed yesterday that the removal is plausible and forwarded its conclusions to the Spanish Ministry of Health, which is responsible for making the decision to lift the measure.
"You cannot rule out taking steps back to control infection curves, but for now the high number of vaccinees and mask use indoors allows us to relax the few measures we have left and propose changes, such as mask use in school playgrounds," Antoni Trilla, the head of epidemiology at the Hospital Clínic and member of the advisory committee of covid, tells ARA .
