In English
The course (work and school) has started in Spain with two forces that each pull to one side of the epidemic curve. Upwards, the delta variant, much more contagious than the previous ones, and which has taken over the ecological niche this summer until producing practically all the cases in Spain. Pushing down, vaccination, that exceeds 73% of the population, coupled with the natural immunity of those who have passed the disease. September has begun with the incidence down (this Wednesday the country has stayed a few tenths of a point from leaving the high risk of transmission, with 150.3 cases per 100,000 inhabitants) and less and less restrictions in many autonomous communities. In order to continue lifting limitations and continue to gain spaces of normality, we will have to wait to know which of the two forces is imposed in the coming weeks: if the curve continues its descent or suffers a rebound that forces not to lift the foot of the brake of the measures against the covid.
With a virus that has always provided surprises, the new ingredients make it even less predictable. Group immunity It is already a chimera that few experts believe possible. They are inclined to think that we will live with an endemic disease that will continue to cause suffering, but less and less, with which we will have to get used to living sooner or later. But there is still a way to go. The Minister of Health, Carolina Darias, has not been in favor of something similar to what the United Kingdom on June 19, the freedom day, the day when practically all restrictions were removed. He prefers that the measures be progressively cut until their total disappearance. After the Interterritorial Council of the National Health System on Wednesday, it has been prudent and has asked that the “culture of care” continue to continue lowering the levels of transmission and hospital occupancy.
To know the speed of progress, the next few weeks will be key. It will then be necessary to check whether the return to schools and offices causes a considerable rise in the virus. And few dare to predict it. Now there are few mirrors in which to look at oneself; A few months ago, experts analyzed what was happening in other countries that were far ahead in vaccination to try to anticipate what would happen in Spain. But now that he is one of those at the forefront, there are few references who can anticipate where the shots will go. “We do not have the crystal ball, but for the first time I am optimistic and I think that if there is a sixth wave, it will be very slight, more similar to the fourth, which was the only one we managed to control,” explains Elena Vanesa Martínez , president of the Spanish Epidemiology Society from León, where this society is holding its annual meeting.
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Most eyes are on schools. Last year they starred in one of the great successes in managing the health crisis in Spain. Despite what many experts feared, they did not become a source of contagion, the classes could be carried out without too many setbacks and presence was majority in the lower levels.
This year the course begins with similar measures, but the return to the classroom will occur with ratios equivalent to before the pandemic, which will force children to keep a less safe distance. Added to this is the delta variant. Some epidemiologists hope to repeat the success of 2020, while others fear that the new factors will propitiate, this time yes, that schools become the main reservoir of the virus among a population that will not have received the vaccine, since there is not yet one approved for children under 12 years of age.
In this scenario, the classrooms could generate a sixth wave that goes from the bottom up, as happened with the fifth among young people, but this time from children to adults, who even vaccinated can be infected, despite being much less likely to get sick seriously or die. Unless some new variant escapes vaccines and gives unpleasant surprises (something that cannot be ruled out), the forecast is that this new wave, if it occurs, would have much less impact on hospitals and deaths. In the fifth wave, which began with only one in five Spaniards with the complete pattern, the fatality was seven times lower than in the previous ones. In a sixth, with more than 70%, it would be normal for the lethality to be lower.
José Martínez Olmos, professor at the Andalusian School of Public Health, wishes the ratios had been kept low in classes, at least for a few months. In spite of everything, he believes that last year’s experience can be taken advantage of: isolation of the classrooms, masks, ventilation and hand washing. “This strategy will probably give us good results again,” he stresses.
Going back to the offices worries him less. Both he and other public health experts consulted believe that it will have a minor impact on the evolution of the epidemic. “I don’t think you have to do anything special,” says Alberto Infante, professor at the National School of Health, “beyond insisting on ventilation, hygiene, personal control measures, the use of a mask and washing hands”. The biggest problem, in his opinion, will be the young population under 30 years of age “due to illegal parties and bottles.”
Many companies that have maintained teleworking until now will begin to ask their workers to return to the office over the following weeks, although currently only 10% of Spanish employees continue to work from home, when last year they did 25%, according to Carlos Gutiérrez, secretary of Youth and New Realities of Work of CC OO, in a report from the EL PAÍS Business supplement.
In order to calibrate the return to normality, it will be necessary to remain attentive to the accumulated incidence, although it is an indicator that can no longer be read as before vaccines, since the same number of infected causes much fewer hospitalizations and deaths, and most, thanks to the punctures, are very mild or asymptomatic. Fernando Rodríguez Artalejo, Professor of Public Health at the Autonomous University of Madrid, believes that “it probably does not make sense” to continue talking about incidents of 25 or 50 cases per 100,000 inhabitants in 14 days to return to normality. In Artalejo’s opinion, below 100 “a lot could already be opened.”
Among half a dozen experts consulted, Artalejo is the most likely to eliminate restrictions. “The logical thing is that the positive trend continues because it is mainly due to the increase in vaccination and greater immunity of young people due to so much exposure. Although there can always be surprises, “he stresses. For this reason, he is in favor of returning to full presence in universities, “where it does not make sense that the restrictions are the same as last year.” And, in a short time, if everything continues to improve, start thinking about doing more activities again, even without a mask in closed spaces. He sees the return of nightlife further due to the nature of this activity, but “in one or two months” he would resume it if cases continue to decline and vaccination rates for young people continue to increase.
The unknowns of vaccination
On the medium-term horizon, several issues remain to be resolved that have to do with vaccination. The first is the third dose. In Spain, at the moment, it will be administered only to around 100,000 people with severe immunosuppression. As long as the data show that the punctures are still protective, the health authorities do not consider increasing it to the rest of the population. This was advised this week by the European Center for Disease Control (ECDC, for its acronym in English), which has also opened the door to elderly people interned in residences. The latest scientific evidence shows that among the first vaccinated, infections are growing, but that protection continues to be robust to avoid hospitalizations and deaths, which is ultimately what has caused the health crisis. Without them, the virus is no worse than the common cold.
The second issue that will be clarified in the coming months is the vaccination of children under 12 years of age. Pharmaceuticals are expected to complete their trials to obtain a vaccine for them in the last quarter. From there, the health authorities of the countries will have to decide whether to use it in a population that runs a minimal risk of complications from covid. It is an ethical debate that will have to be faced, since they account for 11% of the population, without them the cap on vaccinated will be 89%, which in reality will probably be rather around 80% if anti-vaccines are discounted, reluctant and difficult to locate people.
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