Received with confidence for the good progress of the vaccination campaign, Even with a hint of indolence by some sectors due to the youth of those first affected, the fifth wave has once again demonstrated the dangers of underestimating the coronavirus. The 144 deaths reported by the Ministry of Health this Wednesday are the worst record since last May and portend a trail of bad news for the next few weeks at a time when the death toll from this new epidemic outbreak has already exceeded 1,800.
Immunosuppressed people are on this occasion the group among which more deaths are being recorded, according to all the sources consulted. Those over 70 years of age continue to represent the majority of the deaths in this outbreak, 76% of the total, a percentage significantly lower than the 84% they represented in the three previous waves. Most of them are vaccinated – the rate is close to 100% among those over 80 years of age and exceeds 97% among the septuagenarians – but their delicate immune systems continue to make them vulnerable to the virus.
“While deaths fell among the rest of the groups, the immunosuppressed have continued to register very high mortality rates. They are the group hardest hit by the fifth wave, ”laments José Miguel Cisneros, head of infectious diseases at the Virgen del Rocío Hospital (Seville).
Few expected at this point in the pandemic, however, such high death figures. And, despite them, the heads of large hospitals give thanks every day to the very high rates of vaccination coverage among the most vulnerable groups. “Without the vaccines, this would have been a tragedy. We would have experienced a collapse like March 2020 ″, sums up Cisneros. “Without them we would be experiencing a massacre, a hecatomb,” says Federico García, head of microbiology at Hospital San Cecilio (Granada).
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Since last June 23, when the contagion curve began to turn upwards, Spain has diagnosed 946,000 cases of covid and registered 1,847 deaths, according to the balance of daily data provided by Health (which presents certain notification delays). This represents exactly 20% of the positives registered in the entire pandemic, but only 2.2% of the deaths since March 2020.
“The protection that vaccines have given to most vulnerable groups has been crucial. They have reduced infections, but also serious cases that have required hospitalization and, ultimately, deaths, ”explains García.
Not everyone has been able to benefit from vaccines in the same way, however. José Luis Alfonso, head of preventive medicine at the General Hospital of Valencia, places immunosuppressed people as the hardest hit in this fifth wave. “The effectiveness of the vaccine in these patients is much lower. They have much lower rates of antibodies than the rest of the population and they do not develop cellular immunity either ”, he details.
This group is made up mainly of people with cancer, transplants, or autoimmune diseases. Although these types of ailments can manifest themselves at any time in life, their prevalence increases with age. This means that the deaths registered among this group are distributed among the population in a similar way to that of the rest of deaths caused by the coronavirus.
Experts point to two other groups also hit in this fifth wave. The first is that of people who had only received one dose of the vaccine, especially those in their sixties. This group, when receiving the first dose of AstraZeneca, had to wait at first four months to receive the second, although this period has subsequently been reduced to up to four weeks.
The second is that of pregnant women. “The high contagion of the delta variant and its circulation among the younger groups has made it affect them more. Most had not been vaccinated for fear of side effects and for not having been adequately informed. It is a group in which deaths have been few quantitatively, but they are always especially painful, ”says Cisneros.
If the age of the almost 51,000 deceased between June 22, 2020 and the same date in 2021 is compared —Which includes the second, third and fourth waves— with the 1,847 of this fifth there are some differences that experts attribute to the effect of vaccines, always according to data from the Carlos III Health Institute.
Although they are still the majority of the deceased, those over 70 years of age have gone on to represent 76% of the deceased in this wave, eight points less than in the three previous waves. Cisneros attributes this relative decrease to the lower circulation of the virus among the elderly or to the less serious conditions developed by vaccinated people.
On the other hand, those in their sixties have gone from representing 10% of those who died during the second, third and fourth waves to 13% in this fifth, something attributed to the fact that many of them only had a single dose of the vaccine when they were infected. in the last weeks.
The relative weight of the group aged 50 to 59 years (from 4% to 6%), 40 to 49 years (from 1% to 3%) and those under that age has also increased, although in this case the small number of deceased persons makes the comparison less valid. “Mortality decreases a lot with age, but this time the number of infected has been so great among the youngest that it is logical that this increase occurs if the protection that vaccines offer to the elderly is taken into account,” explains Cisneros .
The high mortality that remains among the immunosuppressed is what leads many experts to request the application of the third dose in this group, something that other European countries such as France have already begun to do or Germany has announced that it will do. Although the scientific evidence is not yet conclusive on the benefits of the third prick, current data and the safety demonstrated by vaccines increasingly tip the balance towards this option.
Alfonso believes that everyone over 55 should also receive a third dose. “There is an inverse relationship between the amount of antibodies and cellular immunity in relation to age, so there are several countries that have already announced that they will administer the third dose or are studying it. If we want to have the residences and the population most at risk protected, we should take the step. It is not something so strange and in other diseases more doses are administered. With hepatitis B, for example, we manage to administer up to six ”, concludes this expert.
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