The epidemic curve in Spain is moving towards a kind of plateau. The fourth wave, much less steep than the previous three, seems to be subsiding or, at least, not triggered and the Ministry of Health assumes that the country is entering a “beginning of stabilization.” For now, the accumulated incidence at 14 days, although very high -232.55 cases per 100,000 inhabitants-, barely reflected a slight rise of three points this Thursday after two days of stagnation. Experts blame vaccination and the maintenance of social restrictions in much of the country for the smoothness of the wave, although they warn that the situation in Spain is not buoyant: seven communities and the two autonomous cities are at extreme risk (with one incidence above 250) and one in five intensive care beds is occupied by covid patients.
“Caution and prudence,” insists Daniel López-Acuña, former Director of Emergencies at the World Health Organization. After more than a month with infections on the rise – since March 16 the curve began to rebound – the incidence accumulated at 14 days has registered a stop during this week: since Monday, which was installed in 230 cases, has been dancing on this figure and this Thursday it amounted to 232.55. “We are in a plateau phase, taking a little step forward and another backward. Perhaps the health system does not suffer so much and hopefully there will be a consolidated decline, but we are a bit confused because this wave has not followed the pattern of other waves ”, says Toni Trilla, head of Preventive Medicine at Hospital Clínic de Barcelona.
Some epidemiologists point out that the cumulative incidence at seven days also confirms a stagnation: it has been around 108 cases per 100,000 inhabitants for more than a week in the last seven days, less than 50% of the incidence at 14 days. “If the incidence at seven days is less than 50% than the incidence at 14 days, it means that the curve is going down. This wave is not comparable to the previous ones and it seems that it is stabilizing already. In any case, if there is a rebound, it would not be important: more than a week has passed since Holy Week, which is when there could be an increase in infections, and what is expected is that it will not increase any more ”, said Jesús Molina Cabrillana, spokesperson for the Spanish Society of Preventive Medicine, Public Health and Hygiene.
The speed of transmission of the virus in Spain (the Rt, which measures how many people infects, on average, a positive) also tends to decrease. On April 14, the last day for which figures are available, it was, for the first time in a month, below 1, as recommended by the health authorities to keep the virus at bay: that day, the Rt was 0.98, that is, for every 100 positives another 98 people are infected. “It is good that this continues, but what should guide us is that, if we continue to have a stagnation of such high incidences and intensive care units (ICU) so busy, we should be concerned”, warns López-Acuña.
The truth is that the epidemic situation is very heterogeneous according to the autonomies. The Valencian Community, for example, is at 40 cases per 100,000, the lowest incidence in Spain. And also Galicia, the Balearic Islands and Murcia are below 100. On the other hand, Madrid and Navarra are around 400 cases per 100,000 and the Basque Country exceeds 500. “Crowding of people can influence: it is not the same the population density of Galicia than that of the metropolitan area of Barcelona. In the case of the Valencian Community, what they do very well there is the study of contacts and this can be decisive in isolating cases and promoting quarantines ”, values epidemiologist Joan Caylà. The harshness of social restrictions and compliance with the measures, the experts point out, constitute another of the determining factors in the fluctuation of the epidemic curves: Valencia, for example, has taken very harsh measures and is making a very gentle de-escalation – even on Monday the bars close at six in the afternoon—, while Madrid, which has a 10 times higher incidence, has been much more lax in restrictions —the restaurant lowers the blind at 23.00—.
Experts assume that vaccination has also played a role in the evolution of this wave, but with nuances. With only 21.4% of the population immunized with a dose (especially in the older age groups), epidemiologists agree that the vaccine has not had as much influence on the infection curve, since most of infections occur in younger people who have not had access to the prick. The great effect, they point out, is in the reduction of deaths and hospitalizations, where age is decisive. “Something has been able to influence the contagion curve, but where it has contributed is in serious illness and mortality. There is not, by far, the care overload in November and January, ”says Molina Cabrillana.
Hospital ICUs faced the fourth wave with high occupancy – on March 16, 20% of the beds were occupied by patients with covid – and professionals feared a flood of sick after Easter. However, the entries, for now, have not skyrocketed: this Thursday there were 2,283 patients admitted in critical condition, that is, 22.6% of the available ICU beds were occupied by people with covid. However, López-Acuña reiterates caution: “It is likely that the magnitude of the wave is not so pronounced because there is less mobility than at Christmas, fewer crowds and a segment of the population is protected. But there are a couple of worrying elements: community transmission is not controlled and high occupancy persists in ICUs, with more severe cases linked to the British variant, which gives longer hospital stays ”. The British variant of the virus is the predominant one in Spain since March.
Despite the fact that the situation is not as critical in Spain as in previous waves, experts ask to be extremely cautious with regard to social restrictions and protection measures and not to lower our guard prematurely. “The impact on the health system will necessarily have to go down if the vaccination rate accelerates, but in infections it will take time to see it,” says Trilla. The European Center for Disease Control (ECDC) has released a recommendation that allows two people to remove their masks in a closed space if both are vaccinated or make quarantines and the requirement of diagnostic tests in travel more flexible if people are vaccinated. Molina Cabrillana sees it as feasible, but Trilla and López-Acuña call the recommendation “premature” because it can give “a false security message” and lead to “excessive relaxation.”
Regarding social restrictions, Trilla is committed to “asymmetry in measurements and adapting the size to each community and to the moment.” Molina Cabrillana asks “to endure a little more, until it is below 50 cases per 100,000”, and López-Acuña urges, above all, to “continue with the restrictions in closed atmospheres.” However, if the experts consulted agree on one thing, it is the great pending task: “strictly promoting contact studies”, summarizes Caylà.
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source https://pledgetimes.com/the-fourth-wave-of-the-coronavirus-in-spain-subsides/
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