In this sixth wave of covid, Spain — like other countries — has tried to stop the virus that has spread the fastest in human history — the omicron variant of SARS-CoV-2 — with a mixture of measures that nobody knows certainty to what extent they have been useful. The peak is further and further away, all the indicators have been falling for weeks, and they began to do so at approximately the same time in the most restrictive communities and in those that imposed fewer limitations.
More cosmetic measures have been combined, such as outdoor masks, which as of this Thursday are no longer mandatory, with others that have evidence in their favor, such as this same protection indoors, or ventilation. There have been more severe communities, such as Catalonia, which even imposed a curfew, and others less so, such as Madrid, which was limited to the minimum possible. But in practically the entire territory they have been mild if compared to those of previous waves.
The idea of the health authorities that have imposed restrictions is to stop transmission with the least impact on the economy, reducing social interactions, with fewer capacity or limitation of certain activities; or putting obstacles to the virus when they occur, such as masks, safety distances or capacity restrictions. From the beginning they are applied together without always knowing exactly to what extent they are useful separately. It is impossible: in a health emergency of these characteristics, there is no time to study them in detail to act later. It would be too late.
Pedro Gullón, from the Spanish Society of Epidemiology (SEE), believes that it is “extremely difficult” to know if the measures have been useful. “You would need to measure two very similar areas, one with measurements and one without. The pandemic always ends up affecting some communities more than others, probably due to more structural and prior factors. And the measures that have been imposed are either of doubtful utility, like the covid passport, or very mild. I don’t think they made a difference; perhaps they have moderated growth or helped peak earlier,” he notes.
Intuition would lead one to think that after two years of the pandemic, with greater knowledge of the virus, the measures would be increasingly effective and would be able to stop its spread more effectively. And what we have found is a wave of dimensions never seen before in terms of contagion (not so serious).
But the omicron also has a much higher propagation capacity than its predecessors. And the measures have been much more lax than in other waves, thanks to a greater intrinsic lightness of the variant and to the fact that the vaccines have drastically reduced the number of people who have required hospitalization after becoming infected.
The comparison between communities to check the effectiveness of their respective measures is in vain. The reporting of cases has been so irregular, the infections are so underestimated in most of them, that they do not offer a realistic picture of what has really happened. A more refined approach would be to measure the hospitalizations of each autonomy. In January, the classification was led by a community that had imposed a good number of social restrictions, Aragón (1,808 people hospitalized for every 100,000 inhabitants); and it is followed by Madrid (1,647), which hardly had any. The Canary Islands, with many measures in place (capacity, limit of people in meetings, closing times…), is the one with the fewest hospitalizations (585), but behind it is Extremadura (676), which has not imposed them. These measurements do not take into account the average age of populations, previous immunity, vaccination, mobility or population density. Pure chance also influences the spread of the virus.
Fernando Rodríguez Artalejo, professor of Public Health at the Autonomous University of Madrid, thinks that it is impossible to know the effectiveness of the limitations with the data that is handled: “My impression is that in the face of a highly transmissible variant, the partial restrictions, such as those have done in Catalonia, are insufficient to reduce transmission appreciably. They will have served something, but by leaving out many areas of life where transmission is possible, the net impact ends up being minimal. This same impression is more or less what I have when I look at the situation in Europe.”
On the other hand, Álex Arenas, a researcher at the Rovira i Virgili University of Tarragona, who is part of the team that advises the Generalitat of Catalonia, defends that the measures of this autonomous community have served to prevent hospital collapse: “We had made data projections with and without measurements and what we expected with them were fulfilled. They have been essential in order not to exceed the sanitary ceiling”.
The problem, says Salvador Peiró, an epidemiologist at the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community, is that it is a fish that bites its own tail: “In places with many infections, more measures are imposed, but there is more transmission. You see the figures for places in Catalonia and it may seem that they have not been very effective, but they will have done something to slow down infections.
Another issue not measured by the data is compliance with these measures. One thing is what the regulations say and another is their compliance, which after two years of the pandemic “is much more lax on the part of both citizens and authorities,” in the words of Óscar Zurriaga, from the SEE.
What the experts agree on is that not all measures are the same or have the same impact. These are the main ones:
Vaccines
Without the vaccines, the sixth wave would have been a drama similar to the first, unless harsh social restrictions had been imposed that go far beyond those that have been applied. This is what the data from the Ministry of Health say, which show that the vaccinated have been infected less and, above all, have required less hospitalization. In the last week, the age group between 60 and 79 years, the one that requires the most intensive care, has had a rate of ICU admissions 42 times higher among those who were not vaccinated than among those who were. From this it follows that without the vaccines, the hospitals, which have been left at the limit of their structural capacity, would have completely collapsed.
Isolations and quarantines
Both isolations and quarantines have been increasingly relaxed, but have been kept to at least seven days for people who contract covid. Peiró believes that, beyond the mask indoors, it is the only really useful and widespread measure. “In a way, ómicron can be slowed down a little if you don’t impose very, very extreme measures. But you can slow it down, so that not all cases are at the same time to avoid collapse. And the isolations in this sense have helped, ”he assures.
Face mask
The experts consulted are very critical of the outdoor mask, which was imposed last Christmas and has been in force until this week. They support it indoors, something that is supported by numerous studies to stop the spread of the virus.
Capacity and ventilation
The problem is, in the opinion of Óscar Zurriaga, when the mask is removed in covered spaces. This is what happens in restaurants, bars or nightlife venues. That is why he defends ventilation, something difficult to measure, and the limitation of capacity. “If we try not to crowd many people indoors, we will avoid contagion,” he says.
covid passport
Most of the autonomous communities have imposed the covid passport to enter restaurants. It is a measure highly questioned by experts. Health technicians and the autonomous communities dismantled its usefulness to stop infections in Spain, where 90% of the target population has received at least two doses.
Restriction of hours and nightlife
Catalonia has been the community that has gone the furthest, even limiting mobility at dawn. Others have preferred to impose earlier closures on entertainment and restaurant venues. Everything is aimed at restricting social relations and, therefore, the virus circulates less. But with one as transmissible as this, it is in question to what extent they have achieved it. “The curfew, which has been able to prove useful in other phases, we do not know if it has been able to be so now or not,” says Gullón.
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