The new variant of the coronavirus discovered in the United Kingdom, considered between 30% and 50% more contagious by various studies and which is now also suspected of being more lethal, is spreading through Spain faster than the system sanitary is capable of monitoring. In some areas, such as Cantabria or the northeast of the Community of Madrid, it already accounts for 20% of new infections, according to estimates from reference hospitals based on tests carried out on their patients. The official data on the impact of the strain, however, are almost testimonial and the Ministry of Health only considers 205 confirmed cases.
Without reaching these levels, growth is generalized in most of Spain, according to all the sources consulted. At this point, and after what has been seen in other countries, few professionals reject the possibility that the new variant may be the dominant one when spring arrives in Spain.
“We are registering an increase in the prevalence of the new variant, but the scenario is uncertain. It is difficult to measure the rate of increase and we do not know the impact this will have on the evolution of the pandemic ”, summarizes Jordi Vila Estapé, president of the Spanish Society of Infectious Diseases and Clinical Microbiology (Seimc).
Technological limits are the biggest problem that specialists are running into given the speed with which the scene changes. To consider a case confirmed, it is necessary to complete a genetic sequencing of the virus, something that requires several days (up to two weeks in some cases). “The results that come to us show us a photograph 10 or 15 days before that has already been overwhelmed by reality,” confesses a person in charge of a hospital in the Valencian Community, who asks not to be identified.
This and the low genetic sequencing capacity of Spain (which analyzes 1% of the samples with this technique, a percentage that reaches 10% in countries such as the United Kingdom) explain why the official figures offered so far are so low. The Ministry of Health reported this Friday that “205 cases have been confirmed and the results of 161 samples are awaited.” “The data communicated by the communities to date would indicate that the prevalence is low. We have information from a study of 1,000 random samples with a 0.3% confirmed variant, ”says Health.
The difference between these figures and those provided by hospitals and communities is abysmal. The explanation is that the specialists have found an ally – the PCR tests of the Thermo Fisher brand – that allows them to make reliable estimates almost daily thanks to the mutations of the new variant.
“We are seeing that practically all the samples that these PCRs mark as suspicious of the new variant are later confirmed by genetic sequencing, so it is a very useful indicator”, Juan Carlos Galán, head of virology at the Ramón y Hospital, agrees. Cajal (Madrid), and Manuel Rodríguez Iglesias, head of the microbiology service at the Puerta del Mar hospital (Cádiz).
Galán highlights the great leap that the new variant has made, according to these PCRs. Three weeks ago, they barely accounted for 1% of the total samples analyzed. “Then we went to close to 5% and now we are close to 20% if we take into account the most recent samples that arrive from primary care centers, which are the ones that offer us the most up-to-date information,” he explains. The Ramón y Cajal microbiology service analyzes samples from the northeast of the Community of Madrid and the capital.
“Cantabria proactively seeks these cases”
The Deputy Minister of Health of Madrid, Antonio Zapatero, estimated this Friday at 9% the weight of the new variant in the total of new diagnoses made in the community, although this percentage is an average of a range that would go from 7% to 33%, depending on the area.
Reinhard Wallmann, general director of Public Health of Cantabria, reported last Wednesday that the prevalence of the new variant has escalated from 1% to 19% in less than three weeks, also with results of PCR Thermo Fisher tests. In this community, the only reference center is the Marqués de Valdecilla University Hospital, in Santander.
In the last week of 2020, according to the random samples analyzed, only one of the 98 tests carried out on COVID patients corresponded to the new variant (1%). In the first week of 2021 there were already 49 of 342 (14%), and in the following, 92 of 525 (18%). “In the first days of this week, although the sample is smaller, that percentage is already 19%,” he added. Regarding the differences with other communities, Wallmann stated that “Cantabria proactively seeks these cases, something that other communities do not do or do not do as much.”
In Catalonia, where cases were counted just 10 days ago, the new variant already represents “between 1.5% and 2% of new diagnoses at the Hospital Clínic”, explains Vila Estapé, who is also head of microbiology at this health center. A similar percentage – “somewhat higher or somewhat lower” – to those registered in other large Catalan hospitals such as Bellvitge, Vall d’Hebron and Can Ruti.
Hospital sources indicate that the increase has also been notable —from levels close to 1% to 5% in just one week— in centers in Andalusia and the Valencian Community, although the prevalence is higher in the communities of northern Spain.
“The hypothesis of the greater dissemination of the new variant, whose presence until now was null or testimonial, is the most reasonable, although we still lack a lot of data,” explains Jesús Rodríguez Baño, head of the infectious diseases service at the Virgen de la Hospital. Macarena, in Seville.
Although all the experts insist that all these results are preliminary and that they may suffer from “bias”, the general impression is that it will not be long before the new variant is the dominant one, something that until very recently many experts did not see so sure . The director of health emergencies, Fernando Simón, pointed out this Thursday that this could happen in “mid-March.” “The logical and probable thing is that a variant of new introduction with competitive advantages, will occupy the ecological niche. We cannot know at what speed this will happen, but it is probable and expected that it will happen, although it will depend on other variables ”, admits a spokesman for Health.
According to estimates by the Computational Biology team of the Polytechnic University of Catalonia (UPC), “if the new variant is 50% more contagious, in 40 days it will go from representing 5% of new infections to half”, explains the researcher Clara Prats. “If it is 25% more contagious, it will take 67 days,” he adds.
Data aside, there are also the impressions of the professionals. “You come across cases in which a whole family or all those attending a lunch or dinner are infected. This was something that was not so frequent before, it was normal that there were only some. It is something that makes us think about the greater contagion of the new variant, although we still have to confirm it with data ”, explains the head of the microbiology service at the Puerta del Mar hospital.
The other great unknown to be resolved is the impact of the emergence of the new variant on the evolution of the pandemic. As it is more contagious, experts recall, if its emergence coincides with an increase in incidence, it can skyrocket and increase the healthcare pressure suffered by hospitals, as has happened in the United Kingdom.
The fear is that this could also happen in Spain, where communities such as Madrid and Andalusia, among others, are registering significant increases in incidents. In other communities, which had already begun to bend the curve of the third wave, the new strain “may slow down the decline” or even “cause rebound in the form of a hump”, warn several of the experts consulted.
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