Miguel Hernán (Madrid, 51 years old) is Professor in Epidemiology at Harvard University. With his team, he has analyzed over the last year the effectiveness and safety of vaccines against coronavirus in the United States and Israel, a process in which he has also collaborated with the University of Oxford in the United Kingdom.
Ask. How do you assess the situation of the pandemic in Spain?
Answer. For one thing, it has something of a perfect storm. There was an increase in the incidence caused by the delta variant due to the loss of protection from the vaccines, which is something that in the UK and Israel we have found to start to happen five to six months after the second dose. To this has been added the irruption of another more contagious variant, the omicron. The result is a very rapid increase in infections, not seen since March 2020. But on the other hand, we are much better than a year ago. All those vaccinated have a lower risk of hospitalization. The key question now is to what extent this increase in cases is going to translate into more hospitalizations.
P. We are seeing that the new variant is displacing the delta very quickly.
R. Most likely, it will end up eliminating it as it did before with alpha, although it may happen that the two coexist for a long time if the delta is more efficient infecting the unvaccinated and omicron the already immunized.
P. Some data indicate that the omicron variant, despite being more contagious, causes milder clinical pictures.
R. It is true that in places where the omicron is already the majority, such as areas of the United Kingdom and Madrid, we have not seen income increase to a worrying level for now. But it is too early to draw conclusions, we have only known about it since the end of November and in South Africa we have seen that it causes hospitalizations. It is a scenario with a lot of uncertainty because unless omicron is much lighter than delta, and that is something that no one is saying, the foreseeable thing is that contagions will skyrocket and this will translate into more serious cases.
P. Will this also happen in countries with high vaccination coverage, such as Spain?
R. We are seeing that the incidence increases, although there is a high vaccination coverage. We have found that the risk of hospitalization falls greatly in the population that has received two doses, but also that this protection drops after five or six months after completing the regimen. This should make us cautious. Spain is in the situation where all adults should start receiving the third dose.
P. Everyone?
R. Yes. There are countries in which it began to be given before, such as the United Kingdom, which has also reduced the separation between the second and third doses from six months to three. What our studies have seen is that the third dose greatly reduces the risk of hospitalization in all age groups and also the transmission. Spain has carried out an exemplary vaccination campaign, but perhaps its guard has been lowered with the third dose. Without it, the risk of infection is high and the risk of hospitalization, although low, also rises. In a scenario of many infections, this increases the pressure on the health system. The vaccination centers that we saw at the beginning of the campaign have not been repeated for the third and I think that this is something that should be reinforced now. We’re a little late.
P. Are we facing tough restrictions again, like those adopted by the Netherlands?
R. Restrictions on mobility are to some extent unavoidable. The Netherlands has already decided them and the United Kingdom is considering doing it for two weeks to lower the incidence. These governments are being cautious and want to lower infections before systems are saturated. There are two basic tools that are the usual, masks and contact reduction, to which the third dose is now added.
P. In some cases, however, it seems that they are waiting for Christmas to pass to make decisions.
R. It is logical that there are resistance. Nobody wants to spend another Christmas like 2020. But it is obvious that when these measures are taken before, the exponential transmission is slowed down, which is the one that can overwhelm health systems. It must also be taken into account that, if they are applied before, the time in which they are necessary is shorter.
P. In Spain there are communities, such as Madrid, that have applied fewer restrictions than others.
R. Yes. This is partly explained by the fact that the health personnel have not complained. In London, Boris Johnson was forced to take greater measures when hospital workers took to the streets. In Spain this has not happened despite the fact that there have been many moments in which a great care pressure has become chronic. In other places, a prolonged occupation of ICUs over 100% of the prepandemic capacity and that at various times has exceeded 150% is not conceived without taking measures.
P. In recent days we have once again seen saturated health centers and a low capacity for contact tracing has been evident. Are we repeating mistakes?
R. There are things that are much better and others that could have improved more. Epidemiological surveillance today has more and better data than a year ago. A good vaccination campaign has been carried out. But we have not completed the play. That is where a scientifically powerful Spanish public health agency with autonomy to assess the situation and propose decisions is missed.
P. In the last few days, drugstores are running out of antigen tests. Is that a serious problem?
R. These tests could be a very useful tool if they were very cheap and the population used them three times a week, for example. This would allow us to know that we are infected when we are still asymptomatic and can infect, which is one of the keys to the difficulty of stopping this pandemic. Occasional use today is better than nothing, obviously, but its impact is limited.
P. What do you think of the vaccination campaign for children between the ages of five and 11?
R. It is yet another tool to contain the transmission. Vaccination in this age group is safe. However, if it is not possible to do everything at once, the third dose should be prioritized for all adults.
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