Spain once again placed itself at high risk of transmission by coronavirus on Thursday. The accumulated incidence has returned to the levels of the end of August and has exceeded 300 cases per 100,000 inhabitants for the first time in 14 days (305) since the Ministry of Health and the communities approved a new covid traffic light more lax that placed the bar at this figure to raise the alert. After the fifth wave, the country had taken a three-month break in which the incidence had oscillated between medium and low risk.
It is the third time that Spain has passed this threshold of 300 diagnoses: in the first wave it was not reached because much fewer cases were detected than those that occurred and the fourth one reached a maximum of 235.6, on April 26, very far from the absolute top: 899, on January 29 of this year, during the third. The indicators of the severity of the disease (hospitalizations), however, are much better today than in the preceding waves thanks to vaccination, which means that the global risk, taking into account hospital occupancy, is still medium.
4.4% of hospital beds are occupied by covid patients (which places this metric at low risk), a percentage that rises to 11.3% in ICUs (medium risk). Hospital occupation (5,479 people admitted) is still far from the fifth and fourth waves, when they exceeded 10,000. And very far from the precedents. The record was broken in the third, when practically no people were vaccinated and more than 32,000 admitted patients were registered. The large percentage of the target population with the complete pattern (90% of those over 12 years of age) makes all the experts consulted foresee that this sixth wave will be less lethal than the previous ones.
“It is a very different scenario from all the ones we have experienced so far,” says Antoni Trilla, Professor of Public Health at the University of Barcelona. “It is important to look at the number of cases, but we have to be more concerned about hospital saturation. If we continue to increase transmission a lot, we will all end up more stressed, but the system is at income and ICU levels that are manageable at the moment, much lower than in other waves ”, he adds.
Ignacio Rosell, epidemiologist and coordinator of the covid-19 expert committee in Castilla y León, warns, however, that it should not be trusted. Incidence means risk. I think that obviously we are not going to reach the number of deaths before vaccines. But the transmission could become very high, it is very difficult to get it down before Christmas. And, among many cases, some get worse. We are restless ”, he confesses.
The models show that at least it will continue to rise for a couple of weeks, according to Clara Prats, a researcher in Computational Biology at the Polytechnic University of Catalonia (UPC). “Beyond that, it is difficult to make predictions,” he acknowledges. The incidence in seven days is still considerably higher than half that of 14, marking a clear upward trend. And it does so, in addition, with two holidays in which cases have not been counted. The reality is probably somewhat worse than what the Health reports show.
Why are experts even with vaccines concerned about incidence? Epidemiologist Javier del Águila sums it up: “Perhaps they are giving a feeling of invulnerability that is not true. If they generate 90% protection, it means that in each encounter with the virus there is a probability that the vaccine will fail. And with a lot of transmission there will be more contacts with the virus and, therefore, more risk for everyone ”.
The cases come from the northeast
The distribution of infections is very uneven in Spain. While it is already at a very high level (an accumulated incidence above 500) in Navarra (956), the Basque Country (757) and Aragón (591); in Andalusia and Castilla-La Mancha they do not reach 150. Del Águila observes the same behavior pattern as in previous waves: “We don’t know why, but we see that they start in the northeast, with high transmission in Catalonia, the Basque Country, Navarra and Aragon. From there they go to Madrid, which will probably be the next one that starts to grow, then goes to the rest of the center of the Peninsula and usually arrives later in Andalusia and Galicia ”. The islands, by their very nature, have followed different patterns, which have responded to other factors, such as tourism. This expert, who has studied the geographic distribution of cases throughout the pandemic, believes that something similar to that described may happen on this occasion.
This also translates into very different healthcare pressures. While the hospitals in the least affected areas are practically at normal levels, those in the communities with the highest incidence are already having to stop non-urgent care activity. Catalonia, Navarra, the Basque Country, La Rioja, Aragon and Castilla y León are already at high risk level.
The distribution of diagnoses is also very unequal by age. Children under 12 years of age, the only group that has not yet started the vaccination campaign, bear by far the highest levels of transmission: 533 cases per 100,000 inhabitants in 14 days, followed by 30-somethings (325) and quadragenarians (380). The age of these groups coincides with that of most of the children’s parents, which serves the experts to reinforce the thesis that this wave is mainly driven by infections among the smallest, who then take it home . It is the opposite of what has happened previously.
This makes it difficult to interpret how this week’s weekend and the upcoming holidays can affect infections. “On the one hand, the relationship between children at school is cut off, but on the other it is fostered among older people in other spaces,” reflects Rosell, who insists on advising the population to be prudent and maintain prevention measures.
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