The Ministry of Health wants the sixth wave of the coronavirus to be the last to be managed with the indicators with which it has been done throughout the pandemic. The minister, Carolina Darias, explained this Wednesday after the Interterritorial Council of the National Health System that with a massively vaccinated population and with apparently milder variants “it is necessary to assess a new covid surveillance system” and has opted to “lead ” in international forums this debate.
As EL PAÍS announced this Monday, the Health technicians, the communities and the National Epidemiology Center have finalized a pilot plan to monitor the disease as it has been done for years with the flu, with a network of sentinel doctors who serve as witnesses to know how the virus progresses. In that scenario, testing each case would stop in order to find a significant sample and extrapolate the data.
The minister has not wanted to anticipate what the system to be adopted will be. “This assessment process is already being initiated by expert people from the Warning Report and at the same time we are promoting discussion of where we are going, how we make that transition. And also promoting a debate with our European partners to determine the best options to face a pandemic disease that little by little is acquiring endemic characteristics”, he pointed out.
Although the plans for this sentinel system are advanced and it is backed by a long history with the flu, the surveillance strategy that is finally adopted will have to be agreed with the international authorities. Both the European Center for Disease Control (ECDC) and the World Health Organization (WHO) request, for the moment, exhaustive data, case by case.
Darias has assured that Spain has already asked the ECDC to study new strategies. “I share and dialogue a lot with my European colleagues, who also see the need to open up new horizons. We have to move from emergency surveillance to one of higher quality, compatible with other respiratory phenomena. There are communities that have already designed it and we want to go hand in hand with the autonomies. Spain wants to lead this debate”, assured the minister.
Five autonomous communities are already testing covid sentinel surveillance in health centers and nine in hospitals as a pilot program. One of them is Extremadura. His Minister of Health, José María Vergeles, explained on Tuesday that “shadow” simulations have already been carried out for several weeks, and that they have given “good results”. The advantage of monitoring the disease at key points is that a very precise approximation to reality can be achieved without the need to collapse the entire system.
This proposal represents a paradigm shift that has surprised many international actors. The WHO itself has declared itself against modifying the strategy. Its director in Europe, Hans Kluge, emphasized on Tuesday that covid is not yet an endemic disease. “In the midst of managing the crisis we have to be very cautious with predictions about the future. One of the things we still don’t know is the link between infections and persistent covid, for example,” he warned. WHO experts believe that to treat covid as endemic, cases would have to stabilize and show more predictable patterns, something that has not happened at the moment. The organization predicts that in the next six or eight weeks half of Europeans will be infected.
Darias has responded that it is not an immediate change, but has defended that we must be prepared: “We have to consider where we are going to go and how we are going to do it. Citizens require that we anticipate this type of scenario with all caution, but noting that we are in a new stage, especially due to the very high vaccination coverage.
Although he did not want to give dates, he did mark the end of the sixth wave as the time to start with new systems. Whichever one is adopted, it will mean stopping counting the number of infected, each person who has the slightest symptom will not have to be tested. It will be a complete paradigm shift, once it is implemented.
The current system has been overwhelmed. A sixth explosive wave has made this exhaustive count impossible. Self-tests are replacing medical diagnoses. Many of them do not report to the authorities; there are communities that take them as definitive proof and others that request confirmation in the health system.
Faced with this scenario and with Primary Care completely saturated, voices have been heard asking for this management change to begin now. The Spanish Society of Family and Community Medicine (Semfyc) published this weekend a long editorial this weekend entitled Towards the end of the exceptional, in which he advocates returning to the “old normality”. His thesis is based on the fact that the lethality of the virus is decreasing and that counting and tracking each case is an unrealistic strategy. “Governments should focus their efforts on protecting the most vulnerable people rather than trying to stop, probably with little success, the circulation of the virus at the population level,” the editorial reads.
On the other hand, the other two large primary medical societies, the SEMG and the Semergen, believe that it is too early to change the scenario and have expressed that the pandemic cannot be trivialized. Also several experts and epidemiologists who consider any change in covid surveillance hasty. “We cannot trivialize the pandemic. We are in a situation of exponential growth that overloads primary care and any decision that changes the criteria that is followed has to be based on scientific evidence”, Lorenzo Armenteros, spokesman for SEMG, explained to this newspaper.
What is clear is that the paradigm shift will come sooner or later: it is unsustainable in the long term to measure each case of a respiratory disease as contagious as covid. It remains to define when and how. And Spain wants to lead this process.
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