At last the lack of refinement arrived. After two months of massive home isolation, since the end of June the health surveillance systems generally confirm less than 100 daily cases of SARS-CoV-2 in Spain. Furthermore, most are asymptomatic.
How much we missed what we had! And commuting to work, weekend outings and vacation trips are back. Being away from home has been unstoppable and, in a way, has made us forget that the coronavirus is still here.
COVID-19 outbreaks despite the heat
How could it be otherwise, small and larger COVID-19 outbreaks have begun to be reported throughout the country. It is the inevitable consequence of displacement, with population exchange and an influx of foreigners, whether they are tourists, day laborers from the field or arriving in boats.
Good weather reduces, but does not eliminate, the transmission of SARS-CoV-2. The COVID-19 coronavirus is not seasonal, but humans are. This implies that in summer, carrying out activities in open spaces and the disinfecting effect of prolonged sun exposure help reduce infections. In addition, the measures learned about social distancing are beneficial, with the use of masks, hand hygiene and minimization of interpersonal contacts (hugs, kisses, etc.). All this makes exposure to large inoculums now rare.
Immunization of the non-vulnerable population
It is highly unlikely that a protective vaccine against SARS-CoV-2 infection will be available before Christmas. Similarly, it is inevitable that there will be outbreaks of cases until a sufficient threshold of protection is reached in the population, that is, herd immunity. The new estimates put the proportion of naturally immunized people that is necessary to stop the epidemic at less than 50%.
From antibody tests, we know that no more than 5-10% of the Spanish population has been infected by SARS-CoV-2. However, this excludes geriatric residences, in addition to the fact that this figure rises to 20-25% in large cities such as Madrid. It should be emphasized that seropositive people, whether or not they had symptoms after acute infection, develop immunity (protection) against the coronavirus for 1-2 years , enough time for us to have a vaccine available.
The current outbreaks mainly affect younger people, and the proportion of severe cases and mortality are very low (less than 0.5%). Nothing to do with what happened in March and April, during the first wave of the tsunami, when COVID-19 ravaged the most vulnerable population, especially the elderly and nursing homes.
With this greater benignity of the new infected by SARS-CoV-2 and, in the absence of vaccine, Italian experts say that we could tolerate a “healthy rate of infections among non-vulnerable people” until the autumn. In other words, a good strategy to prevent the risk of a second wave would consist precisely in tolerating outbreaks among non-vulnerable people during the summer, that is, without risk of severity.
SARS-CoV-2 infection without antibodies
Exposure to small inocula of the coronavirus is associated with mild or asymptomatic forms. Some of these patients with few symptoms do not develop antibodies or lose them promptly. Well, recent research suggests that in these cases immune memory is also produced, so that there would be partial protection against COVID-19. This is the experience in Italy, where the pandemic has acquired a benignity that cannot be explained otherwise. There continue to be new diagnoses, but very few suffer from severe forms or require hospitalization.
Avoid going back to massive lockdowns
Universal confinement was a desperate measure. Now smarter protection of the most vulnerable can be programmed. The drama of March and April was the result of an unfortunate and abrupt coincidence of infections in the elderly and unprepared hospitals.
Many health workers – doctors and nurses – became ill or were on sick leave due to quarantine, largely because there was not enough protective material available. The flood of patients overwhelmed hospitals and care was often suboptimal.
Now we have health protection material and we know how to better treat COVID-19, with dexamethasone and remdesivir severe cases. We can also quickly adapt hospital spaces according to demand and medicalize hotels. And, above all, nursing homes are better served.
The damages of prolonged confinement are devastating to the economy and, worse still, to people’s mental health. Humans are social and we need the stimulation derived from contact with others. This is easily recognizable in children, in whom isolation impairs psychomotor and cognitive development. But also in the elderly, in whom the absence of stimulation accelerates the deterioration associated with age.
Health reinforcement, rapid diagnostic tests and distancing
In summary, since it is not positive to maintain confinement indefinitely, we have to devise new ways to regain normalcy without putting the lives of our most vulnerable population at risk.
In this sense, it is worth highlighting three measures to achieve this balance.
- The first is to strengthen health systems , with special attention to medical care services for the elderly in homes and nursing homes.
- The second is to devise rapid diagnostic tests, if possible in saliva, cheap and available in pharmacies, that can be repeated as many times as is convenient, to quickly isolate new positive cases and know who is immunized.
- Finally, it is essential to reaffirm social distancing measures in coexistence (masks, avoiding physical contact, frequent hand cleaning, activities in open spaces, etc.), especially with the elderly.
Vicente Soriano. Faculty of Health Sciences & Medical Center, UNIR – International University of La Rioja
This article was originally published on The Conversation. Read the original.
