Now that the advent of a new wave of COVID-19 is feared, it must be said that the worst thing is, above all, that this fear prevents making the right decisions. We must not increase it in our fears, but neither underestimate the situation.
What is the situation?
There is talk of the “fourth” wave without a precise analysis allowing us to know how many waves there have actually been. And without considering that, depending on the territorial unit used, the numbering of the wave may vary.
If we refer to what was observed in Spain at the national level, and using the accumulated incidence at 14 days (IA14) as a measure, we can count the following as recognizable:
- The first, which affected from March to May 2020.
- The second, from July to November 2020.
- The third, from December 2020 to February 2021.
But within them, qualifications could be made. Many. Because the criteria used to define cases, or the availability and use of diagnostic tests, or the effect on mortality or hospital admissions, have not been the same.
Nor have the slopes of the IA14 curve, nor the severity in terms of deaths, been the same. Neither the fall in the incidence between waves, since only in the month of June 2020 the values could be considered acceptable.
Nowadays the, let’s call it, third wave has fallen quite quickly, but without ever reaching “ground”. At the national level , a value of 120 cases per 100,000 inhabitants has not even been reached in IA14. And it is seeing, in recent days, a change in trend.
But the situation is not the same in all autonomous communities. While a few maintain values well below these figures (Comunitat Valenciana, Baleares, Murcia), others have remained at all times well above (Madrid, Ceuta and Melilla). What is worse, in some the trend has completely broken, and they are beginning to rise (Navarra and the Basque Country).
But there is more. In some European countries, close to and linked to Spain (mainly France and Italy), the situation is worse and in others (Germany), it is simply not better.
On the other hand, vaccination in Spain is still far from protecting a significant proportion of the population. Right now there are 2,505,842 people with the full guideline. This represents 5.3% of the population. Although it is important to highlight that 90% of institutionalized people in Spain are already fully protected by the vaccine.
And what are the risks?
- The number of susceptible people. Adding to the fully vaccinated population that which has been infected during the pandemic (3,255,324) we have 12.2% of the inhabitants. Given that the ENE-COVID study in the last published round, the fourth, estimated the population with IgG antibodies at 9.9%, and that this corresponds to a time before the third wave, it can be considered that people with antibodies will overcome at present this figure widely. However, the number of susceptible people in Spain is still very high: many people can still be affected by the virus.
- Variants of the virus. The spread of variant B.1.1.7, the British one, is wide (more than 50% in most of the autonomous communities and in some it represents more than 70% of the total cases) and has increased rapidly in recent weeks . This variant is related to an increase in transmissibility and could lead to an increase in lethality.
- Increased mobility due to the holidays . Holy week begins and, despite the perimeter closures of the autonomous communities, mobility may increase. And you can also do it from countries with a worse situation than Spain.
- Economic pressures and pandemic fatigue. The measures necessary to contain the virus sometimes generate rejection and their compliance can be compromised, especially when, in some cases, the authorities reluctantly accept them. The economic impact that the measures have on many sectors of the economy causes pressure on decision-makers in the political sphere, who try to alleviate this impact. Sometimes, being reluctant or more permissive in its adoption or in monitoring its compliance. And occasionally incurring contradictions and inconsistencies that disconcert the population.
- The saturation of the health system. Despite the improvement, all levels of the system (primary, hospitals, public health) continue to be pressured and stressed. And exhausted after a year without stopping.
The responsibility of organized society
It is still possible to avoid that the effect of this wave is as terrible as it was that of the previous one. For this, the entire society, authorities and citizens must be asked not to fall into unfounded optimism.
As the Spanish Epidemiology Society has done, we must continue to make calls to adopt the measures required as the situation evolves and to maximize compliance with and respect for them, and to limit mobility as much as possible. It is everyone’s responsibility because it affects the whole of society.
And it should also be considered that the adoption, or the reinforcement of measures when necessary, is done with criteria of equity, considering all the scenarios and truly supporting the people and sectors that are being most affected. No one can be considered safe without thinking about the whole of society, local and global.
We are better prepared, but we can do better. Vaccination may alleviate the more serious effects seen in previous waves. But it will not be enough if there is no cooperation from society as a whole.
Óscar Zurriaga, Associate Professor. Department of Preventive Medicine and Public Health (UV). Serv. Epidemiological Studies and Statistic. Sanit. (Valencian generalitat). Unit Joint Research on Rare Diseases FISABIO-UVEG. CIBER Epidemiology and Public Health, University of Valencia
This article was originally published on The Conversation. Read the original.
