Friday, January 28

Low risk does not mean zero risk: the pandemic is not over and the job has not yet been completed

Fortunately, and thanks to a great collective effort, the incidence of the pandemic has continued to decline and we have returned, after many months, to below 50 cases per 100,000 inhabitants on average for the entire country. This places us at a low risk of transmission, and consequently of healthcare pressure, and although this situation opens up optimistic expectations, we must be very clear that this does not mean that the risk is null or non-existent.

The virus is still present and has the potential to mutate and thereby generate threatening variants that are more contagious and elusive to the efficacy of vaccines. We still do not know the true duration of immunity generated by natural infection and by vaccines. Vaccines are not sterilizing and do not prevent infection and contagion, even though they do protect us, fortunately, from the severity, the risk of hospitalization and the risk of death. In addition, we are already clear that in the case of COVID-19, group immunity does not occur with high percentages of vaccination coverage and that, although the percentages of vaccinated people are very high, we still lack around 5.3 million people over 12 years of age to receive the complete guideline so that they have the necessary individual protection.

We must congratulate ourselves for the effort made. The achievements have been exemplary, with vaccination coverage that is at the forefront of Europe and that unleashes the curiosity and envy of countries such as Germany, France or the United Kingdom, among others, and even the United States, which are notably the furthest behind in the population scope of vaccination.

But there have also been important the achievements in terms of non-pharmacological measures that have been maintained for the time necessary to manage to cut the curve and reduce infections, with an important collaboration of the population that even continues to wear the mask to a large extent in exteriors due to the uncertainty of being able to guarantee physical distances and avoid crowds.

Let us not forget that the reduction in incidence is not only due to the advance in vaccination but also, and very importantly, to the permanence of the restrictive and protective measures, including the measures adopted to return to school from the beginning of the current school year. They have allowed us to reduce unprotected social interactions, with the regrettable exception of some massive events and uncontrolled and irresponsible macro bottles. Some countries that launched the bells to the flight and prematurely relaxed restrictions, such as the United Kingdom and its “Freedom day” on July 1, today have an incidence of around 700 cases per one hundred thousand inhabitants, they have stalled in the advance of vaccination and again suffer significant pressure from care. And in several countries in Europe in recent weeks, infections have risen again.

Therefore, the challenge remains to keep transmission at bay, avoid new waves, no matter how severe and deadly they may be, and even promote an even greater decrease in the number of infections to place us below 25 per hundred thousand inhabitants. To do this you have to keep your guard up.

Transmission containment measures have been relaxed while the incidence has decreased, in some Autonomous Communities (CCAA) more hastily than in others, but the important thing now is to understand that the virus is still active and that we should not rush into the relaxation of restrictions in the areas of greatest risk (eg closed entertainment venues, large sports centers, social residences and, above all, schools). Let’s not forget that variants that are more contagious and prone to escape the efficacy of vaccines can arise.

In addition, one must be cautious in the autumn-winter season, a period in which other respiratory viruses will be added and especially the seasonal flu. Let us not forget that, despite the considerable decrease in the average incidence, we are still not below 25 per one hundred thousand inhabitants in most of the Spanish territory, with the exception of Asturias and Galicia, and that the incidence in children under 12 years of age, a group that so far cannot be vaccinated because it does not yet have EMA approval for it, is higher than the average incidence for all ages (79.9 per hundred thousand). And, not least, that in many Autonomous Communities the healthcare pressure continues to be above the thresholds (5%) that give us a reasonable margin of safety, with Catalonia, the Basque Country and Madrid with figures of 8.9 and 11% respectively .

The development of the vaccination strategy has been generally very satisfactory and although 36.8 million people are already vaccinated with the full schedule, (87.5% of the target population), there are still 5.3 million to be vaccinated with the full schedule. of people over 12 years of age, who are still susceptible to severe cases, hospitalization or even a fatal outcome. To which we should add, when approved, those under 12 years of age, who make up 11% of the population. Taking into account that only 4% of the population is openly against being vaccinated, much work remains to be done to convince the rest and conclude the vaccination among the target population.

For all the above, it is inadvisable to encourage the false security that has been installed by proclaiming that the pandemic has already passed. Many pronouncements, from almost all instances, pose, very lightly, “the end of the pandemic.” But as much as we all want to overcome this difficult situation, the task is not yet finished. Neither the disease has been eradicated nor the virus has disappeared. It is not time to lower our guard but to rethink a transmission containment strategy and finalize the first round of vaccination taking into account the lessons learned during the last 20 months.

It would be highly recommended that the Public Health Commission now create an orienting framework to guide regional actions in this new phase of pandemic control, which involves reorienting actions once the health emergency associated with the pandemic has been overcome, in order to encourage the Interterritorial Council to be able to stay ahead of events and act with true territorial cohesion to give priority to what is required today.

In the short term we have to reduce the risk of outbreaks of COVID-19. This implies understanding that suspected cases must be diagnosed early, outbreaks detected early, and diagnostic tests performed on cases and their contacts, whether or not they are vaccinated. Thorough and retrospective screening must be intensified more than ever, and effective isolation of symptomatic or asymptomatic positives must be ensured. We are at a time when outbreak control and contagion tracking capabilities, as well as protective measures, have become the central strategy, rather than generalized restrictions on social interactions.

It is once again a time when it is necessary to do reinforced containment and this implies not dismantling the epidemiological surveillance, diagnostic tests and tracers. In other words, the strengthening and consolidation of public health services, human resources and infrastructures in all the Autonomous Communities is urgently required, in addition to, and as a prerequisite for, the creation of the State Agency or Center for Public health.

As vaccines are not sterilizing, many of the non-pharmacological measures (mask, distance, ventilation, hygiene of public and private spaces) will continue to be necessary, especially when the beginning of autumn leads to an increase in interactions in closed spaces and greater circulation. of other respiratory viruses (influenza and others) of high impact in terms of morbidity, work absenteeism, care overload and mortality, whose symptoms are easily confused with COVID and whose control, as the experience of winter 2020-2021 demonstrated, can greatly benefit of your application.

We must continue to emphasize using the mask indoors, especially in poorly ventilated spaces, ensuring its use outdoors when the safe distance is not guaranteed or there are crowds, in public transport, in health and social-health facilities, and maintaining protective measures. at school. It must be taken into account that there are population groups that require special attention and that protection measures must be promoted, understanding that there are groups of people whose living conditions and whose clinical, age and cultural characteristics will require a special effort to raise awareness, sensitization and care and attention.

For all these reasons, it will be essential to restore the full functionality of primary care, reduce the virtuality with which it has been operating in the pandemic phase, reestablish the usual circuits of face-to-face care for people, and intensify community actions and socio-health coordination. This is one of the most important immediate challenges.

Undoubtedly, this will require a determined commitment in all the Autonomous Communities to invest more in primary care in order to provide it with the necessary personnel and management schemes that allow the development of multiprofessional care models capable of reorienting services with health promotion criteria , disease prevention, fast care and personalized treatment. Attention to people living in residences and coordination with social services will also have to be reinforced. Diagnostic capacity and early intervention in post-COVID syndrome and in the face of mental health and substance abuse problems, the prevalence of which is increasing as a result of the different situations created during the pandemic, should also be strengthened. Recent and positive announcements in this regard should be finalized as soon as possible.

In addition, we must focus in the coming weeks on the absolute priority of vaccinating those who do not yet have the full regimen, going to the repechage of around 10% of the target population that is not yet vaccinated. This is fundamental and becomes more important than the possible extension of a third dose to the general population, for which until now there is no solid evidence that indicates it beyond certain risk groups and elderly people who live in residences. However, it has been chosen, and without a strong argument in favor of it, to apply a third dose to all those over 70 years of age, six months after having received the full regimen. We must weigh what this implies in terms of the resources and efforts required to apply 7 million more doses at a time when the most critical thing would be to achieve good coverage of vaccination against seasonal influenza in the highest risk groups. .

In summary, it is now time to begin the recovery of the health system, strengthen the areas that have structural weaknesses highlighted by the pandemic, such as public health, primary care and mental health, while we begin to respond to the health impacts and medium-term social services of this.

In other words, the pandemic is not over, much less in the global sphere. No CCAA or any country is an island in epidemic terms when a global pandemic is still present that has caused so many deaths and continues to produce a high number of infections It is the most ominous pandemic of the last century with more than 236 million registered cases in the world, about 69 million cases in Europe, and almost 5 million confirmed cases and around 90 thousand deaths attributed in Spain. Fortunately we are leaving the health emergency. But, both in the world, in Europe and in Spain, the epidemic risk persists and we cannot conclude the work.