The escalation of infections among young people must be stopped. The increase in COVID-19 cases among people under 30 years of age in Spain, the vast majority not yet vaccinated, is causing, in what seems to be the final stretch of the pandemic, the general incidence to grow and also hospitalizations little by little , although not with the same force as in previous waves as they are a less vulnerable population. What does clearly happen again is that Primary Care, where the majority of mild cases are treated, and Public Health, where they are tracked, again suffer an extra saturation. And also, for now, Spain is once again leading the contagion rates in Europe and to star on the cover of Financial times, with what that can mean for tourism. It all coincides with the expansion of the Delta variant, against which the vaccines appear to be effective, although slightly less than against the currently dominant variant, Alpha.
The Mallorca outbreak reveals the difficulty of enforcing sanitary regulations this summer
What can be done about this? President Pedro Sánchez has completely ruled out a tightening of the measures that involves the application of the curfew, which would require a new state of alarm. The Government refused to extend this exceptional tool from May, largely because it sent a message of improvement and normality in the face of the reactivation of tourism. The president on Wednesday minimized the impact that the outbreaks that have been taking place in recent days on the Spanish economy and stressed that the EU has improved its growth forecasts. Minister Carolina Darias also flatly rules out the curfew: “It is not on the table.” Currently, more than 50% of the population has at least one dose, and almost all those over 70 complete the regimen.
The Government maintains that the communities have the necessary tools to face the final stretch of the pandemic and leaves the activation of them in their hands depending on the evolution in each territory, but without entering into whether or not they should harden them. “In the Interterritorial Council there are a series of answers that the communities can give and it is not necessary to approve anything other than what is agreed by Health with the communities,” they point out from Moncloa. The spokesman for the Ministry of Health, Fernando Simón, for his part avoided the blaming speech against young people: “The high incidence among young people is not due to young people, it is fundamentally because they are not vaccinated. (…) We have young people asked for an effort that they have had to extend more, “he said, alluding to the fact that by age they are the last of the campaign’s prioritization. The communities are now beginning to puncture those under 30. Madrid for example, although it is the last in posts in general, opens the self-appointment this Friday. But some, like the Basque Country, postpone them until August.
In addition to the important factor of vaccination, experts and technicians link the explosion to the reopening of nightlife, which was illustrated with the macro outbreak in Mallorca. The Alerts Report, with experts who advise the Ministry, does recommend in an internal position to close nightlife and limit indoor hours, and even “value” a new curfew. The latter was also requested by Castilla y León. Sanidad demarcates itself from these recommendations and does not endorse them. At a press conference, Darias said that the body only “establishes proposals.” What the Ministry has done is to remind the autonomous communities that they have 5 million antigen tests at their disposal to enhance screening, and also to the Army trackers if they need them. Among young people, explain sources from the organization, it is “more complicated” to limit the outbreaks (because they have had more contacts, they do not want to “expose” acquaintances, or are afraid for their parents, for example), although they recognize that it is necessary to accelerate the vaccination process so that “there is no replication in hospitals”, these sources indicate. Catalonia has decided to close the night bars again. The incidence among Catalans between the ages of 20 and 29 has already exceeded 2,000 cases, a figure that had not been seen since the start of the pandemic.
Faced with an unprecedented situation: vaccination, nightlife, and reinforcements
Pedro Gullón, a member of the Spanish Epidemiology Society, explains that this situation requires “a lot of innovation”, because it is unprecedented in the pandemic: growth with great speed, but that only affects a specific sector. He is in favor of proposing restrictions “only in places where cases are enhanced, such as nightlife interiors”, and discards the curfew: “Already during the worst of the pandemic it had certain ethical and effectiveness limitations I do not see it. I do not see applying general measures that affect the entire population, it is very complicated with more than 50% of the country vaccinated. ”
Gullón specifies that measures would be effective at three levels. First, “vaccinate as quickly as possible. In some they go very well and in others, as in Madrid, not so fast”, so that young people are protected as soon as possible and this advance stops. Second, “restrict nightlife, or if it cannot be completely, maybe a few hours or indoors. In the places with the highest incidence, do not accelerate the de-escalation of this type of leisure, let’s say. And promote safer outdoor activities, since it is summer. There is a belief that you cannot control the capacity there, but you can, for example at festivals. That way there would not be such a great pressure against the sector. ” And third, “although it could be the first: reinforcing the tracking systems. Closing the macro shoots in these specific age fragments, guaranteeing effective quarantines, cutting the chain of transmission.” Complaints about quarantines in Mallorca hotels perhaps imply that there is a message about the preventions that we still have to take that is not getting well, says this doctor, co-author of books such as Epidemiocracy.
The Executive trusts both the recovery and the overcoming of the current increase in the incidence of vaccination. “We are having exceptional, spectacular data,” said the president at a press conference in Riga (Latvia) on Wednesday in which he insisted that an average of more than 400,000 people a day is being vaccinated and reaching records of more than 700,000 doses administered. “We must accelerate the vaccination,” add government sources. “In the approach that is being made is that once we have covered the most vulnerable generations we have to overlap the vaccination of different ages to protect those who are suffering the highest incidence, the young,” said Sánchez.
What problems are you posing if young people don’t fill the hospitals?
Young people under 30, or even 40, do not have a proportionally large impact in hospitals. But “the problem is that the pandemic is thought from 0 to 10. And there is a risk range of 3.4”, said Adrián Aginagalde, director of the Public Health Observatory of Cantabria, a community that is in the second position in the ranking of incidence these groups and where they are having real problems in tracking cases related to discos.
“Their parents will be with at least one dose. But some may have pneumonia, and some may end up entering,” recalled Aginagalde. Although the immunized population increases, in addition, there are still vulnerable people: many over 60 who only have a dose of AstraZeneca / Oxford for the time of that drug, or those who have developed “vaccine failure”, that is, they have not generated immunity with inoculation (5% of those injected with Pfizer / BioNTech, based on proven efficacy).
In addition to that, there are the consequences on the health system at the Primary and Public Health level. They are “those parts of the health system that have not appeared in the statistics throughout the pandemic,” says Mario Fontán Vela, a specialist in Preventive Medicine. “It is still a highly communicable disease, there are still large sectors of the population without vaccination and although the impact in terms of collective health is not the same as other waves by vaccinated people, we do have to take into account the social impact that derives from their management (isolations and quarantine) ”, he develops,“ that is, we still have to keep ourselves in a framework of analysis that is not apocalyptic, but that does not deny the repercussions ”. And without forgetting: “Open the framework towards what is not COVID, since if Primary and Public Health have to dedicate their resources to COVID-19, other pathologies that arrive in worse conditions at hospitals are neglected.”