Spain’s health experts divided over whether Covid-19 should be treated like flu

The Spanish government's plans to view Covid-19 as an "endemic disease" similar to seasonal influenza would mean infections aren’t counted so rigorously, a strategy that not all health professionals in Spain agree with as cases continue rising. 

People, some wearing face-masks, walk in a street as they enjoy a day out in Barcelona on December 31, 2021. (Photo by Pau BARRENA / AFP)
People, some wearing face-masks, walk in a street as they enjoy a day out in Barcelona on December 31, 2021. (Photo by Pau BARRENA / AFP)

On the same day that Spain’s fortnightly infection rate reached new heights – 2,989 cases per 100,000 people – Prime Minister Pedro Sánchez on Monday confirmed that his government wants to change the current daily reporting of Covid cases to a surveillance system that’s used for the winter flu.

Although Sánchez didn’t offer many details about these new parameters to monitor Covid-19, he did say that the exhaustive control of cases would be abandoned, and therefore also the call for testing upon the onset of any Covid-19 symptom. 

His government wants to treat Covid-19 as an “endemic disease” similar to la gripe (the flu in Spanish), given its low mortality rate with Omicron the dominant strain in particular.

To justify this decision, Sánchez stressed that “the situation” of the pandemic “is not that of a year ago”, since “we know the virus better and while waiting for what the reports say, Omicron seems to have milder health consequences”.

According to the Socialists’ leader, his government has been “working for weeks” with the country’s Centre for Health Alerts and Emergencies (CAES) to determine these new parameters and is now agreeing on the final details with the regions. 

No start date has yet been given, but it’s not expected that the new system will be implemented until Spain’s six coronavirus wave is over.

Spain’s Health Ministry did say back in August 2021 that it intended to stop using the infection rate and other case number indicators to determine if the country’s epidemiological situation was improving or worsening, but the idea has been put on ice until now. 

If health authorities adopt the same monitoring approach as with seasonal influenza, instead of reporting every Covid case that’s detected in the country, something unsustainable in the long term, a group of primary health care doctors from health centres and hospitals in Spain will be strategically chosen to act as witnesses and report back.

Most primary care workers have called for this to happen, saying that acquired immunity in the population and the Omicron variant allow for it to work, and that the current testing and quarantine measures are unfeasible at this stage. 

According to the President of Spain’s Society of Family Medicine Salvador Tranche, the decision will “save” the currently overburdened primary health care system, which is having to deal with a barrage of patients with mild symptoms when it could be diagnosing other pathologies.

For Tranche, rather than the infection rate it should be bed occupancy rate of Covid patients in hospital wards and ICUs that’s used as the main parameter.

But it’s not an opinion that all health professionals in the country agree with. 

“If we stop taking action, what we are going to have are more infections,” leading epidemiologist and former WHO directive Daniel López Acuña told Spanish broadcaster RTVE, arguing that focusing only on serious cases and hospitalisations is “like cheating while playing Solitaire”.

“It’s a mistake to think that the problem will no longer exist by not counting infections, or by reducing the number of days of isolation, or by establishing quarantines in schools with five children instead of maintaining what was had. The problem continues to be there, and it has to be addressed,” López Acuña concluded.

For the spokesperson for the Spanish Society of General and Family Physicians (SEMG) Lorenzo Armenteros, it would be “hasty” to implement this new monitoring system in an attempt to “minimise the situation”. 

“Do we have to see as normal that there are 200 deaths a day?” argued Vicente Martín of Spanish Society of Primary Care Physicians (SEMERGEN).

“What is the number of deaths that should be considered acceptable?”

Over the past three weeks, there have been 1,500 Covid deaths recorded in Spain. 

It’s a far cry from the 19,000 people who died in Spain from Covid during two months last winter in the midst of the country’s third wave, but a fatality figure that’s growing again, albeit at a slower pace. 

The World Health Organisation’s Regional Director for Europe Hans Kluge has also said that considering Covid-19 an endemic disease is “not a good idea” as the virus has already surprised the world “more than once” already and that “we must be very cautious with predictions for the future”.

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Covid-19: European summer holidays threatened by rise of subvariants

A resurgence of Covid-19 cases in Europe, this time driven by new, fast-spreading Omicron subvariants, is once again threatening to disrupt people's summer plans.

Covid-19: European summer holidays threatened by rise of subvariants

Several Western European nations have recently recorded their highest daily case numbers in months, due in part to Omicron sub-variants BA.4 and BA.5.

The increase in cases has spurred calls for increased vigilance across a continent that has relaxed most if not all coronavirus restrictions.

The first resurgence came in May in Portugal, where BA.5 propelled a wave that hit almost 30,000 cases a day at the beginning of June. That wave has since started to subside, however.

READ ALSO: KEY POINTS: German Health Ministry lays out autumn Covid plan

Italy recorded more than 62,700 cases on Tuesday, nearly doubling the number from the previous week, the health ministry said. 

Germany meanwhile reported more than 122,000 cases on Tuesday. 

France recorded over 95,000 cases on Tuesday, its highest daily number since late April, representing a 45-percent increase in just a week.

Austria this Wednesday recorded more than 10,000 for the first time since April.

READ ALSO: Italy’s transport mask rule extended to September as Covid rate rises

Cases have also surged in Britain, where there has been a seven-fold increase in Omicron reinfection, according to the Office for National Statistics (ONS).

The ONS blamed the rise on the BA.4 and BA.5 variants, but also said Covid fell to the sixth most common cause of death in May, accounting for 3.3 percent of all deaths in England and Wales.

BA.5 ‘taking over’

Mircea Sofonea, an epidemiologist at the University of Montpellier, said Covid’s European summer wave could be explained by two factors.

READ ALSO: 11,000 new cases: Will Austria reintroduce restrictions as infection numbers rise?

One is declining immunity, because “the protection conferred by an infection or a vaccine dose decreases in time,” he told AFP.

The other came down to the new subvariants BA.4 and particularly BA.5, which are spreading more quickly because they appear to be both more contagious and better able to escape immunity.

Olivier Schwartz, head of the virus and immunity unit at the Pasteur Institute in Paris, said BA.5 was “taking over” because it is 10 percent more contagious than BA.2.

“We are faced with a continuous evolution of the virus, which encounters people who already have antibodies — because they have been previously infected or vaccinated — and then must find a selective advantage to be able to sneak in,” he said.

READ ALSO: Tourists: What to do if you test positive for Covid in France

But are the new subvariants more severe?

“Based on limited data, there is no evidence of BA.4 and BA.5 being associated with increased infection severity compared to the circulating variants BA.1 and BA.2,” the European Centre for Disease Prevention and Control (ECDC) said last week.

But rising cases can result in increasing hospitalisations and deaths, the ECDC warned.

Could masks be making a comeback over summer? (Photo by OSCAR DEL POZO / AFP)

Alain Fischer, who coordinates France’s pandemic vaccine strategy, warned that the country’s hospitalisations had begun to rise, which would likely lead to more intensive care admissions and eventually more deaths.

However, in Germany, virologist Klaus Stohr told the ZDF channel that “nothing dramatic will happen in the intensive care units in hospitals”.

Return of the mask? 

The ECDC called on European countries to “remain vigilant” by maintaining testing and surveillance systems.

“It is expected that additional booster doses will be needed for those groups most at risk of severe disease, in anticipation of future waves,” it added.

Faced with rising cases, last week Italy’s government chose to extend a requirement to wear medical grade FFP2 masks on public transport until September 30.

“I want to continue to recommend protecting yourself by getting a second booster shot,” said Italy’s Health Minister Roberto Speranza, who recently tested positive for Covid.

READ ALSO: Spain to offer fourth Covid-19 vaccine dose to ‘entire population’

Fischer said France had “clearly insufficient vaccination rates” and that a second booster shot was needed.

Germany’s government is waiting on expert advice on June 30 to decide whether to reimpose mandatory mask-wearing rules indoors.

The chairman of the World Medical Association, German doctor Frank Ulrich Montgomery, has recommended a “toolbox” against the Covid wave that includes mask-wearing, vaccination and limiting the number of contacts.