Outbreak or seventh wave? Health experts divided as Covid cases rise in Spain

Spain’s decision to stop counting all infections has some epidemiologists arguing health authorities are turning a blind eye to rising cases. But is the country truly heading towards a seventh wave?

Outbreak or seventh wave? Health experts divided as Covid cases rise in Spain
Some health experts are against the Spanish government's approach of not counting all Covid infections in the country and removing quarantine for positive cases.(Photo by Pau BARRENA / AFP)

Three weeks since the Easter holidays came to a close and the indoor face mask rule was lifted in Spain, the Covid infection rate among over-59s has increased considerably, for most health experts predictably. 

It’s double what it was on April 1st – going from 459 cases per 100,000 up to 813 per 100,000 – and although Covid hospitalisations have risen by 78 percent in a month, pressure on hospitals remains stable. 

Not that this can be considered a complete picture of the epidemiological situation in Spain as the health ministry decided last March it would stop requesting data from the regions for infections among under-60s. 

This is part of the Spanish government’s plan of managing Covid-19 in a similar way to other endemic diseases such as seasonal influenza. 

The focus in recent weeks has been lifting Covid restrictions, not counting and reporting all Covid infections as frequently and rigorously and keeping a close eye only on the elderly and vulnerable. In a nutshell, returning to life pre-coronavirus.

But for some epidemiologists, the 55,578 new infections and 234 Covid deaths in the past week are indicative of the fact that the virus is still raging strong and that the end of Covid rules may have come too soon.

“We’re not facing a silent wave of the pandemic.  We’re walking blindfolded into a new wave, we don’t want to see it and we don’t want to name it,” Daniel López-Acuña, former director of emergencies at the World Health Organisation, told public broadcaster RTVE.

“There is a considerable rise in the infection rate, and  a rise in the infection rate sustained over time is a new wave, whether you want to call it that or not , López-Acuña added, arguing that if the incidence in under-60s were also analysed, “we would see the same infection rate or greater”.

Epidemiologist Quique Bassat argues that although there is talk among health experts of a seventh wave, “what we don’t know is how long it will last and if this is the beginning of what will end up being a seventh wave, or if it’s really just a new outbreak.” 

For Bassat, who is regularly interviewed on La Sexta and Antena 3 news, a rise in cases after the Easter holidays and the removal of face masks indoors is “what was expected”, but that “doesn’t mean that the population should be scared” and it “isn’t necessary to change the current strategy” of the health ministry.

“Pressure on healthcare is what has to determine if we should take a step back in the de-escalation of Covid-19 measures,” Bassat concludes.

It’s clear that the Spanish government’s approach to this stage of the pandemic is subject to a variety of opinions among the scientific community.

Some health experts, such as immunologist Matilde Cañelles of Spain’s Higher Council for Scientific Research (CSIC), consider it “irresponsible” to stop quarantine for positive cases and not count infections when there are still 30 people dying of Covid every day in Spain. 

Others take a more pragmatic approach and call for the fourth dose (second booster) of the Covid-19 booster vaccine to be offered to over-80s in the country as previously suggested, as the infection rate in this group is now over the 1,000 per 100,000 mark.

For epidemiologist Oriol Mitjà, Covid-19 adviser for the Catalan government, the coming weeks will shed more light on how big this coronavirus wave will be.

“Omicron is a variant with vaccine escape and with the potential to infect up to 60-70 percent of the population. 30 percent were infected at Christmas, 30 percent will avoid it and 30 percent can be infected now,” Mitjà tweeted.

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Spain to stop counting Covid infections except for serious cases

Spain’s Health Ministry on Thursday announced it will stop keeping count of all Covid-19 infections in the country, with the exception of serious cases and those affecting vulnerable people.

Spain to stop counting Covid infections except for serious cases

It’s a decision that’s been in the pipeline for some time and one which will effectively mean that the national infection rate, one of the key epidemiological indicators up to now, will no longer be used to evaluate the state of the pandemic in Spain. 

On Thursday March 10th, Spain’s Interterritorial National Health Council (CISNS) announced that it will soon begin a transition towards not counting each and every new Covid-19 infection there is, and focus instead on monitoring high-risk groups and serious coronavirus cases. 

With such high vaccination rates in the country and a dominant Omicron variant that’s proven less lethal than previous strains, the national and regional health representatives that make up CISNS have seen little sense in continuing with the exhaustive surveillance system that’s been in place for the past two years.

Spanish Health Minister Carolina Darias has not yet specified when the change in surveillance will come into effect, but details are expected soon.

According to Darias, the transitional system will still be “capable of detecting increases in Covid incidence among the general population” and will allow for “the early detection of new variants and measures of vaccine effectiveness”.

The Health Minister already confirmed last week that instead of daily infection and vaccination reports as has been the case until now, there will only be two a week going forward.

However, given the latest announcement, such reports will not include mild or asymptomatic cases that citizens report to their local health centres. 

Back in mid-January, Spanish health authorities announced that they wanted to start monitoring the pandemic in a similar way to seasonal flu and serve as an example to the rest of the world of what reclassifying Covid would mean.

This process is being described as the gripalización (influenza-tion) of the pandemic, whereas others are calling for Spain’s general health system to be covidizado (‘covisized’), two newly coined terms which describe different ways to adapt to a post-pandemic world.

In the end, other European countries have been faster to remove all Covid restrictions, but Spain is now taking small steps towards easing its outdated coronavirus rulebook. 

There had been hopes that the Interterritorial National Health Council meeting held in Zaragoza on Thursday would also lead to a decision on the end of rule for face masks in indoor settings, but no announcement has yet been made on this.