Friday, March 29

The sixth wave is ending, but not the pandemic


After a sixth wave with transmission rates never seen before, the incidence of covid-19 cases is falling rapidly in practically all of Spain. Also in the countries around us. And restrictions are relaxed. Do we do well?

Salvador Peiro

SALVADOR PEIRO Researcher, Health Services Research Area, FISABIO PUBLIC HEALTH, Fisabio

After a sixth wave with transmission rates never seen before, the incidence of covid-19 cases is falling rapidly in practically all of Spain. Also in the countries around us. Hospital admissions and intensive care units also fall. And, finally, mortality also decreases.

Parallel to these falls, the restrictions are softening. The days of isolation in confirmed cases are reduced, the quarantines in close contacts disappear, the obligation to wear masks outdoors, the capacity and the limits of diners. Massive events and parties reappear. And we are thinking about when to remove the masks indoors. Even forgetting about testing (which would mean ignoring the isolation of non-symptomatic positives).

No one rules out a possible rebound. Some saw tooth or some outbreak in some places. But we begin to lift our heads and ask ourselves about the nearest future. Although we can draw some post-omicron scenarios, to be honest, we don’t have good answers. At least not very precise.

What’s next?

We have some historical experience with other respiratory viruses, such as influenza or respiratory syncytial virus. And, despite being old acquaintances, it is not a pleasant experience. Every winter these viruses put us on the ropes: overflowing health centers, crowded hospital emergencies, beds in the corridors, suspended surgeries… And, from time to time, a worse winter.

However, we have almost no experience with SARS-CoV-2. Just a couple of years, very long and with very changing situations. So we don’t know how the virus will behave when we come out of the sixth wave. Do new surprises await us? How much social disruption will it be capable of causing?

An “optimistic” post-pandemic scenario is that it will behave similar to the flu. Endemic with epidemic situations when conditions are favourable. Perhaps, like the flu, only in winter; maybe all year. Surely with severe forms in the elderly, immunocompromised or other vulnerable people, but with mortality rates much lower than those seen so far. It is possible that things will get complicated and we will face winters with combined epidemics of influenza and covid-19.

In a more “pessimistic” scenario, SARS-CoV-2 would continue to generate new variants. Some capable of evading, more or less partially, the immune protection (individual, but also collective) that we have been building with so much effort and suffering based on infections, vaccination and booster doses.

In this scenario, the immune protection conferred by vaccines (or natural infection) would be reduced over time. More regarding the risk of infection than the risk of serious illness. New variants that are more transmissible, with more infections and, perhaps –or perhaps not– capable of producing more serious conditions. Because the widespread belief that viruses tend to get milder over time is fundamentally just that, a belief.

A surveillance network for respiratory infections

What to do so that no scenario catches us by surprise? Probably, the first thing is to accelerate the improvement of epidemiological surveillance and incorporate covid-19 into a renewed respiratory infection monitoring system. It involves expanding and improving the primary care sentinel network and integrating the information (also improved) from the hospital sentinel network, including emergencies, hospitalization and microbiology laboratories. And, of course, increase our ability to sequence.

It would not hurt to maintain some monitoring of the presence of SARS-CoV-2 in wastewater, an indicator that allows outbreaks to be anticipated. And build cohorts of people to test (PCR) periodically, using random samples of the general population, and of specific groups such as elderly people in residences, health personnel and children.

It would also be advisable to monitor the probable decay over time of neutralizing antibodies through regular seroprevalence surveys.

These are activities that combine public health and care actions with epidemiological research methods. Ideal terrain for that long-awaited State Public Health Agency that, although it requires an intelligent design, is also an urgent need.

New regulation on the ventilation of interior spaces

Covid-19 has taught us a lot about aerosol transmission and excess risk in indoor spaces. Improving the quality of the air that we share with other people in those spaces is essential. The air conditioning installations of collective spaces require new regulations in relation to their capacity to renew the air or its filtering to reduce biological contaminants.

Without a doubt, the modernization of these facilities is especially urgent in spaces with vulnerable people (residences, hospitals, health centers…). But also in leisure spaces (cinemas, theaters, discos…) and, of course, in schools and educational centers and in spaces with significant capacity.

Obviously, new booster doses (very likely in vulnerable people) and the role of new treatments will also have to be assessed. Interest will grow as second and third generation vaccines are licensed. It also seems logical to maintain the masks in symptomatic patients (of any respiratory infection and in any context) and in certain situations (outbreaks, centers with vulnerable people in territories with a high incidence).

If the worst scenarios of an increase in serious cases materialize, more things will have to be done. Even stepping back on restrictions.

We came out of the sixth wave leaving behind a lot of natural infection and a lot of third doses. Taking into account the occupation of the ICUs, very few unvaccinated will have overcome this wave without being infected. Probably – and although the war situation in Europe does not help – we now have some breathing time to recover mentally and socially from covid-19.

It is also a time to prepare the health and social response to –perhaps close, perhaps distant– outbreaks. More than arguing about the name “endemia” or “pandemic”, it is important to prepare that response. It cannot be done without uncertainty and without some imprecision. Probably not without making some mistakes either. But the biggest mistake at this point would be the complacency of the “end of the pandemic”.

This article has been published in The Conversation


www.hoy.es

Also Read  Bridal fashion against child marriage

Leave a Reply

Your email address will not be published. Required fields are marked *