The coronavirus incidence rate in Spain has fallen to its lowest level since August 2020. According to the latest Health Ministry report, released on Wednesday, the 14-day cumulative number of cases per 100,000 inhabitants now stands at 98.7. This is the first time the incidence rate has fallen below 100 cases since August 12, when it stood at 96. At that time, the second wave of the coronavirus was starting to take shape and transmission rates were rising.
Now, however, the situation in Spain is very different. The fourth wave – which was much smaller than many experts predicted – peaked on April 25, with the 14-day cumulative number of cases per 100,000 inhabitants reaching 235, and since then, the incidence rate has been steadily falling. The data point fell sharply at first, and then more slowly, but neither the easing of coronavirus restrictions nor the end of the state of alarm has interrupted the downward trend.
The Covid-19 vaccination drive is key to Spain’s falling incidence rate. Almost the entire over-70 population (who accounted for eight in 10 deaths due to Covid-19) has been fully vaccinated. The over-60s are also on the way to getting full protection, but this process is taking longer as this age group is receiving the Oxford-AstraZeneca vaccine – a medication that requires a 12-week waiting period between the first and second shot, according to Health Ministry recommendations. Meanwhile, nearly half of the 50-59 age group has been fully vaccinated.
With these high levels of vaccination coverage among the over-50s, the coronavirus is spreading primarily among younger age groups. Indeed, there is high transmission among youths, which is stopping the global number of cases in Spain from falling more quickly, Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts (CCAES), said on Monday. But the seriousness of the disease and the mortality rate fall significantly in these age groups. Hospitalizations and fatalities can occur, but the risk is much lower. The number of hospital admissions and Covid-19 deaths has also been on a downward trend since April, even though there is typically a delay between the fall in cases and these data points.
In Spain, 3,089 people are currently in the hospital with Covid-19 – a figure similar to August. But while last year admissions were on the rise, now they are falling. Covid-19 patients occupy 2.5% of hospital beds – down from 25% at the beginning of February, the highest figure recorded since this data point began to be published (it was not released during the first wave).
Spain’s intensive care units (ICUs) are in a similar situation, with the occupancy rate at 10%. This figure takes into account the total number of beds that can be made available for intensive care patients (for instance, by adapting surgeries), not the structural number, which is much lower. Even so, it represents a big drop since February, when 45% of ICU beds were occupied by Covid-19 patients.
With respect to Covid-19 deaths, the exact number of daily fatalities cannot be known until a few weeks have passed, as there are often reporting delays. But it is estimated that around 20 daily deaths have been recorded in the past few days, a figure that is also on a downward trend. Most of the victims are people 60 and over who contracted the coronavirus before being fully vaccinated and had been suffering from the disease for weeks. Young patients have also died from Covid-19, but they continue to be the minority.
Is the downward trend definitive?
The question now is if the downward trend is definitive or if there is still the risk of new coronavirus waves. Given that the most at-risk groups have been vaccinated, it is unlikely that hospital admissions and deaths will rise significantly, unless there are surprises from a new coronavirus variant, which is not so far expected. But according to Manuel Franco, the spokesperson for the Spanish Society of Public Health (Sespas), the risk of an uptick in cases remains. “A third of the population has still not received both [vaccine] doses, so there is margin for rises to happen,” he said.
Franco also pointed out that the epidemiological situation varies between Spain’s regions, which are responsible for containing the pandemic in their territories as well as the vaccination drive. While four regions – the Balearic Islands, Valencia, Galicia and Murcia – have an incidence rate below 50 cases (which, among other data points, indicates a situation of low risk), in two – Andalusia and La Rioja – the figure is above the 150-threshold, considered an indicator of high risk, according to the coronavirus alert system. “I think with these figures we have to assume that we are not all the same and that different measures have to be taken in each place according to their circumstances,” he said.
With respect to a possible rise in cases, Antoni Trilla, professor of preventive medicine at Barcelona University, said that when it comes to the coronavirus pandemic nothing can be “ruled out.” The expert explained that while it is unlikely a new wave will overwhelm the healthcare system, the incidence rate could rise and fall, meaning coronavirus restrictions will still be needed. Spanish Prime Minister Pedro Sánchez announced on Wednesday that the mandatory use of face masks while outdoor will “soon” come to an end, but no date has been set for the measure to be lifted.
Trilla pointed to the United Kingdom, where the deescalation of restrictions has had to be paused due to a rise in cases associated with the delta variant of the coronavirus, first detected in India. “This variant appears to be more contagious, although, with the data we have, we are not seeing an increase in the seriousness of the disease,” he said. “We don’t know what the impact will be here: [in the UK] there were more people with one dose, but here there are more who are fully vaccinated. We also have higher temperatures. We will have to be on alert.”
Trilla added that it is important to monitor the epidemiological situation in other European countries, as changes are sometimes recorded there before they are detected in Spain, and vice versa. Spain is currently the European country with one of the highest incidence rates, outstripped only by France, the Netherlands, Switzerland, Belgium, Greece, Denmark, Lithuania and Latvia, according to the European Center for Disease Control and Prevention (ECDC), whose data differ slightly to what is reported in Spain. In most European countries, the 14-day cumulative number of cases per 100,000 inhabitants is below 100, while in seven it is below 50: Poland, Romania, Hungary, Bulgaria, Finland, Malta and Iceland.
English version by Melissa Kitson.