Covid-19 deaths during the fifth wave of the pandemic in Spain slowly begin to fall

The worst of the fifth wave of Covid-19 in Spain is now over. According to the latest report released by the Health Ministry on Friday, the 14-day cumulative number of coronavirus cases per 100,000 inhabitants has now fallen below 200, something that has not been seen since July 4. The fall in the curve of infections, which began at the end of that month, arrived two weeks later in hospitals. But an improvement was still to be seen in the number of fatalities, which until now had continued to rise.

The data supplied by the ministry is now showing a small fall in Covid-19 deaths, albeit with a daily total that is still above 100 (on Friday there were 155 fatalities reported). Since the fifth wave began, at the beginning of June, there have been 3,800 people who died after a positive coronavirus test, most of them seniors: the average age is 80.

The exact number of deaths is a statistic that’s impossible to measure in real time. The notifications are subject to reporting delays that preclude taking a true snapshot until two or three weeks have passed. But the data that are supplied daily by the ministry are an approximate measure of what is happening. Every day, the ministry adds the number of new Covid-19 deaths reported by the regions – which are in charge of their healthcare systems – to its reports, even though many of them have a date of death that is from days or even weeks ago. The ministry assigns each death to the day that it took place as well as offering a daily number of how many fatalities were confirmed in the previous week.

Both of these statistics are slowly falling. This past week, a total of 795 Covid-19 fatalities were reported, which is 69 fewer than the previous week. And the average of daily deaths (with confirmed dates) is 48, compared to 50 the week before. These latter data points will rise as more deaths are reported and assigned to their corresponding day. Delays to reporting mean that the lines of these graphs oscillate constantly and there are no clear trends, in contrast to what usually happens with the cumulative incidence and hospitalizations. Several weeks will have to pass for these data to be consolidated and an accurate analysis of when and how these fatalities began to fall.

What is clear is that the death rate during this fifth wave has been much lower than that of the others. As the health minister, Carolina Darias, pointed out on Wednesday, it was 0.2% – that means that for every 1,000 positive cases, two people have died. Since the pandemic hit, that figure has been 1.7%, which is more than eight times higher. This statistic is also tainted by the first wave, when a very small proportion of actual infections were officially recorded. If the last wave is compared with those that came after the spring of 2020, it can be seen that Covid-19 has killed seven times fewer people.

That said, in absolute numbers, the fifth wave has left many deaths behind – many more than the majority of experts had predicted. This is, according to the epidemiologists consulted, because the explosion of cases at the start of the summer was so huge that, while in relative terms the proportion of patients who succumbed to the virus was low, the raw number shot up. This summer so far, more than 1.1 million cases have been detected; meanwhile, in the fourth wave, around 600,000 infections were registered, leading to around 9,000 deaths. This was more than double than the fifth wave (these are approximate data – fatalities cannot always be clearly assigned to a specific wave, given that some people suffer an infection for a long time before they succumb).

Salvador Peiró, a doctor specializing in public health, adds a detail with this data. “We count among the deaths anyone who has tested positive for the coronavirus, which does not necessarily mean that this is what has killed them.” Fernando Rodríguez Artalejo, a professor in public health at Madrid’s Autonomous University, adds that for many vulnerable older people the infection “unbalances many previous pathologies and they end up succumbing.”

The average age of the victims in this wave has fallen to 80, which is six years lower than a year ago, according to the data supplied by the Health Ministry. However, it has not specified which percentage of these were already fully vaccinated. Also, this does not mean that there is a higher death rate among young people than previously, but rather that fewer seniors have died.

According to the latest report from the Carlos III Institute in Madrid, and based on provisional data from the fifth wave, 80% of the victims continue to be over the age of 70 in Spain, while two out of every three were over 80. By age range, it is highly possible that a good percentage were already vaccinated and they are among the rare cases where death is the outcome, as Artalejo refers to. “The risk of dying for a vaccinated person in their 80s is becoming the same as for an unvaccinated 30-year-old,” he explains. “It’s starting to become rare, but with so much transmission, it does happen.”

For seniors, however, the chance of dying from the coronavirus is also much lower now. Between the second and the fourth wave (there is no trustworthy data from the first) 22% of the over-90s who got infected passed away, a figure that has now fallen to 9.7%. Before, 14% of octogenarians died, a figure that has now gone down to 5.5%. Previously, 5% of those who were aged between 70 and 79 died, a figure that has fallen to 1.7%, according to the preliminary data from the Carlos III institute.

What’s more, Peiró points out, the treatment of serious cases of Covid-19 has improved along with the handling of such patients, meaning that some of the deaths that are being reported now are the result of infections that took place more than six weeks ago. At that time, a good proportion of 60- 69-year-olds were still awaiting their second dose of the Oxford-AstraZeneca, which was being administered in Spain with a considerable gap between shots.

Spain’s vaccination campaign last week hit the target of inoculating 70% of the population. This allows for some hope in the face of future waves. Based on what has been seen up until now, the death rate should be even lower: nine out of every 10 residents aged over 40 are now fully vaccinated, and the process is progressing for minors.

While the vaccines are starting to show a certain weakness when it comes to avoiding infection months after they are administered, they are still robust when it comes to avoiding serious illness and death. For those who are vulnerable due to weakened immune systems, a third dose will soon be administered.

Specialists believe that if the curve of infections starts to rise again, hospital admissions will have to be closely monitored. If, at any time, the vaccine starts to lose its effect among seniors and the death rate rises, the possibility of a third vaccine jab for this group will also have to be considered.

English version by Simon Hunter.