Experts optimistic Spain will avoid sixth coronavirus wave despite surge in cases across Europe

After a good start to the fall, with the best coronavirus indicators in more than a year, the positive trend in Spain has taken a turn. The national 14-day incidence rate fell to its lowest point in mid-October, with 40 cases per 100,000 inhabitants, and since then, it has been slowly rising. It broke the 50-mark, considered “low risk” on November 4, and on Thursday, it reached 67 cases per 100,000.

As has been seen throughout the pandemic, the spike in cases has taken two weeks to be reflected in hospital and intensive care unit (ICU) admissions. Hospitalizations dropped to a record low on October 29, when 1,640 Covid-19 patients were recorded – a figure that now stands at 1,933. Meanwhile, in Spain’s ICUs, admissions reached their lowest point on November 5, with 386 patients. Since then, this figure has been fairly stable, with some small rises, with 395 Covid-19 patients currently in ICUs, according to Thursday’s report from the Health Ministry.

Despite the success of Spain’s Covid-19 vaccination drive – 88.9% of the over-12 population is fully vaccinated, according to the Health Ministry – there are growing concerns about the delicate situation in many other European countries. Germany, Austria and the Netherlands, which have lower vaccination rates than Spain, on Thursday reported the highest daily number of coronavirus cases seen since the beginning of the pandemic. Fatalities for Covid-19 are also rising in these countries. The question many are asking now is if Spain is on the brink of a sixth wave.

“The situation in Europe is a bit scary and the data in Spain are not good, given the indicators are rising. But I would not call what is happening here a wave,” explains Quique Bassat, an epidemiologist and researcher at the Catalan Institution for Research and Advanced Studies (ICREA) at the ISGlobal Institute in Barcelona. “The rise is not that explosive, the impact on the health system is not significant, and nor is it likely to be, thanks to the vaccines. It’s more of an uptick that is rising slowly and that we must monitor now to see how it evolves.”

Clara Prats, a researcher of Computational Biology at Catalonia’s Polytechnical University (UPC), expects that “cases are going to continue to rise for at least two more weeks.” She adds: “It’s more difficult to specify beyond that, although the advantage we have in Spain is that it has been the last country to see a rise and we can compare ourselves to those where it happened earlier and have similar vaccination rates. One example is Denmark. What we are seeing there is that the rise in cases has been significant but sustained since September, when they removed the last restrictions.”

The increase in contagions in Denmark, which went from reporting 300 daily cases in September to more than 2,000 now, has been big enough to prompt the Danish government to reintroduce measures such as the requirement to present the so-called “Covid Pass” – which shows if the bearer is fully vaccinated or has recently tested negative for the virus – in order to enter bars and restaurants. But the situation in Denmark’s hospitals, with 307 ward admissions and 41 in the ICUs, has not worsened significantly. Given that the country has a population of 5.8 million, this is a similar situation to what is reported in Spanish regions such as Valencia and Madrid, which are home to a comparable number of people.

The situation in Europe is a bit scary. But I would not call what is happening in Spain a wave

Quique Bassat, epidemiologist at the Catalan Institution for Research and Advanced Studies

This is the reason why many experts believe that when it comes to making decisions about the pandemic, the focus should be on the impact it is having on the health system. José Miguel Cisneros, the head of infectious diseases at Virgen del Rocío Hospital in Seville, explains: “Cases are going to rise in Spain as well, but the situation is not going to be like what we saw before thanks to the protection achieved with the vaccines. The rise will be less and have less of an impact on hospitals. In this situation, it does not make much sense to talk about waves just based on the incidence rate, because it will never be over. Vaccines reduce infections a lot, but don’t prevent all of them. That’s why there will continue to be rises in cases just as there are with other coronaviruses that cause the common cold and that we don’t even monitor. Now is the time to shift the focus of the importance of the indicator and put it on hospitalizations and the ICU admissions.”

Experts say that the improvement in vaccination coverage, with respect to the previous waves, is reason to be confident that the indicators will not worsen too much. “In June, when the fifth wave began, we had two important weak points that we have now overcome,” says Clara Prats. “The younger population was not vaccinated [now nearly 80% of teenagers and the 20-29 age group are fully immunized], which allowed the virus to spread at great speed. And many people aged between 60 and 69 who had been vaccinated with AstraZeneca still had not received the second dose, which significantly increased the number of serious cases and hospitalizations among them,” she explains, in reference to the 12-week interval between the first and second shot of the Oxford-AstraZeneca vaccine. “This is not going to happen again.”

In Spain, there are two large groups that have yet to be immunized. The largest of them is the under-12 population, who represent around five million people. So far, no Covid-19 vaccine has been approved for this age group, although the European Medicines Agency (EMA) is currently studying whether to approve a child’s dose of the Pfizer-BioNTech vaccine. But experts do not believe the under-12s will trigger a new coronavirus wave. Children do not catch the virus easily and, if infected, most have mild cases or are asymptomatic – which is why most specialists do not believe it is necessary to vaccinate them against Covid-19.

Although there have been at least two significant outbreaks in schools recently – one in Getafe in the Madrid region, with at least 56 cases, and another in San Cugat in Barcelona, with more than 40 – the data available confirms that children play a minor role when it comes to spreading the virus. The most recent and complete data on this subject is from the Catalan regional government. This information shows that 82% of cases detected among children in early education centers (for students aged between three and six) since the beginning of the school year, and 78% of cases in primary school (from six to 12) did not infect any classmate or teacher.

The other big group that has not been vaccinated are the 3.7 million people who have rejected the vaccine. This includes 40,000 people in the over-70 population, 110,000 in the 60-69 age bracket and nearly 40,000 in the 50-59 age group – all demographics that are more vulnerable to Covid-19. Although there is no data on a national level, information released by some Spanish regions – which are in charge of their healthcare systems, Covid-19 vaccinations and coronavirus restrictions – show that this is the group that is largely developing the most serious cases and being admitted into ICUs.

Cases are also going to rise in Spain, but the situation is not going to be like what we saw before thanks to the vaccines

José Miguel Cisneros, head of infectious diseases at Virgen del Rocío Hospital

Murcia reported a few days ago that seven people in ICUs in the region had not been vaccinated. A spokesperson from Valencia explained: “In the last week of October, there were 11 people in ICUs due to the coronavirus, of whom 10 were not vaccinated.” And Navarre stated that “three direct emergency admissions to the ICU recorded in the last week were unvaccinated people.”

“It’s important to ensure that the maximum number of people who are still not vaccinated protect themselves, for their health and the health of others, because doing this would help reduce the spread of the virus in society,” says José Miguel Cisneros, who believes this should be the priority over vaccinating children.

José Luis Alfonso, head of preventive medicine at Valencia’s General Hospital, does however believe children may need to be vaccinated in order to bring the incidence rate down – an argument he makes in view of immunocompromised individuals, who are one of the largest groups in ICUs. “We are seeing that one in six people who receive a third shot do not develop antibodies. These are patients who need to take immunosuppressants due to autoimmune diseases or cancer treatments and for whom the community spread of the virus is a risk,” he explains.

In the past few weeks, Europe has turned into one of the global epicenters of the pandemic. According to the European Center for Disease Control and Prevention (ECDC), countries in the north and east of the continent are recording the worst figures. In the United Kingdom, where face mask rules were relaxed in England in July, the number of daily Covid-19 fatalities recently exceeded 150. And in Germany, authorities reported 235 deaths on Thursday. The two countries have lower vaccination coverage than Spain – in both cases, 67% of the population is completely immunized, compared to 80% in Spain, according to Oxford University’s Our World in Data website.

“These percentage points of difference could be one of the determining reasons that explain what is happening,” says Cisneros. “We know that group immunity is inversely proportional to a virus’s capacity to spread and for some time, we have known that the 70% we initially set [for group immunity] was not enough and that we had to reach or exceed 80%. These points of difference are surely what is slowing down the circulation of the virus in Spain.”