After three months, Spain returns to high-risk situation for coronavirus transmission

This current wave marks the third time that the country has broken the 300 barrier for cases per 100,000 inhabitants over 14 days. Thanks to the vaccination campaign, however, the situation in hospitals is much better than during previous spikes

Covid in Spain
People wearing masks on Barcelona's La Rambla street this week.MASSIMILIANO MINOCRI (EL PAÍS)
Pablo Linde

Spain is back at a “high risk” level in terms of the transmission of the coronavirus. According to the latest report from the central Health Ministry, which was released on Thursday evening, the 14-day cumulative incidence currently stands at 305 cases per 100,000 inhabitants. This is the first time that the figure has broken the 300-barrier since the ministry and the regional governments agreed on a new, more relaxed traffic light system to measure the impact of the pandemic. This sixth wave of the health crisis in Spain comes after a three-month period when the incidence was at a low- or medium-risk level.

The ministry also reported 84 Covid-related deaths since Tuesday, given that Wednesday was a national holiday. The official death toll from the pandemic in Spain now stands at 88,321, with around 5.3 million cases detected.

This is the third time that the 14-day incidence in Spain has passed the 300 mark. During the first wave, in the spring of 2020, the level was not reached due to the very limited testing capacity at the time. During the fourth wave, the incidence reached 235.6, on April 26. The record was set on January 29 of this year, when the data point hit 899 during the third wave.

Other indicators, however, such as hospitalizations, are at a much better level than during previous waves thanks to the widespread vaccination coverage. This means that the global risk, taking into account hospital occupation, is still medium.

The latest Health Ministry report shows that 4.4% of hospital beds are occupied by Covid-19 patients, which is low risk according to the new traffic light system. In Spain’s intensive care units (ICUs), meanwhile, the level is 11.3%, which is medium risk.

With 5,479 Covid-19 patients, hospital occupancy is far from that of the fourth and fifth waves, when the figure exceeded 10,000. Even worse was the third wave, when practically no one had been vaccinated and there were more than 32,000 patients receiving treatment at one point.

With more than 90% of the target population in Spain vaccinated – i.e. the over-12s – all of the experts consulted by EL PAÍS predict that this sixth wave will be far less lethal than the others.

“This is a very different scenario from those that we have experienced up until now,” explains Antoni Trilla, a public health professor at the University of Barcelona. “It’s important to look at the number of cases, but we should be more concerned about the strain on hospitals. If transmission keeps increasing by much more we will all end up with more stress, but the system is at a level in terms of admissions and the ICUs that for now is manageable, much more than during other waves.”

Ignacio Rosell, an epidemiologist and coordinator of the committee of Covid-19 experts in the region of Castilla y León, warns, however, that being overconfident is not a good idea. “[A high] incidence means risk,” he explains. “I believe that evidently we are not going to see the same number of fatalities as we did before the vaccines. But transmission could end up being very high, it will be very difficult to get it down before Christmas. And, among so many cases, there will be some that will be complicated. We are nervous,” he adds.

Computer modeling shows that infections will continue to rise for at least a couple of weeks, according to Clara Prats, a researcher in computational biology at the Catalan Polytechnic University (UPC). “Beyond then it’s hard to make predictions,” she admits. The seven-day incidence continues to be considerably higher than half the 14-day indicator, suggesting a clearly rising trend. And this is without counting December 6 and 8, which were national holidays in Spain and for which cases were not included. The reality of the situation is likely somewhat worse than is being reflected by the Health Ministry reports.

Why are the experts concerned about the incidence, even with such high vaccine coverage? Epidemiologist Javier del Águila sums it up. “It’s possible that [the vaccines] are giving a sensation of invulnerability that is not accurate. If they generate 90% protection that means that with every encounter with the virus there’s a chance that the vaccine will fail. And with very high transmission there will be more contacts with the virus, and as such, greater risk for everybody.”

The distribution of infections is very unequal across Spain. While regions such as Navarre (956), the Basque Country (757) and Aragón (591) are at very high levels, Andalusia and Castilla-La Mancha have not even broken the 150-mark.

Del Águila explains that he is seeing the same pattern as in previous waves. “We don’t know why, but we see that they start in the northeast, with high transmission in Catalonia, the Basque Country, Navarre and Aragón. And from there, they spread to Madrid, which is likely the next place where cases will start to rise, then they spread to the rest of the central peninsula and they usually arrive later in Andalusia and Galicia.”

The Balearic and the Canary Islands, given their situation, have followed different patterns, ones that are down to other factors such as tourism. Del Águila, who has studied the geographical distribution of cases during the whole pandemic, believes that on this occasion something similar could occur once more.

This also translates into very different levels of pressure on the healthcare system. While hospitals in the less-affected areas are practically operating normally, those in regions with a higher incidence are already having to stop non-essential procedures. Hospitals in Catalonia, Navarre, Basque Country, La Rioja, Aragón and Castilla y León are already at high-risk levels.

The distribution of cases is also very unequal according to age. The under-12s, the only group that is yet to be included in the vaccination campaign, are far and away those with the highest levels: 533 cases per 100,000 inhabitants over 14 days, followed by the 30-39 group (325) and 40-49 group (380). The age of these groups coincides with the age that most parents of young children have, backing up the experts’ theory that this wave is mostly being driven by infections among kids, who then take the virus home with them. This is the opposite to what has happened in previous waves.

This makes it difficult to predict how the national holidays this week and the upcoming holiday season will affect infection levels. “On the one hand, there will be no contact between children in schools, but on the other, there will be more contacts with older people in other spaces,” explains Rosell, who insists on the need to advise citizens to be prudent and to maintain protection measures.

In Spain, masks are currently obligatory for all schoolchildren over the age of six in schools. The vaccination campaign for the five- to 12-year-old group is due to begin across the country from December 15 onward.

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