With cases on the rise, Spain adapts influenza surveillance system to Covid-19

As the highly transmissible omicron variant of the coronavirus continues to spread in Spain, authorities are finalizing a plan for a new Covid-19 surveillance system that will mirror the one that has been used for years to monitor the flu. The new system will extrapolate numbers from a statistically significant sample, rather than rely on daily reporting of each and every diagnosed infection.

The system comes as case counts in Spain continue to hit new records: on Friday, the Health Ministry reported 242,440 new infections. More than seven million coronavirus cases have now been detected since the beginning of the pandemic. Speaking on Friday, Spanish Prime Minister Pedro Sánchez said that most of the cases being registered were asymptomatic, adding: “We are going to have to learn to live with it [the coronavirus] as we do with many other viruses.”

Health officials have been working for months on adapting what is known as influenza sentinel surveillance. Under the new system, there will be no more reporting of every single diagnosed infection, nor will tests be carried out at the slightest symptom. The coronavirus will be monitored just like any other respiratory illness.

A group of healthcare professionals from primary care centers and hospitals will be created to monitor the situation. The goal will be to create a statistically significant sample with information gathered from all over the country, much as is done with surveys. This will help determine how the disease is spreading – both in its mild and severe forms – through extrapolation rather than through painstaking case counts.

The strategy has been in development since the summer of 2020 and is now entering its final phase. A cross-section of officials from the Health Alert and Emergency Coordination Center (CCAES), the National Epidemiology Center (CNE) and the Ponencia de Alertas, which includes regional health technicians, will meet several times this week to discuss when and how the new surveillance system should go into effect. There is no set date yet, although the transition is not expected before the end of the current wave.

“Given how tremendously transmissible Covid is right now, it is an enormous challenge to strictly meet universal surveillance protocols; it’s becoming impossible,” said Amparo Larrauri, head of the influenza and other respiratory diseases surveillance group at CNE. As a reflection of this difficulty, protocols have already been relaxed in Spain, where close contacts of positive cases no longer need to get tested unless they show symptoms.

“Faced with this new reality, we are working on a transition from universal surveillance to sentinel surveillance for mild respiratory infections in primary centers and severe ones in hospitals. But you can’t change things overnight. We have international commitments [to report all cases] and the sentinel systems need to be consolidated,” she added.

Five Spanish regions have started pilot programs in their primary healthcare centers, and nine have introduced them in hospitals. “With consolidated surveillance systems we could probably gather precise, better-quality information and avoid what’s happening now,” said Larrauri, speaking about the current strain on the primary healthcare system and the difficulties of reporting new cases with the highly transmissible omicron variant.

The sixth wave has yet to reach its peak, and could yet overwhelm hospitals. Although mass vaccination and the virus’ mutations are causing milder cases, the sheer number of infections is also causing high volumes of hospital admissions. On Friday there were 14,426 patients, more than at the peak of the fourth and fifth waves. Of these, 2,056 were in intensive care, more than at the peak of the fifth wave (2,031) and close to the highs of the fourth (2,356).

Iván Sanz, head of the National Influenza Center in Valladolid, noted that treating Covid-19 like the flu does not mean minimizing its importance. According to an estimate by the Carlos III Health Institute, influenza caused around 15,000 deaths, directly or indirectly, during the 2017-2018 season, for an average of 41 every day.

Back to school

Spanish children went back to school on Monday after the Christmas holidays to an uncertain situation. Workers across all sectors of the economy have been getting infected – sick leaves increased sevenfold in December – and teachers are no exception. The Education Ministry has admitted there will probably be a spike in teacher absences due to illness, but hopes the trend will slow down by late January.

Whether schools are prepared to deal with these staffing shortages is another story, and the majority opinion among teachers seems to be that they are not, particularly in regions where the numbers of substitute teachers have been reduced. Madrid and Andalusia, for instance, announced last year that they would have 7,679 and 5,300 fewer teachers respectively this academic year compared with 2020-2021.

Spanish schools will also not be conducting routine tests on teachers and students, the way they are in other European countries. Only the northeastern region of Catalonia said it will test the close contacts of infected individuals. And last week, a meeting of central and regional health officials decided that from now on an entire class will only be quarantined if there are five or more positive cases among the student group. The move affects early and elementary education, where children remain largely unvaccinated.

By comparison, students in France who are close contacts of a positive case must undergo a free test, while in Germany students are getting tested every week and in Italy, there will be large-scale screenings at education centers.

“We’re doing things on the fly, without being informed. There should be a complementary strategy by the regions to, say, test teachers and students, but there is absolutely nothing,” said Vicente Mañes, president of the association of public school principals. Mañes said that schools in Spain are not being viewed as a place to learn so much as a place to help families balance their home and working needs.

“We need to quickly do PCRs on students and teachers, and find immediate replacements for those who are out sick,” added Juan Villegas, a teacher at Maestro Juan de Ávila secondary school in Ciudad Real. “Without measures like these, the decision to keep schools open is efficient from a social viewpoint, but not from an educational one.”