Spain seeking to ‘lead’ world with new Covid-19 monitoring system

The Health Ministry is finalizing a coronavirus surveillance plan that will mirror the one used for the flu, but a leading WHO official and two primary healthcare associations have expressed reservations

Health workers carry out free antigen tests in Lugo.
Health workers carry out free antigen tests in Lugo.Eliseo Trigo (EFE)
Pablo Linde

The Spanish Health Ministry wants the ongoing sixth wave of the coronavirus pandemic in the country to be the last that is managed using the indicators that have been in place since the crisis began. Speaking on Wednesday, Health Minister Carolina Darias told reporters that with a largely vaccinated population, and variants such as omicron that appear to be much milder, “it is necessary to evaluate a new Covid monitoring system,” and said that Spain would be seeking to “take the lead” with this debate in international settings.

As was reported by EL PAÍS on Monday, staff from the Health Ministry, the regions and the National Epidemiology Center are finalizing a pilot plan to monitor the illness as has been done for years with the flu, via a network of doctors who can report how the virus is spreading. In this scenario, tests on each case would no longer be carried out, with data instead being extrapolated from a significant sample of the population.

Darias – who was speaking after a meeting of the Inter-Territorial Council of the National Health System (CISNS), which brings together the central Health Ministry and the regions – did not specify the system that will be introduced. “This evaluation process is already being started by experts from the [alert team advising the government], and at the same time we are advancing a debate as to where we are headed, how we will carry out this transition,” she told reporters. “And we are also fostering a debate with our European partners to determine the best options to deal with a pandemic disease that bit by bit is acquiring endemic characteristics.”

While the plans for this monitoring system are advanced and are backed by a long history of treating the flu in a similar way, the strategy that will eventually be adopted will have to be agreed with international authorities. Both the European Center for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) are, for now, requesting exhaustive, case-by-case data on the pandemic.

Darias explained that Spain has already called on the ECDC to study new strategies. “I share a lot and often speak with my European colleagues, who also see the need to look to new horizons,” she continued. “We need to move from emergency monitoring to one with better quality, that is compatible with other respiratory phenomena. There are regions that have already designed this and we want to move forward hand in hand with the territories. Spain wants to lead this debate.”

We are fostering debate with our European partners to determine the best options to deal with a pandemic disease that bit by bit is acquiring endemic characteristics
Spanish Health Minister Carolina Darias

Five of Spain’s regions – which are in charge of their healthcare systems, vaccination campaigns and coronavirus restrictions – are already rehearsing a pilot monitoring program in their healthcare centers, while nine are doing so in hospitals. One of these is Extremadura, whose health chief, José María Vergeles, explained on Tuesday that shadow simulations have been carried out over a period of several weeks, and that these have had “good results.” The advantage of monitoring the disease in key areas is that a very precise snapshot of the real situation can be garnered, without the need to overwhelm the system with tests for all cases.

This proposal is a significant paradigm shift, one that has surprised many international figures. The WHO, for example, has expressed its opposition to the change in strategy. Its director in Europe, Hans Kluge, made clear on Tuesday that Covid-19 cannot yet be considered an endemic disease. Experts from the WHO believe that cases will have to stabilize before this can happen, and display more predictable patterns. The organization has also predicted that in the coming six or eight weeks, half of Europeans will become infected with the virus.

Darias responded to this saying that this will not be an immediate change, but she argued that preparation was required. “We have to consider where we are headed to and how we are going to get there,” she said. “Citizens need us to anticipate this kind of scenario with great caution, but confirming that we are in a new state, above all due to the very high vaccination coverage.”

The waiting room of a primary healthcare center in Barcelona in December.
The waiting room of a primary healthcare center in Barcelona in December.Albert Garcia (EL PAÍS)

While she avoided giving dates, she did point to the end of the sixth wave as the moment when these new systems would come into force. Whichever one is adopted, it will include no longer counting the number of infections, and people with symptoms will no longer have to take a test.

The current system has been completely overwhelmed since the explosive sixth wave took hold before Christmas. Home antigen testing kits are replacing those carried out by healthcare professionals, and many positive cases are not being reported nor officially counted by the authorities – some regions take these results as confirmed, while others require another test within the healthcare system.

Given this situation in Spain, and with the primary healthcare system in particular overwhelmed, there has already been a chorus of voices calling for this change in management to start now. The Spanish Society for Family and Community Medicine (Semfyc) published a long editorial this weekend titled “Toward the end of exceptionality,” in which it argues for the need to return to the “old normality.” The thesis is based on the fact that the lethality of the virus is constantly falling, and that counting and tracking every case is an unrealistic strategy. “Governments should focus their efforts on protecting the most vulnerable rather than trying to stop, no doubt unsuccessfully, the circulation of the virus among the population,” it reads.

The other two major primary healthcare associations, SEMG and Semergen, believe that it is still too early to change strategy and believe that the severity of the pandemic should not be played down. A number of experts and epidemiologists also agree that any change in Covid monitoring is still too early. “We cannot trivialize the pandemic,” says Lorenzo Armenteros, SEMG spokesperson, in conversation with EL PAÍS. “We are in a situation of exponential growth that is overloading primary healthcare and any situation that changes the criteria followed must be based on scientific evidence.”

What is clear is that this paradigm shift will arrive, sooner or later. In the long term, registering each case of a respiratory illness that is as contagious as Covid is unsustainable. What must be done is to define how and when this will happen – and Spain wants to lead this process.

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