Doctors call it the “silent wave”–a spike in Covid cases that began in early June, just a few months after Spain’s Ministry of Health and local public health officials halted their exhaustive diagnostic data collection at the end of March. There are fewer outbreaks than before, and fewer serious cases than in the days before vaccines were available. But the number of mild cases continues to grow due to two omicron subvariants (BA.4 and BA.5) that can infect people who recently had the disease, and are producing a notable increase in hospitalizations. This is what doctors are seeing in their patients, and what the pandemic statistics are currently reporting.
What wave are we in?
The last clear-cut wave of Covid was number six, which peaked in January 2022 with the big explosion in omicron cases. Cases dipped after that, followed by another upswing in April, which some considered to be the seventh wave. After another drop in May, Covid diagnoses began to surge again in early June, which could be called the eighth wave, unless you discount the April upswing.
How are Covid cases being reported?
Since the end of March, Spain’s Ministry of Health and local public health officials have only collected diagnostic test data for people over 60, since diagnostic tests for younger, healthy individuals are not indicated. This prevents us from knowing whether there is a higher incidence in other age ranges. Also, many positive tests may go unreported since self-testing in pharmacies was authorized.
How many cases are there now, and is it higher than in other waves?
For the 14-day period ending June 28, there were 841 cases per 100,000 people (over 60) in Spain, which has risen steadily since the beginning of the month. We are roughly at May levels, where we remained at more than 800 cases per 100,000 people for most of the month. The difference is that those numbers remained steady throughout the month of May, whereas now there is a clear and rapid upward trend. This is similar to the highs reported in the pre-omicron waves: 899 in the third wave and 700 in the fifth wave. But we are still well below the peak of the sixth wave, when the cumulative number of cases exceeded 3,000.
What parts of Spain have been most affected?
Madrid has the highest cumulative incidence among the over-60 population: 1,450 cases per 100,000. Six other regions are above 1,000 cases per 100,000: the Balearic Islands, the Canary Islands, Castilla-La Mancha, Extremadura, Galicia, and La Rioja. Andalusia has the fewest cases by far–271. All the other regions are above 500.
What are the omicron BA.4 and BA.5 subvariants?
Practically all the cases in the current wave are caused by an omicron subvariant. But the original omicron variant, which arrived in Spain at the end of 2021, is no longer spreading. It has evolved into subvariants and the BA.4 and BA.5 subvariants are now making the rounds. According to the latest report from the Ministry of Health, these subvariants continue to spread and already represent between 19.2% and 76.3% of all infections, depending on the region. But this report is almost immediately outdated due to the rapidly evolving nature of the pandemic, so it is likely that these subvariants are even more widespread.
Are they more contagious?
These subvariants appear to be even more contagious than the original omicron variant, itself much more transmissible than the delta variant, which was more contagious than the preceding variants. The coronavirus is able to mutate into variants that can evade antibodies from vaccines and those the body produces naturally, which is why people can be reinfected.
Are these subvariants more severe, and are hospitalizations rising sharply?
These subvariants do not seem to be causing more serious illness than the previous ones. Although more precise research is needed, the vaccine continues to exhibit a high level of protection against serious illness and death. However, the number of hospitalizations is increasing, along with the overall number of infections. As of June 28, 9,500 people remain hospitalized with Covid in Spain (almost 1,200 more than four days prior), occupying 7.8% of the hospital bed capacity. There were 433 Covid patients in intensive care units (a 4.9% occupancy rate), 73 more than more than four days prior. This is the first time since Easter that the number of Covid patients in intensive care has risen above 400. Although the case load is still manageable, if the current upward trend continues, healthcare worker illness and partial hospital closures due to summer vacations could pose problems for hospitals over the next few months.
What are the symptoms?
More studies are needed for a detailed identification of all the symptoms of these subvariants. Doctors are reporting that a large majority of people have mild symptoms typical of Covid: headache, sore throat, fatigue, fever, runny nose, cough, etc.
Will this wave continue to grow?
It is very difficult to predict how Covid waves will behave. Spain’s neighbor provides the closest point of comparison. Portugal has a high vaccination rate, and the current subvariant wave has already in decline for more than a week. The wave peaked in Portugal at 3,600 positive diagnoses per 100,000 inhabitants, the highest ever recorded in the country. However, previous waves placed much more pressure on hospitals than the current one. The latest data indicate a downward trend: there are 1,743 hospitalized Covid patients, of which 85 are in the ICU. This is well below the number experienced during the first great wave in Portugal, when hospitalizations exceeded 3,000 patients, 500 of which were in intensive care. Portugal’s experience is merely a point of reference and does not portend a similar experience in Spain.
Is the increase in infections due to the elimination of the mask requirement?
No direct temporal relationship has been established between the end of the mandatory use of masks and the increase in cases. Transmission has been at very high levels since before the indoor mask requirement was dropped, and has not fallen below 400 cases per 100,000 people since last autumn. The mask requirement isn’t the only restriction that has been lifted–hardly any restrictions remain in place, not even mandatory isolation for Covid-infected patients. However, masks have proven effective in reducing the likelihood of infection, and some places like Catalonia have asked the elderly to voluntarily wear masks indoors.
Will another vaccine dose be needed?
The Ministry of Health does not plan to give another vaccine dose to people who already got a booster (53.5% of the population) until after the end of the summer, although it encourages adults over 18 to get a booster if they haven’t already done so. It is very likely that more effective vaccines targeting the new variants will be approved by autumn, and that people over 80 and those living in nursing homes will begin to receive them (what would be a fourth dose). Spain’s Public Health Commission, the government agency responsible for vaccine administration, has not made any statements about the rest of the population yet.