Spain is taking risks to start treating COVID-19 like any other disease

As of this Monday, Spain has begun to apply one of the most far-reaching changes since the start of the pandemic: from now on there will be no more isolation or tests for mild and asymptomatic corovirus patients. Staying home without seeing anyone will only be a recommendation and diagnosis in these cases will only be possible through a pharmacy test. This decision brings us closer to assuming COVID-19, two years after the onset of the crisis, as another disease and pushes Spanish society towards an almost complete coexistence with the virus.

The story is not new. This is probably the biggest and most dizzying move, but it explores the trajectory that started with the sixth wave. The spread of Omicron infections has forced decisions that already meant less control over transmission under system collapse conditions and, de facto, put an end to the previous model based on restricting the circulation of the virus by restricting social interaction. Now the Ministry of Health and the societies themselves believe that Spain has left behind the “acute phase” of the pandemic, though it has not ignored the risks.

This has been the case since the beginning of the crisis. Decisions were made considering a number of pros and cons, depending on the different phases and scenarios in which the impossibility of a virus elimination strategy is known as Zero COVID. In the new protocol it is no different. Once the isolation is complete, health authorities receive a “certain level of coronavirus transmission” in the population and believe, as they left in writing, that “this is a risk management decision based on an assessment of their residual level.” Acceptable to the public. Resources will be focused on preventing serious illness and death, “trying to maintain a controlled level of transmission that does not cause overload” in the health care system. This is a plan on paper.

The jump is unevenly valued among specialists. There are not blacks and whites, but a lot of gray and criteria tension that has been felt in Spain for months. Some consultations argue that this is a “logical” step since vaccines are already widely available and reduce the worst effects of the virus; The other half of the experts believe that it is now “urgent” to change the surveillance and control of cases, with an incidence rate that is still high – the last one we are going to hear about under the current system is 461 cases. Per 100,000 inhabitants – and just as contagious as ómicron.

Is this a moment?

Lifting the isolation should have been “more meditative” because “it can spread infections a lot,” said Lorenzo Armenteros, a spokesman for the Spanish General Practitioners’ Association. Joan Caila, former head of the epidemiology department at the Public Health Agency of Barcelona and a member of the Spanish Society of Epidemiology, shares that it is “premature” and will support achieving the same low incidence of the virus as recently observed. Fifth wave, about 50 cases per 100,000 inhabitants taking these types of measures.

I consider it risky that part of the population thinks that there is no danger now

Joan Kayla
– Former Head of the Epidemiological Service of the Public Health Agency of Barcelona

“Low-frequency would be ideal, but I doubt that what happened at the end of the summer could be repeated in the context of restoring some social life and without measures other than the inner mask,” said preventive Mario Fontaine. Who, in spite of this view, considers it a natural step. “Surveillance makes sense if you are going to make a decision based on how the parameters are changing and we have already spent months in which incident variations do not change the scenario,” he argues. In other words, stricter measures will not be taken as the transfer increases as the focus is only on how congested the healthcare system is.

On the other hand, some epidemiologists fear that the end of isolation will send a message that the pandemic is over. “I find it risky that part of the population suggests that there is no danger now,” she said. The new strategy in this regard is clear: the pandemic is not over, it has just gone through an “acute phase”. However, there is no information campaign for the population at this time and no public explanations have been made regarding this change of management. Health Minister Carolina Darias met with health advisers last Wednesday but did not give the press conference that would normally follow that meeting. “The decision can lead to insecurity and should be considered with good communication,” Fontaine said.

A new stage of individual responsibility

From Monday, a large part of the population will be released from isolation if they have mild symptoms of COVID, but this does not mean that a normal life is optimal for them. The new strategy, in fact, recommends these people reduce interactions, wear a mask constantly, and avoid seeing vulnerable people or attending big events. In addition, if possible, the patient is advised to stay home while working remotely. According to experts, this is a new stage when it comes to individual responsibility.

“Whether the increase in transmission will depend on the prevention measures taken,” at the individual level, but also in a specific environment such as work, explains Jose Maria Molero, a member of the Spanish Society of Family and Public Medicine. Restore the functioning of the healthcare system. In fact, the latter, that health is liberated, is one of the goals that justifies the new strategy.

Fernando Rodriguez Artalejo, Professor of Preventive Medicine and Public Health at the Autonomous University of Madrid, is one of those who considers the new measures “very reasonable”. On the one hand, because “they are adapting surveillance and control systems to what the last wave has established.” “Because almost everyone has some degree of immunity and it seems that omicron is lighter, the vast majority of cases are mild, so it makes no sense to test all people who have a compatible clinical picture,” they explain. On the other hand, because it is not very clear among public health and healthcare professionals how much isolation was completed “in a social climate, we assume that the disease will pass mildly.”

Uncertain scenario

In any case, Artalejo warns that “common sense” will henceforth be important for both COVID and other communicable respiratory diseases. “Wear a mask and do not approach socially vulnerable people. This is the case with the flu, in fact, it should have happened years ago, “- said the expert. Fontan believes that the key is to restore the message that he claims “penetrated during the pandemic”, which is related to the fact that when a person is sick, “they must take care of themselves and protect the environment as much as possible.” That is, limit social relationships and try not to go to work.

People who may think they are positive will take the test and if they can stay home from work remotely, they will, but the rest will not. And in an environment where this is not done, there will be more risk

Anna Lupia
– Epidemiologist at the Institute of Global Health in Barcelona

Something that, however, is not possible for everyone. “There are areas where individual responsibility has less opportunity for agency. “It would be necessary to make it easier for people to make these decisions without losing their jobs,” Fontaine said.

Anna Lupia draws attention to this idea and warns that the decision to end isolation carries the risk that it “deepens the existing inequality”. “People who may think they’re positive will be tested and if they can stay home while working remotely, they will, but the rest will not.” “And in an environment where this is not done, there will be more risk.” The researcher does not share the moment chosen to take this step. “This is a step forward in faith because we do not know how the virus will behave and it will force the vulnerable to live in a slightly more risky space,” he said.

This is another hot spot: the uncertainty that the future holds. The strategy itself considers the possibility of a reversal if trends change. “Today it is reasonable, but another story is that the virus is mutating, people are losing immunity, we still have problems. The experience of such pandemics is so small that everything that can be done is speculation, ”Artalejo admits. To move from a disease that has become so important to becoming another means to travel to a new unknown terrain. “We see at what point and we do not know well how to do it on a technical level, but also socially,” – said Fontaine.