Spain will not have to wait for group immunity to leave the pandemic behind. With four out of every five citizens immunized and a percentage that exceeds 95% among the vulnerable population, the country is entering a new stage in which living with the virus will become part of daily life. The new, more contagious variants and the persistence of unvaccinated population groups —5.2 million children under 12 years of age, without approved serum, but also 4.6 million older than that age who have not yet received any doses— they lead experts to consider its eradication almost impossible. There will continue to be outbreaks and infections will reach vaccinated people, but the circulation of the pathogen will slow down and severe cases will fall until COVID is just another infectious disease, as the flu is now.
Amós García, president of the Spanish Association of Vaccination (AEV), summarizes: “This virus has come to stay and we will get used to living with it.
But it is necessary to hinder its circulation and avoid the dramatic burden of hospitalizations and deaths.
We have the tool to make it a mild pathology, which is vaccines ”.
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Denmark: the country that already lives without restrictions
Spain reaches 70% of its vaccinated population
While countries like China or New Zealand have opted for a zero tolerance policy against the virus, which leads them to confine entire cities every time a small cluster of cases appears, Europe has applied a gradual approach in which restrictions are tightened and relax to the rhythm of the successive waves. The one that the continent has experienced this summer, the experts and public officials consulted agree, must be the last important one, except for extraordinary unforeseen events, although it is possible that there will be some slight rebound. A hopeful figure for Spain is the accelerated fall in hospitalizations and admissions to the ICU, currently 837, data not seen since June, although then vaccination coverage did not reach half the population.
In this scenario, the question is to know at what rate it is necessary to gradually remove the restrictions that have marked the lives of citizens during the last 18 months.
Countries like Denmark have already left them behind, but in Spain there are still doubts about the next steps to take.
"We have to get three things first," explains Africa González, professor of immunology at the Center for Biomedical Research (CINBIO).
“The incidence should drop from 25 cases per 100,000 inhabitants [in the last 14 days;
this Friday it was 69.37].
We must sequence the variants in circulation to anticipate if one arises that could put us in check.
And we have to protect the immunosuppressed, "he details.
Ildefonso Hernández, spokesperson for the Spanish Society of Public Health and Health Administration (SESPAS), agrees that surveillance will be key in the coming months: “You have to sequence, but you also have to do a good search for cases and control outbreaks, something that should be possible due to the least incidence ”.
With some nuances, experts agree that it is already at the beginning of the end of the pandemic.
We must be cautious and flexible when withdrawing protection measures and continue advancing in vaccination - one in five people between 20 and 39 years of age has not yet received a dose - but the high immunity achieved should prevent the virus from recovering the land that the end of the restrictions will leave free.
A report by the Public Health England (PHE) agency revealed two weeks ago that 95% of the English population over 17 years old have antibodies against the virus. The work, based on the monitoring of blood donors, details that almost 20% have developed them after having passed the infection, while the rest have done so thanks to vaccines. These percentages assume that immunity is close to 85% among the general population, with a trend that remains slightly upward.
Similar studies have not been carried out in Spain, but the available data point in the same direction. Those offered by the Generalitat of Catalonia, for example, indicate that the immunized population already exceeds 75%, between vaccinated and infected (almost 5% of the population in the last six months). The difference with England is explained because the system used by PHE allows detecting antibodies in people who have passed the infection asymptomatically and Catalonia only counts those who have contracted the virus in the last semester. In addition, this community is almost four percentage points below the Spanish average in vaccination coverage.
This optimistic look towards the future does not, however, hide several elements of uncertainty. "For now we do not have sterilizing vaccines that prevent all infections. They protect to a great extent against serious cases and death, but with them the virus will continue to be out there ”, recalls Ildefonso Hernández.
It is also not known how long the protection conferred by vaccines lasts and if a booster dose may be necessary in the future.
The European Medicines Agency (EMA) and the FDA, its US equivalent, defend, according to the available evidence, that all vaccines so far maintain their efficacy and that only those immunosuppressed and older require a third dose.
In this case, the objective is not to stop a fall in defenses, but to help these groups develop the same immunity that the rest of the population achieves with two punctures.
Immunize children
Vaccination of children under 12 years of age continues to be another issue to be resolved.
Pfizer-BioNTech has announced that its research reveals that its vaccine is safe for children from 5 to 11 years old and has initiated the procedures to obtain its approval by regulatory agencies, although experts remember that the results have not yet been published.
"We are waiting for them to analyze them with a magnifying glass and confirm that there is no alarm signal," says Quique Bassat, ICREA research epidemiologist at the ISGlobal institute.
“You have to see that the cases of myocarditis that have been seen in adolescents and young adults do not occur in children.
My opinion is that although it can be approved for these ages, it is probable that a massive vaccination is not necessary ”, he adds.
José Miguel Cisneros, head of infectious diseases at the Virgen del Rocío Hospital (Seville) highlights: “It will be a difficult decision that requires a very important ethical evaluation.
Children would not be vaccinated because they develop severe cases, but to help protect adults.
And that requires being very clear that vaccines are totally safe for them ”.
On the other hand, despite the high coverage achieved in developed countries, in Africa these do not even reach 7% of its 1.2 billion inhabitants, according to the Oxford University repository Our World in Data.
Experts agree that in the face of this brutal contrast, for social justice and to avoid new variants, "the smartest thing to do would be to make a global effort to send vaccines to these countries and help them immunize their populations."
The time of the de-escalation
While keeping all these elements in mind, the almost unanimous opinion among experts and administrations is that the time has come to face the definitive de-escalation.
How to do it was one of the issues that occupied a large part of the meeting of the general directors of Public Health of the communities and the Ministry of Health this Thursday in Mahón, within the framework of the School of Public Health of Menorca.
“The withdrawal of many measures has already begun, such as meeting limits, hours and capacity.
It would be desirable to do it in a simple and orderly way to avoid the disparity of decisions that we have seen in the last year.
There is fatigue in the population and it would be best if only the essential restrictions remained and with a clear horizon for their elimination ”, explain sources attending the meeting.
France has already announced that as of October 4, masks will no longer be necessary in primary schools, one of the most anticipated decisions among Spanish families and schools.
“What remains for us now is to confirm that the return to schools and work does not substantially change current trends.
If they don't for the next three to four weeks, then we may be able to move past these last protective measures.
But it would be hasty to do it without confirming beforehand that the situation is not reversed, ”says Quique Bassat.
“We are already near the end.
But be careful, let's go game by game.
We need to continue increasing vaccination coverage and verify that each measure we withdraw does not alter the decline in the indicators.
Only then will we safely reach the goal soon ”, concludes Amós García.