The perfect storm of the sixth wave: the explosion of the omicron arrives at Christmas, with few restrictions and immunity falling

Covid infections surround the street. To a greater or lesser extent, but there is no school, office, group of friends or family that gets rid of a case nearby. “Everyone knows someone who has caught COVID in the last few days. Or that it is close contact of a positive ”, sums up physicist and computational biology expert Clara Prats. The sixth wave of coronavirus beats strongly in Spain and breaks all infection statistics, although hospitals still resist: this Thursday the highest number of infections in a day (almost 73,000 cases) and the incidence were reported, with 911 per 100,000 inhabitants , closed the year at all-time highs, even above the levels registered in the third wave. What is special about this new claw of the virus? Above all, that this wave grows like a kind of perfect storm:there are few restrictions, vaccine immunity against infection is decreasing and a new variant has entered the game board, the omicron, more contagious and with a certain escape from the vaccine. In just a few weeks, the world has turned upside down again, with soaring infections, border closures and severe restrictions in parts of Europe. In Spain, health centers are on the verge of collapse, there is a shortage of self-diagnostic tests in pharmacies and hospitals, still far from saturation, hold their breath as they see the pressure on healthcare grow. The next few days will be crucial to gauge the severity of the wave, experts warn.In just a few weeks, the world has turned upside down again, with soaring infections, border closures and severe restrictions in parts of Europe. In Spain, health centers are on the verge of collapse, there is a shortage of self-diagnostic tests in pharmacies and hospitals, still far from saturation, hold their breath as they see the pressure on healthcare grow. The next few days will be crucial to gauge the severity of the wave, experts warn.In just a few weeks, the world has turned upside down again, with soaring infections, border closures and severe restrictions in parts of Europe. In Spain, health centers are on the verge of collapse, there is a shortage of self-diagnostic tests in pharmacies and hospitals, still far from saturation, hold their breath as they see the pressure on healthcare grow. The next few days will be crucial to gauge the severity of the wave, experts warn.The next few days will be crucial to gauge the severity of the wave, experts warn.The next few days will be crucial to gauge the severity of the wave, experts warn.

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The reason why omicron seems so much lighter

The sixth wave is, in reality, “two waves in one”, synthesizes Prats. “There is a beginning with the delta variant that is complicated with omicron. In autumn, the curve grows little by little, like in slow motion and with room for reaction. But suddenly, omicron arrives and changes everything from one day to the next. First it reached Madrid, then Catalonia and it spread. When you reach 40% omicron, the contagions skyrocket ”. According to the latest report from the Ministry of Health on sequencing variants, with very preliminary data from the week of December 6 to 12, 47% of the samples analyzed were already from the omicron. The new variant is displacing the one that was dominant until now, the delta. In fact, some communities already report higher figures, such as Madrid, where 80% of cases already belong to this lineage.

On the ground, health centers are saturated, with queues of patients at the doors that turn to the street and professionals on the brink of collapse. Patients, with or without symptoms, desperately seek a diagnostic test in outpatient clinics or pharmacies to find out if they have been infected; or they wait impatiently for the call that does not come from overwhelmed trackers; or they wait confined in their house to see what happens. A feeling of “general lack of control”, in the words of epidemiologist Mario Fontán, floods the street: “It is a lack of control because people need to have their clinical symptoms confirmed and they give them sick leave. A sensation of greater chaos has been generated than the severity of the clinic requires, ”Fontán explained a few days ago. But this snowball that is getting bigger now comes from behind,weeks ago.

One of the first elements that has spurred the rise of the virus is, in fact, the relaxation of control measures. When the epidemic curve began to rise, at the beginning of November, in Spain there were hardly more restrictions than the mandatory mask indoors. Now, a month and a half later and with the incidence 18 times higher than then, the covid passport has been incorporated as a safe-conduct to enter certain spaces in some communities and the Government has recovered the mandatory face mask outdoors, a measure highly questioned by the experts due to its low effectiveness. Only seven communities are committed to more severe restrictions, such as timetables and capacity or, in the case of Catalonia, the toughest, also a curfew and limitation of meetings.

In addition to the scarcity of measures, other variables have also converged that have ended up configuring that perfect storm that is now raging: vaccine protection, especially against infection, declines over time. Although it is greater and more stable in the face of serious events, a study by the Ministry of Health concludes, for example, that the effectiveness against infection and against symptomatic infection in the group aged 50 to 59 years progressively decreases over time: it is greater than 90% in those vaccinated in September and drops to 69% in those vaccinated in April; in the 40-49 age group, the effectiveness against infection is 80% in those vaccinated in September and falls to 35% in those vaccinated in June. Tomàs Pumarola, Head of Microbiology at the Vall d'Hebron Hospital in Barcelona,specifies that vaccines "continue to work very well in the face of gravity, but protection against infection decreases after six months."

That is why the Government has accelerated vaccination with the third doses, prioritizing vulnerable groups, such as the immunosuppressed or the oldest groups (86% of those over 70 already have it). In total, 45% of adults over 40 have already received this booster shot and the president, Pedro Sánchez, has announced that all those vaccinated with Pfizer or Moderna will receive the third dose six months after completing the vaccination schedule. The Government wants 80% of those over 60 to be vaccinated before the end of the year and at the beginning of March, all 40-year-olds.

This decline in vaccination protection, added to the current moment of maximum social interaction and mobility through the Constitution Bridge and the Christmas holidays, have ended up fanning the flames of a fire that lit the delta and expanded the omicron. Daniel Prieto-Alhambra, Professor of Pharmacoepidemiology at the University of Oxford, points out several peculiarities of this wave: “If you think about the sixth wave with the delta, the key to evolution depended on vaccination [in Spain the coverage was greater than in other European countries] and restrictions in different countries: here, in the United Kingdom, for example, a mask was not used in the summer or in closed spaces, while in Spain it was [and autumn was harder in the United Kingdom with incidents 20 times higher than those of Spain]. But nevertheless,If we focus on the sixth wave with the omicron, the key is that it has a greater capacity to infect vaccinated people than the delta, but since most infections are between vaccinated, the percentage of income is much lower than in previous waves ”.

The omicron has homogenized, for the worse, the situation in Europe.

Incidents up or down, countries are submerged in an explosion of infections, points out José Martínez Olmos, professor at the Andalusian School of Public Health: “Before the omicron, what differentiated us from other countries was the best vaccination and longest trajectory of Being outdoors, due to the weather, but now, with this variant, contagions are equalized.

We have no borders ”.

The only good part is that the first studies, still preliminary, in South Africa, Scotland and England suggest that the wave is less severe and, in fact, in the African country, where the variant was discovered, the curve seems to have peaked after four weeks of ascent and begins to bend, according to the repository Our World in Data, a website linked to the University of Oxford.

The omicron explosion

The new variant, spearhead of the expansion of this wave, is more transmissible than any other lineage seen before, experts insist. Cases double every two to three days, according to the World Health Organization. In fact, it was detected just a month ago in South Africa and has already spread to more than 100 countries. It has a greater capacity than the delta to infect vaccinated people and reinfect those who have had the disease. In Europe, which had already been dragging a blazing rise in infections in several countries for weeks, the omicron has set off all alarms and States such as the Netherlands or Belgium - with incidences of more than 1,000 cases per 100,000 in 14 days - have already announced severe confinements or restrictions.

The explosion of cases exceeds the sight in the fifth wave, explains Prieto-Alhambra: “In summer it was a wave of young people who remained unvaccinated. But now, as the omicron has a greater capacity to infect those vaccinated, the susceptible population is the entire population, except those who have the third dose on. The

of people to infect is much higher and the number of cases to be expected, too ”. This week, Spain has broken a record of infections reported in the pandemic for three consecutive days.

The impact of this wave can be "brutal", experts explain. Even though the severity with the omicron is less - the first studies are very preliminary and it is too early to confirm it, the specialists clarify - the flood of infections will imply - in absolute numbers, although not in percentage terms - more hospital admissions and will strain the health system. “A small percentage of a very large number, you still get a very large number at the population impact level. Without doing anything, the omicron being half as severe as the delta, it puts us in a catastrophic scenario. It would double the peak of previous waves ”, warns Prieto-Alhambra. In Spain, at the beginning of February 2021, in the middle of the third wave, there were more than 30,000 hospitalized patients with covid. In intensive care, 4 were exceeded.800 patients due to the coronavirus.

Now there are far fewer - 7,924 patients admitted, 1,515 in critical condition - and hospitals are not yet stressed at the level of other waves.

But expectations are bleak, predicts Toni Trilla, head of Epidemiology at Hospital Clínic: "There will be stress in the health system sustained over time and an overflowing and difficult to manage work in primary care."

Job disruption

However, even if the severity is effectively less in this wave and hospitals avoid collapse, the explosion of infections will cause a significant labor disruption in many sectors. Starting with the health centers. According to the latest Health report, on Thursday, in the last seven days 2,598 toilets infected with coronavirus were diagnosed, almost double than two weeks ago. Magda Campins, head of Epidemiology at Vall d'Hebron in Barcelona, ​​admits that they are “scared by the casualties”: “We have been with 30 daily casualties due to infections for almost a week. Not even in the fifth wave we had had so many. And if we now have this level of professional leave and the income is as expected, I don't know how we are going to manage this ”.

Although the Public Health Commission agreed this week that vaccinated close contacts do not have to quarantine, the economic impact of so many positives on the street will be high, experts say. For Pumarola, "the great work disruption is more associated with the confinement of the parents by the confined child than by the infected toilets". Children under 12 years of age have been the group with the highest incidence until a few weeks ago - on Thursday it was more than 1,000 cases per 100,000, but the groups between 20 and 50 years old already exceeded them - and, in fact, schools have finished the first quarter with a record of outbreaks since February: in the third week of December, 547 outbreaks have been reported with 2,791 cases in educational centers, according to Health.The Government also wants to speed up the vaccination of this group - 21% have already received the first dose - and has promised that 70% of children of this age will have the first puncture in the arm in the week of February 7 .

Trilla also warns: "This variant has the capacity to infect and cause hyperdisseminating events, which can cause more casualties in an entire group of workers."

Prieto-Alhambra denounces "the nonsense" of dissociating between economy and health and criticizes, in fact, the measure of not ordering the quarantines of close contacts "when it is known that the vaccine does not protect against infection": "There is no economy without Health.

To have 50,000 cases a day is to have 50,000 casualties a day and that is a brutal economic disruption ”.

Bad communication

The experts also denounce the scarce institutional communication that has accompanied this wave. Some shortcomings, they point out, that have fueled public discontent. Elena Vanessa Martínez, president of the Spanish Epidemiology Society, regrets the “disconnect between the technicians and the political level”: “We have not learned anything. Primary care and public health infrastructure should be strengthened because they were essential as the first shield against the virus and it has not been done. Among the population it has become apparent that no restrictions are needed, that with a test it is already done. And what people do is go to look for tests because they see it as their salvation, because there are no other measures ”. Campins agrees: “The communication of politicians and Public Health is very bad. Until recently it was said that there would be no restrictions and when you give that message,people trust themselves ”.

There are still unknowns to be resolved about how this new wave will evolve and, above all, its severity. The next few days will be key, experts point out, and the restrictions that are taken to contain the infections, too. Only with the vaccination, they warn, it will be impossible, although they admit that the third doses must be accelerated. Since the summer, assumes Prieto-Alhambra, "Spain fell into complacency and in third doses they are slower than the United Kingdom, which already has more than 54% of the population over 12 with booster doses." Accelerating these punctures is another of the strategic lines announced this week by President Sánchez to stop the sixth wave.

However, the race against the virus is far from over and the struggle now is to go ahead, says Pumarola: “This virus is capable of changing a lot, gradually or in leaps and bounds.

We ourselves, with the measures we put in place, are constantly forcing the virus to change.

The H3N2 flu virus made its pandemic in 1965 and even now puts us on edge when it comes.

Well, this is what is going to happen with the covid ”.