Almost two years after the start of the pandemic, Europe is facing the most explosive wave to date. The omicron variant, which predominates throughout the continent, has triggered the number of infections to an unprecedented level in a matter of days. More contagious than the previous ones, it is also milder. It causes less lethality and fewer hospitalizations in a population that is largely immunized, either by the vaccines or by having been previously infected. Is it time to start thinking about the new normal? The debate has already settled in Europe, where countries like Spain propose a change in strategy and monitor covid as if it were a common flu.
The reduction in quarantine and isolation that many have approved these days points in that direction: society cannot live permanently in a state of emergency or put economic activity and public services at risk, they argue. Members of the Boris Johnson government are clearly committed to starting to treat covid in the United Kingdom as an endemic disease. Spain proposes to stop testing and accounting for each case and pass a surveillance similar to that of the flu, in which a network of sentinel doctors serve as witnesses to know how the virus progresses.
Most experts and countries such as France and Germany consider that it is still early to speak of an endemic disease (a disease with a high prevalence and constant over time), but there are more and more voices asking to prepare for when it arrives.
The European public health agency (ECDC) endorses the Spanish strategy to start monitoring covid as it is done with other diseases.
"The ECDC encourages countries to make the transition from an emergency surveillance system to others that are more sustainable and goal-oriented," a spokesperson for the organization told EL PAÍS.
"We hope that more Member States [besides Spain] will want to switch to a long-term sustainable surveillance approach," he added.
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Spain wants to "lead" internationally the change in covid surveillance strategy
In reality, it is not only the greater lightness of the omicron that is pushing a change in strategy. Its explosive contagiousness has put the system to the limit. "The Spanish proposal makes sense because the rapid increase in incidence makes contact tracing impossible and has overwhelmed diagnostic capabilities," says Eva Grill, an epidemiologist at the Ludwig Maximilian University in Munich. German laboratories have warned this week that they are reaching their limit. Lothar Wieler, the president of the Robert Koch Institute for Infectious Diseases, announced Friday that a decision will have to be made on who gets a PCR. Critical infrastructure employees will have priority so as not to put their operation at risk.
The European Commission is reluctant to change the approach openly proposed by the United Kingdom and Spain suggests: "The European Medicines Agency and the WHO have indicated that although omicron can promote greater natural immunity that would be added to that of vaccines and could be a first step towards a scenario close to endemic, we are not yet at that stage and the virus still behaves as a dangerous pandemic virus, "said a spokesperson for Commissioner Stella Kyariakides. "We are still in the midst of a pandemic," he stressed. Marco Cavalieri, responsible for the vaccine strategy of the European Medicines Agency, responded to Pedro Sánchez's proposal, calling it hasty. “Ómicron is highly contagious and causes high numbers of infected people. It is important to be aware of your potential load and
do not underestimate it as a mild disease, ”he insisted at a press conference.
The WHO is also in no hurry to change the model.
In its latest report, the organization calculates that more than 50% of the European population – some 250 million people – will have been infected with covid in the next six to eight weeks.
"We have to be very cautious with predictions about the future," said its director for Europe, Hans Kluge, who considers the Spanish proposal premature.
Kluge recalled that the coronavirus is still capable of mutating again and becoming a new threat.
"You have to be very cautious with predictions about the future," he said.
But even cautious Germany is beginning to see a way out of the pandemic.
Its star virologist, Christian Drosten, affirmed this Friday that at some point it will be necessary to let the covid itself “update” the population's immunity.
Although he pointed out that while in other countries, with a higher vaccination rate and more infections, this may be feasible soon, perhaps it is too soon for Germany to run that risk.
The country still has three million people over 60 years of age who have not been vaccinated and almost nine have not yet received the booster dose that best protects against omicron.
"For us the biggest obstacle is the low vaccination rate," he acknowledged.
Vaccination against covid in Berlin (Germany) on January 8. HANNIBAL HANSCHKE (AFP)
Germany has reduced the quarantine from 14 to 10 days while registering contagion figures never seen since the pandemic began. In France, infections are also on the rise, with around 300,000 daily cases this week, six times more than a month ago. With the president, Emmanuel Macron, in the middle of the electoral campaign for the April elections, the debate about a return to normality has hardly caught on. Nor in Italy, where infections are also skyrocketing and the mandatory vaccination for people over 50 has just been announced as of February 15, something that Austria will also do as of February 1. Hospitalizations in Italy have been rising since the beginning of the year and there is consensus that the situation is still too delicate to consider the next phase. What's more,The Italian anti-vaccine movement has organized to resist forced immunization.
Nor is Spain in favor of changing its strategy now, but of acting when the sixth wave ends and then ceasing to manage the pandemic with the indicators that have been used until now. "Without a doubt, it is time to open the debate," says Grill, to be prepared when the situation improves. Today, the epidemiologist sees three possible options. The first is strict control and mitigation, as China does. "For Europe this is neither feasible nor acceptable now," he says. Another possibility would be to “just go with the flow”, that is, abolish mitigation measures, reduce quarantines and stop doing contact tracing. “It would be potentially feasible in countries with high vaccination or immunization rates, but a high price would have to be paid, at least for the unvaccinated,and there is the risk of overloading healthcare,” he explains.
Germany has opted for a “middle way” with a covid pass in restaurants, leisure and shops, antigen tests and the obligation to wear FFP2 masks in transport. At the moment the country does not seem willing to reduce restrictions, but could tighten them if hospitalization rates rise again, which are now going down. These measures, Grill believes, could work if they are complemented by a rapid alert system that takes into account the incidence and also admissions to the ICU. Of course, in the event that countries decide to monitor covid in a less exhaustive way, the ECDC warns that in some countries the current systems to measure the flu would not be sensitive enough for the coronavirus. The new method should cover a more representative part of the population and have more testing and sequencing capacity.
