The idea is not new but the circumstances are. Israel has taken up the possibility of allowing a massive contagion of the population as a way to accelerate its immunity since omicron seems uncontrollable. “The storm will happen, we cannot avoid it,” said the Israeli prime minister, Naftali Benet. The country, one of the fastest in vaccination (they are now studying a second booster, that is, a fourth dose), is experiencing the largest increase in infections in recent months.
Many have seen the possibility launched by Benet as an endorsement of the vision that the countries most skeptical of the pandemic adopted at the beginning of it. The United Kingdom, the United States, Brazil and Sweden flirted with this idea, assuming that Covid was similar to a flu.. It was soon revealed that SARS-CoV-2 was more transmissible and virulent, and that this strategy was a mistake: infections multiplied, healthcare systems were pushed to the limit, and many people died.
During the subsequent year and a half, the strategy to be followed has been to achieve a balance between minimizing the impact on health and the continuity of economic and social activity. Vaccinations, lockdowns, curfews, and Covid passports all serve that purpose. Only a few countries have put forward a ‘zero Covid’ vision, with strict measures to nip the spread of the virus in the bud, such as South Korea, Japan or Australia.
The appearance of omicron at the end of November has been a shock that poses, according to some, a paradigm shift. First, because it is more transmissible: if each infected person could infect up to 3 people with the original strain and 7 with delta, that number could reach 10 with the new variant, indicates the journalist specializing in health. Talha Khan Burki in an article in The Lancet Respiratory Medicine. The records of infections that we are living attest to this.
Second, because everything indicates that the disease it generates is milder. It multiplies rapidly in the upper airways (nose, mouth, throat) but not in the lower airways (lungs), reducing the risk of pneumonia. Hospitalizations are not growing at the same level as in previous waves And most of the symptoms that doctors are looking at are those of a common cold.
The immunity achieved by the population through vaccines and the disease itself after almost two years present in our lives would also be contributing to this lightness. In fact, it is Israel’s high level of vaccination that raises the possibility of a leap forward in managing the pandemic: it has a net underneath if the stunt goes wrong.
Spain, with 79.8% of the population vaccinated with the complete regimen, is one of the most advanced countries in immunization. The impact of omicron is being more than remarkable, with new records of infections every day in the last week, which at the moment has not translated, fortunately, into a proportional increase in hospitalizations.
What has grown is the pressure on primary care, with very long lines of people at the doors of health centers waiting for a test to certify the disease to proceed to discharge or isolation. The doctors themselves are pointing out the absurdity of the situation: paralyze the first level of care due to simple colds.
Should we change the paradigm?
That is why some argue that it is time for a next step in the management of the pandemic, since the balance between risk (serious illness or death) and benefit (the economy) has changed. However, the specialists consulted by EL ESPAÑOL are very skeptical of the Israeli approach and believe that the time has not yet come to test a strategy radically opposite to the current one.
“It is extremely risky,” says the epidemiologist Joan Caylá. “This infection is not just a cold. If it infects many people, as is happening now in Spain, the vast majority will go well but there will be a percentage with pneumonia, which will get complicated, some will go to ICU and end in death“.
There is the question. Revenues are being lower than would be expected before the arrival of omicron, but that does not mean that we are out of danger. In fact, hospital occupancy and ICU occupancy are at medium and high risk, respectively, according to the latest Covid traffic light prepared by the Government and the autonomous communities.
2.2% of those infected have entered the sixth wave, a figure lower than the 3.8% that did so during the fifth and undoubtedly much lower than the 7.3% of those infected who ended up in hospital between the second and fourth waves of the virus. But this implies that people continue to enter hospitals and that the record of infections that we have experienced in recent days will increase the pressure on clinics. For example, between Christmas Eve and the weekend, 200,000 new infections were reported: that will imply 4,400 new admissions. The risk of hospital collapse remains real.
By comparison, Israel handles data for new cases and much lower hospitalizations. According to the Oxford University portal Our World in Data, the Spanish incidence is six times higher than the Israeli one: 1,366 daily cases per million people compared to 200. The Middle Eastern country has 13 weekly admissions per million inhabitants, for 165 in Spain, a figure that exceeds the rate of new admissions from Denmark and the United Kingdom, other countries affected by omicron.
The percentage of positives among the tests performed is another indicator to measure the pandemic: it accounts for the amount of transmission that is being detected. WHO recommends that the figure be less than 5%. Israel complies with it with 2.5%. Spain has 18.8% positivity, which implies that there are more infections than are being detected. And that implies, in turn, that there will be more hospitalizations.
The anti-Covid measures taken by Public Health have one objective: to avoid hospital collapse and not be able to attend to all those who need it. As the specialist says SalvadorPeiró, current measures should focus on “slowing down the transmission” so that there is no plug in the system. “Make the wave last longer” but not reach a critical peak.
The strategy of mass contagion is not new: when there was no measles vaccine and a child contracted it, the children of the neighbors used to be brought together to become infected and immunized, since the disease is not serious at those ages. With SARS-CoV-2 it was seen that it was not viable, since “the likelihood of complications from measles is much lower“, Remembers Joan Caylá.
The epidemiologist admits that this virus “is very complicated, this type of pandemic is something we have never seen before.” That is why he believes that, both in Spain and in the rest of the countries, “there is still a lot” to suggest that the massive contagion is more beneficial than harmful.