What measures should we take in the face of the increased incidence of Covid-19?

We begin the week of Christmas 2021 with an increasing cumulative incidence and above 500 cases per 100,000 inhabitants in 14 days, according to the report of the Alerts and Emergencies Coordination Center. However, the situation is not the same as other times that we have reached these levels of incidence. What’s going on?

In the graph below it can be seen, comparing the part on the left (corresponding to December 2020) and the part on the right (with the most recent data), how right now we are in a situation of:

• A number of cases above the one we had prior to last Christmas.

• A hospital occupancy, ICU and deaths lower than the same dates last year.

In addition, we can add that we find a level of restrictions and mobility closer to what we had before the pandemic.

What does this mean? We are going to briefly try to analyze the current situation by comparing it with past situations to consider how to act now.

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Covid-19 has changed little; the situation, a lot

The virus itself has changed little since the first wave. Yes, it is true that new variants with greater transmissibility have appeared, but their main characteristics remain the same: their modes of transmission, their symptoms, the events that further promote their spread … What has changed is the situation in which the disease occurs. transmission.

And the situation has changed in several respects. On the one hand, and principally, vaccination. Vaccines are playing a very important role in containing hospitalizations and deaths. Even though it is not their main role, we know that they are also capable of reducing transmission.

On the other hand, and as a consequence of the vaccination, we have recovered many face-to-face activities that had been stopped since March 2020. This fact has had very positive social effects, but it also increases the ease with which respiratory viruses can be transmitted.

In summary, the current situation favors transmission, but the possibility that the cases end up in a serious situation is lower.

Advocacy isn’t everything, but it’s still important

In recent months we have heard a lot that cumulative incidence is no longer the best indicator to measure the evolution of the covid-19 pandemic. This is due to the point that we have commented previously: if the vaccines make the vast majority of cases mild, the measures would have to be taken according to the hospital occupation.

This perspective of giving more importance to hospital occupancy data is correct. A cumulative incidence of 500 cases per 100,000 inhabitants does not have the same meaning and consequences in December 2021 as in August 2020. However, the phrase “incidence no longer serves as an indicator” raises many problems:

Because, let’s keep it in mind, vaccines don’t change who is most vulnerable. Although vaccinated people have a lower risk of serious disease, a vaccinated person with a previous chronic disease and a young, healthy vaccinated person do not have the same chance of developing severe COVID-19.

And so what can we do in the current situation?

Each wave of the pandemic also brings a wave of more imaginative measures. Many of them, such as covid-19 passports, with doubtful or null effectiveness in our context. But as we have commented before, the virus does not change, what changes is the context. And what does that mean? It means that the measures that serve to contain the epidemic are the same that we have always had: vaccination, avoiding crowds, ventilation, masks … What changes is the context in which we apply them.

Understanding this context, what we have to do is modulate and adapt to reality what we already know works. That can happen by:

1. Reduce the transmission of the virus. Although hospitalizations and deaths are different from other waves, we have already seen that very high incidences can lead to problems. But the measures we take now have to take into account that restrictions can cause very large economic and social side effects. Any public health measure must always be proportional to the risk and assess its consequences. Therefore, right now it would be urgent to implement those measures that have the greatest impact with the fewest side effects. Between them, delay large crowds (massive concerts) and implement teleworking at least until the end of January. The labor outbreaks in recent weeks pose a problem for the control of the pandemic.

2. Continue with the vaccination program to avoid the maximum possible number of serious cases. This implies vaccinating girls and boys between the ages of 5 and 11, booster doses for people in vulnerable situations, and an active search for unvaccinated people to increase vaccination coverage.

3. Strengthen primary care and epidemiological surveillance systems. This is to reactivate the efforts of the follow-up of cases and contacts (the famous trackers dismantled in almost all places) and to facilitate the work of primary care. To achieve this, primary care centers must focus primarily on treating common pathology and offloading part of the work they do on covid-19. The best way to do this is to support the centers with more places to test for covid-19, and decentralize the bureaucratic procedures for the management of casualties. In hospitals, moreover, it would be advisable to put an end to the eventuality of covid contracts, which impede personnel planning and condemn precariousness.

Each wave poses different situations and, as we said before, the virus hardly changes: what changes is the context for applying measures. This forces us to be smarter, to adapt to each situation that generates new uncertainties. The pandemic presents us with new challenges every day that we have to face.

Pedro Gullón Tosio, Assistant Professor of Public Health, University of Alcalá

This article was originally published on The Conversation. read the original.