Spain is ready to turn the page in the management of the pandemic. The Ministry of Health has just published the new surveillance and control strategy against COVID-19, that introduces far-reaching changes in the day to day as of next Monday. With this document, agreed between Health and the autonomous communities after weeks of debate, the Government considers the "acute phase" of the pandemic to be over and faces a new stage that places Spain among the first European countries to abandon the isolation of cases Mild or asymptomatic positives. This is the most critical point of the strategy, but the more than 20 pages of document contemplate other important decisions, such as a stricter limitation of diagnostic tests and close monitoring only of serious or vulnerable cases.
What will be the impact? How risky are these decisions? The set of measures raises many questions and involves assuming some uncertainties. The document that came forward on Tuesday implies, as it states literally, "accepting a certain level of transmission of the coronavirus in vaccinated and young populations in which the infection has a lower population impact in terms of severity."
92% of the Spanish population is vaccinated, which justifies the strategy, and there is good immunity generated by the avalanche of infections, especially from the last great wave, although the virus is still dangerous for the elderly or sick. So the Government and communities, at the proposal of the technicians, have chosen to "direct efforts to reduce the impact in terms of the severity of infections, trying to maintain a controllable level of transmission that does not generate an excessive overload on the health system", assuming that it is a "risk management decision, based on evaluating what residual levels are acceptable to society".
If I find myself with mild symptoms and I am not a person at risk, what should I do?
If you are not over 60 years old, you are not immunosuppressed or you are pregnant, in principle there is not much risk of complicating the disease if you are vaccinated. The new strategy exempts this majority population group from isolating if they have symptoms that could be COVID-19, but recommends that if they are mild (that is, there is no dyspnea or very high fever for several days), "reduce social interactions , using the mask constantly and maintaining proper hand hygiene" for ten days. If you are in this situation, it is very important that you avoid contact with vulnerable people or go to events with many people.
Can I go to work, then?
The strategy recommends staying home working "whenever possible" and in the event that the illness is so mild that it does not require sick leave.
Is there no automatic cancellation?
No. COVID-19 is no longer a reason for automatic temporary disability, as it has been until now, when isolation was mandatory. The criterion for giving or not a discharge goes from being epidemiological, for public health reasons, to clinical. That is, depending on the symptoms of the patients and how much they incapacitate.
In the workplace, in any case, collective protection measures must be maintained, such as ventilation, the use of a mask (as in any interior space) and the separation between workers, all included in the protocol for occupational risk prevention services against exposure to SARS-CoV-2.
What if I feel bad?
If the coronavirus causes discomfort that requires rest due to symptoms, you should go to the doctor to request a leave. As with any other disease.
Will they do a diagnostic test at the health center?
No. PCR and antigen tests are very limited in this new phase of the pandemic. With the strategy, the Ministries of Health and the Ministry hope that "health care will be normalized, minimizing the risks." In other words, reduce the workload of Primary Care so that it can see patients whose care has been postponed in the last two years due to the saturation of the system and the precariousness in which this level of care was already before the pandemic.
So who will have access to an official test to confirm if they are positive?
The strategy cites several groups. On the one hand, the vulnerable population, understanding as such people aged 60 or over, those who are immunocompromised due to their illness or due to treatment, and pregnant women.
They will also be able to confirm if people who live or work in nursing homes, hospitals, prisons or other centers with institutionalized people are infected. Whoever cares for vulnerable people at home, for example, falls within the group should have access to a diagnostic test.
Likewise, people who present a "respiratory infection picture" in the lower airways that require admission will be tested. And also to those who have been in the last two weeks in a region where a new variant is circulating that is not present in Spain and to the migrant population recently arrived in the country.
This is the strict theory, but the strategy opens the hand so that health professionals can test people who are not in these groups "under clinical criteria". It is not indicated, however, to carry out confirmation tests in the health center on people with a positive pharmacy antigen test who do not meet any of the above conditions.
Keep in mind that since the end of December Certain restrictions on diagnostic tests already exist in Spain. PCR is only performed on vulnerable people, due to age or illness. The decision was then made due to the overflow that the large number of infections generated in health centers and it was a first step that brought Spain closer to the turning point that this new strategy represents. From now on, the use of all tests will be saved and home antigen tests will not be counted in the statistics.
If I work in a hospital or nursing home, how do I proceed?
In these cases, workers must go to their occupational health department or health center, as indicated, to carry out a diagnostic test. In the meantime, it is recommended that they stay home so as not to expose the vulnerable people they work with to infection.
Once the positive is confirmed, these people who work in vulnerable environments will not perform their function in the five days following the diagnosis or the onset of symptoms. Before returning, and as long as they have been without symptoms for a day, they will undergo an antigen test. If they are negative, they can be reincorporated; if not, they will be retested every 24 hours. In nursing homes, only "workers in direct contact" with the elderly will be tested, the rest will return to their jobs five days later without the need for testing.
"The indication of isolations, in this phase, is therefore limited to very specific settings, in which prevention and control practices are key to mitigating the effects of COVID-19 in terms of morbidity, mortality and burden of care. health", declares the strategy to explain these exceptions.
If I care for an elderly person, does the same protocol apply to me?
Yes, you must contact the health services for a diagnostic test and, if the infection is confirmed, not go to work for at least five days afterwards.
And in schools?
In the educational field, no specific actions or measures are established "other than those defined in the strategy", so that positive teachers will not be forced to isolate themselves, even if it is recommended, and neither will schoolchildren. School quarantines had already been relaxed in recent months: after the Christmas holidays, he changed the protocol to avoid sending children home if there was a positive in class and The classroom was only being closed if there was an accumulation of five or more infections.
Are isolations maintained for positives in hospitals and residences?
Yes, they are the exceptions. Positive residents will be isolated for at least five days and as long as the symptoms have ended, in addition to studying all close contacts to prevent the virus from spreading in a very vulnerable environment. It is one of the few environments where tracking will be maintained. For the rest, it disappears. In these situations, contacts are prescribed diagnostic testing within three to five days.
The two circuits are also maintained in hospitals: infections "must be isolated during their hospital stay" until they have a negative or positive PCR but with low viral loads. After discharge, isolation will not be indicated but it is recommended that they remain at home "if the clinic continues".
Are screenings maintained in hospitals?
No longer. The new strategy no longer considers it "necessary, in a general way, to carry out screening prior to admission or to certain care actions". In any case, hospital centers may consider the use of screening in specific situations and with the aim of protecting vulnerable patients at the discretion of those responsible for infection control.
If I have been in contact with a positive, what is the protocol?
On March 5, the Public Health Commission already agreed to eliminate quarantines for all close contacts, including those not vaccinated. This does not change. Only contacts in vulnerable environments will be controlled, who are recommended to do a diagnostic test between three and five days later.
In any case, all close contacts are recommended to reduce social interactions as much as possible by wearing a mask "constantly" and especially to avoid contact with vulnerable people in the following ten days.
If I want to take a plane out of Spain, will I still need a vaccination certificate or a negative test?
Yes, this does not change at the moment for the European Union.
Is the pandemic over with this new strategy?
No. The protocol assumes that Spain is still in a pandemic although it has already gone through, unless there are setbacks, the "acute phase".
Are the changes permanent or can they be reversed?
This approach will be maintained as long as the indicators for the use of care services "remain at a low level at the national level and in more than half of the autonomous communities. In addition, the trend must remain downward for at least two weeks in the territories necessary to cover at least 80% of the Spanish population".
This means that the strategy is reversible in the event that there is a "significant change in the trend that indicates an uncontrolled circulation of SARS-CoV-2 or a change in the epidemiological situation that requires reestablishing surveillance and control measures, at the proposal of the Report on Alerts and Preparedness and Response Plans".
If not all cases are confirmed, what data is the Ministry of Health going to offer to show the evolution of the pandemic?
Sources from the Ministry of Health assure that they will continue to publish data. However, with the change in strategy, the reports will also change. As of Monday, it is still mandatory to notify all confirmed positives in health centers and hospitals. The difference is that with the new limits imposed on diagnostic tests, these figures will only cover serious cases or those that occur in vulnerable people or environments.
To see the trend in mild cases, Health and the communities will use the information from the sentinel networks that already exist in a series of healthcare centers and that provide samples that can later be extrapolated. These networks have incorporated in most of the communities the count of influenza or the syncytial virus, but only in some the SARS-CoV-2.