The paradox of a summer without a pandemic but with a coronavirus

A summer without masks. A summer with third and fourth doses. A summer without a pandemic, but with coronavirus. Although experts are still reluctant to announce the end of the COVID-19 pandemic, they all recognize that this will be a completely different year than the previous two. In 2020, the first confinement and the long de-escalation had just ended, and the appearance of the first outbreaks was carefully monitored, back in July. In 2021, with a society exhausted after the second state of alarm and disparate restrictions depending on the territories, the light began to see thanks to vaccines. The promise of a new normal was near.

The summer of 2022 has started with a better scenario thanks to two key factors: vaccines and omicron. But, although this can give a respite to make postponed trips and also to spend some quieter time with loved ones, specialists warn that the care learned must continue to be applied and continue to protect the vulnerable.

"The restrictions no longer exist, nor are they expected," says the epidemiologist Javier del Águila, who has been analyzing the pandemic for more than two years. "There is a total normalization of life because the disease exists, but socially we have accepted that the virus is going to stay with us." For this to happen, he says, it has been essential to see "how the impact of each wave is less in terms of income and people dying." "Although there will continue to be deaths, we are facing a scenario of social normalization," he says.

Even so, the Minister of Health, Carolina Darias, has asked for "prudence" this Friday because a greater transmission of the virus has been detected and, therefore, an increase in infections. She has also recommended wearing a mask indoors. Darias has insisted that the evolution of the disease continues to be "permanently" monitored and has indicated that the increase in cases, mainly, is taking place as a consequence of the increase in new omicron sublineages, such as BA4 and BA5, which they are more transmissible but less serious than those detected in previous stages.

The first difference with what happened 12 months ago has to do with the vaccine. Injections against COVID-19 work and proof of this is that the increase in the number of infections in recent weeks it has not directly translated into an increase in ICU pressure.

"Many things have changed. The percentage of vaccination is one of the things that has changed, as well as the severity of the disease, both things are now very different," confirms Elena Martínez, president of the Spanish Society of Epidemiology. At this point, more than 92% of the population has the complete pattern.

However, Martínez does not consider that "the pandemic has passed" and asks to continue maintaining care. "We have to continue to protect the vulnerable," he stresses. "You are seeing an increase in infections; this does not mean that we do not go on vacation, because everyone wants it. After two years, we all want a normal summer."

Thanks to the effect of the vaccines, and this is a giant step in the run-up to the holidays, the pressure in the ICUs has remained stable and around 4% since mid-April. Although at this time it is not possible to establish a comparison of total infections with respect to what was happening at this point a year ago, it can be seen how in recent weeks infections have been increasing and that this has not translated into a great escalation in intensive care.

"There is a mismatch between the number of hospital admissions and the number of ICU admissions. The pressure in the ICU is not important," confirms Javier Segura, president of the Madrid Association of Public Health.

For example, the accumulated incidence in people over 60 years of age, the age group on which the Ministry of Health now focuses its data, currently reaches 991 cases per 100,000 inhabitants – a rate that exceeds 1,500 cases in Madrid or La Rioja–. Last Friday this figure was almost 250 points lower, at 755. However, as the graph points out, the ICU curve continues to resist.

The upward trend in the number of cases can also be witnessed by looking at the number of people admitted with COVID-19 to hospital. Since the beginning of June, the curve has only gone up: on June 3 there were 6,481 people admitted and currently there are 10,251. However, the action of the vaccines – and of the accumulated immunity – has meant that, for the first time since the start of the pandemic, despite an obvious increase in infections, the ICU admission curve remains flat. And it must be borne in mind that at this time the contagions reported are much lower since the March system change.

For Segura, not having hospitals collapsed at the beginning of this third summer living with the virus is "one of the positive parts." But he asks that it not be forgotten that there are still cases of persistent COVID, vulnerable people who could end up with a much more serious condition and an unknown: what will happen when the summer is over?

Segura expects that the protection of people who put on the reinforcement at the beginning of the year will begin to drop from July and August. "In summer there will be an increase in the incidence that we hope will be with a low level of mortality. But when the fall arrives, with the drop in immunity in people over 60 and in chronic patients, combined with the possible appearance of a new variant, We know what it's going to mean."

Ómicron is the second big difference compared to last summer. The variant detected at the beginning of the year, as well as its lineages, is much less lethal than the previous ones, and that fear will "always" be there, Del Águila also acknowledges. "I always say that, although it is unlikely, we are always one variant away from everything that we have advanced going to waste," he says in a serious tone.

In order for the summer to run smoothly, experts recommend applying what you have learned in the past to the present. In other words, if you think you may have COVID-19 or a respiratory infection, it is important to try not to be in contact with the elderly or the sick, or avoid going to work if there are symptoms. "It is important to keep remembering two things: that we are still in a pandemic and that preventive measures to protect vulnerable people must not disappear," adds the president of the SEE. "It would be good to maintain the customs. If you find yourself with the flu, that you don't have to go to work. We are responsible for trying to protect others," she recalls.

Del Águila believes that "an improvement in public communication by the authorities" would also be good at this time. That what is communicated by the Government and the ministries "is not contradictory" would be of great help so that "people better manage their particular situations" when making their decisions.ñ

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