Salvador Peiró
Epidemiologist, researcher in the Health Services and Pharmacoepidemiology Research Area of the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community (FISABIO) and Director of Gaceta Sanitaria, the scientific journal of the Spanish Society of Public Health and Health Administration (SESPAS)
The Public Health Commission's decision is reasonable in the current context in Spain, with a very high proportion of people with a complete regimen, of people with booster doses (particularly high in older people, who are the ones who produce the most serious cases) and also of people who have passed the infection. This last aspect is relevant because the unvaccinated have caused a disproportionate number of severe cases and, foreseeably, most of them will have passed the infection and it will be difficult for them to repeat this half of the occupancy of the Covid ICU.
Although spikes or sawtooths in transmission and, of course, new variants are to be expected, the population has significant protection against severe disease which, at least in theory, may allow covid-19 to be managed in a similar way to other upper respiratory tract infections where aetiological diagnosis (testing) and isolation are unusual.
More uncertain is how it will be operationalised to minimise the impact of outbreaks on some vulnerable populations. When transmission is high (and we are still at a time of high transmission, although the current testing strategy does not allow for accurate quantification) it is difficult to prevent it from reaching nursing homes (which will now be six months after booster doses) and vulnerable groups. If transmission increases in these vulnerable groups, and even though the proportion of severe cases is much lower now than before Omicron and the third doses, it will lead to hospitalisations and deaths.
Nor have epidemiological surveillance measures been articulated (they have been postponed to next year) to replace the current ones, or alternative measures to warn of spikes in vulnerable populations in advance of the - later - indicators of hospitalisation.
In short, a reasonable decision, albeit with some uncertainty about its impact, and one that should be accompanied by other measures to anticipate possible upturns, especially those affecting population groups at higher risk of developing severe covid.