Could there be a new wave?

On May 5, 2023, the World Health Organization (WHO) declared the end of the international health emergency due to Covid-19. However, That summer we again suffered an increase in cases in Spainalthough It began to be detected later than this year, at the beginning of Augustwhen there were 99.4 cases per 100,000 inhabitants. Where are we now? The latest weekly reports from the Acute Respiratory Infection Surveillance System (sivira) estimate a growth in incidence of Covid-19: with data from June 3 to 9, 107.7 cases per 100,000 inhabitants (the previous week was 85.4 cases per 100,000 inhabitants; the previous week, 57.7 cases). Are these figures cause for alarm? Do they announce a next wave? Experts consulted (doctors, pharmacists and microbiologists) sound the alarm in the right measure.

Lorenzo Armenterosspokesperson for the Spanish Society of General and Family Physicians (SEMG), explains to this medium what the current situation is: “Sivira data is based exclusively on the alert network, with random cases that are not significant. In primary care (PC) it is even more random than in hospitals, because the sentinel centers of the alert network occasionally do a complete battery of tests (covid, flu A, flu B) on someone who has a respiratory infection. It is considered that these data from Sivira are a tip of what really exists.”says Armenteros.

In fact, he mentions the non-seasonality of the SARS-CoV-2 virus: “If we extrapolate the increase we have in respiratory diseases that are inappropriate for the times we are in, where the seasonal infections of Respiratory Syncytial Virus (RSV) and influenza (A or B) are usually exceptional, We can consider that many of the respiratory infections we see would be Covid. But We cannot prove it, because we have no way to do so. If we were in winter, we could consider that it is more flu or RSV. The omicron is not seasonal and, in fact, the big omicron that we had and from which practically everyone caught it was in one summer.

To this we must add another factor: “Another reason why Covid cases are growing is because of the loss of hybrid immunity that we had for having suffered from Covid and having been vaccinated. The omicron variant vaccine, which was the last, has not been taken by many people. In fact, “The majority of admission cases are frail, unvaccinated patients.”.

That is, it clarifies that Last year’s vaccine “was not just another dose, but a new vaccine, because it contained variants that had not existed until then. “The previous ones covered the old variants, and the last vaccine is the one that already had the circulating omicron variants.”

How do you analyze this data? Pilar Marí Claramontevowel of Clinical Analysts of the General Council of Official Colleges of Pharmacists (COF)? “From the data we have in the sentinel centers, where random tests are carried out (they do not follow the same criteria throughout Spain) a significant rebound in Covid positives is seen“, indicates someone who works in a private laboratory in Castellón.

However, he clarifies: “For this new variant (BA.2.86) that is displacing the previous ones, as it is still of Omicron lineage, The tests are still effective and continue to work. But we must consider that everything depends on our level of antibodies, either because we have herd immunity, because we are vaccinated or because we have had Covid. Although This variant is very transmissibleand that is why there is a rebound, Many times the symptoms are very mild, and overlap with allergies and rhinitis, typical at this time of year. “That’s why there are many people who don’t get tested or go to the doctor, which also means that it’s not serious.”

Even so, he clarifies that a greater rebound in Covid cases does not have to translate into greater attendance at emergency departments or more hospital admissions. That said, yes there are, but states that they are “neither significant nor worrying”.

CAUTION WITH VULNERABLES

Of course, both Claramonte and Armenteros emphasize the need to be cautious and use masks and tests to protect vulnerable people, whether they are the elderly, children, pregnant women, immunosuppressed patients, cancer patients… Therefore, in view of these data , Armenteros points out that “It is advisable that, if cases continue to grow at this level, vulnerable patients try to wear a mask in health centers, as well as at the slightest respiratory symptom. We professionals are already using it.”

In line with this, he comments that since last summer doctors have been seeing an increase in a pathology that until now was only common to see in children: strep throat. Now we are seeing many in adults as well, as well as RSV. We doctors always want to give surnames to what we see, and we do not like at all that classification and minimization that the Ministry of Health has, when it says that we classify all of them as acute respiratory diseases in PC or serious in hospital. We would like to have testing available to know if we are dealing with Covid or the flu. And we can only identify, in this case, if it is a streptococcus. We do have specific tests for that.”

These infections may be due, as he explains, to the fact that this winter there have been many flu cases: “That has been able to reduce our local defenses. “Once you have gone through a viral process, there are more options for catching a bacterial process.”

CATCHBOX OF RESPIRATORY DISEASES

The SEMG spokesperson makes this reflection: “We assume that, since the Covid disease was minimized, We now put all respiratory infections in that mixed bag; They are not classified, they are not given a last name. But extrapolating, and in view of the growth in hospitals and in the results of the sentinel network in AP, we could say that there is a growth of Covid. It is not a major epidemic wave, but the data is more striking a month and a half or two months ago.

So, aren’t tests still being done in primary care (PC) centers?: “For a long time We no longer have tests in AP. The pandemic is considered to have disappeared and this has become epidemic. As the effect is relatively low, the tests have been stopped being supplied to the centers; you may have some, but they are no longer ordered or supplied. What we do is tell the patient to do a self-test to confirm it, so that he is calm and in case he lives with vulnerable people,” he indicates.

Armenteros clarifies that “As tests are no longer being done in AP, the size of Sivira’s growth is completely estimativewith data from patients from the sentinel network or through tests in hospitals,” Armenteros points out. And it is explained: “There are the respiratory infections that are now considered acute, all those of PC, and the serious ones, which are those of patients who “They go to hospitals, they do a test because they have respiratory decompensation or because they do a PCR before an operation (but it is no longer mandatory), and they identify themselves more specifically.”

VALIDITY OF THE SELF-TEST AND INCREASE IN THEIR DISPENSATION

Are the self-tests dispensed in pharmacies still valid? “Yes, you can continue to trust them, because they carry various antigens, which detects any variant of the family of omicron. Furthermore, it is clearly seen when they arrive at the hospital that they are positive. The current variant, which we call Pirola, is the most common now,” Claramonte clarifies.

Are pharmacies being sued? Yes, without any doubt. This is how he details it to this newspaper Juan Enrique Garridoacting national member of pharmacy office pharmacists (on June 19 he will take over Piedad García Marcos): “Demand is increasing and we have had important peaks. At some point we have even been caught offside and we have had to ask again for more tests to be sent, because the demand exceeded what we had.”

Garrido adds that they have been noticing it for several weeks: “In addition, in Jaén we have many cases of allergies and some of the symptoms coincided, especially regarding the nasal and mucus issue. “People don’t know if it’s an allergy or something viral, and they decide to take the test to rule it out.”he comments.

Qualifies that Both Covid tests and combined tests are demanded: “This isn’t usually the season for the flu, but people are still suing them.”

Even so, the dispensing data has nothing to do with those of previous years. With half a year left, Spanish pharmacies have dispensed less than one million units of exclusively Covid tests (919,641.12), which represents almost 3 million euros (2,973,113.92 euros), according to Iqviawith data until May 2024. Of course, Unlike in previous years, more combined covid and flu tests are being sold: almost a million and a half (1,445,646.44).

In 2023, 8 and a half million units will be sold (8,521,581.13) worth more than 26 million euros (26,270,906.27 euros).

Yes indeed, 2022 was the year of boomwith almost 60 million tests sold (58,892,671.62) for more than 209 million euros (290,130,134.95 euros).

2021 was a much weaker year, with more than 14 million tests sold (14,682,950.93), and 2020, the beginning of the pandemic, was anecdotalwith 41,804.85 tests sold.

Could we return to the hardest moments of the pandemic? “It is difficult to predict. But, given the evolution of other epidemics, it seems that they are reducing in extent. People are infected a lot, but the degree of impact is weaker,” clarifies Armenteros.

WHY THE FLIRT VARIANT IS CONCERNING

However, consider that “Yes, there are certain alarming data, because the Flirt variant, which is now in the United States (about 30%), has a strain, KP.2, in which Mutations different from those of the spicule have been found. Until now all variants had mutations in the spicule, and that is why we assumed that our defense was based on that differentiating part that was the spicule and it protected us more. But those variations that present mutations in areas other than the spicule can give rise to other more aggressive lineages or sublineages, because our defenses are not prepared for these mutations,” he indicates.

The predominant variant in Spainas Sivira details, is the BA.2.86 (59.62%), popularly known as pyrola, “with a predominance of 81.49% since the beginning of the season corresponding to the circulation of JN.1 lineages and sublineages.” According to Armenteros, “they are almost 70% in AP and 90% in hospitals.”

Although this variant is not more virulent, Armenteros details a characteristic that differentiates it: “The patient perceives the anosmia or acute loss of smell, and dysgeusa, or alteration of taste; something that in the latest variants of omicron was not characteristic”.