Catalonia faces the fourth wave of the covid pandemic

  • The health workers warn that each regrowth starts with a greater occupation of ucis than the previous one

  • Catalonia will decree a new regional confinement from midnight from Thursday to Friday

There are many voices that already speak of one fourth wave of coronavirus. For days the indicators have risen as much as in Catalonia as in Spain. And many countries in Europe are already immersed in it. The problem is that each pandemic wave starts with more patients in ucis than the previous one.

The care pressure and the probable deprogramming of ordinary activity are worrisome. The toilets rule out that the current tvaccination loop (16% in all of Spain) serve to break the new wave. More restrictions will come. For now, Catalonia will once again be confined to the region from this Friday at 00 hours. The question is whether it will be enough.

What is the epidemiological situation?

If Catalonia is not already immersed in a fourth wave of coronavirus, it will enter it in a few days, according to the experts consulted by this newspaper. “It’s a bit scary because this is a movie we’ve already seen,” he says. Pere Domingo, coordinator of the ‘covid plant’ of the Hospital de la Santa Creu y Sant Pau and a member of the Infectious Diseases unit of the center. “It looks a lot like the beginning of the third wave, with one difference: now the ucis are fuller of patients with coronavirus, “he adds.

According to the Head of Infectious Diseases of Hospital del Mar, Juan Pablo Horcajada, the territory is “already beginning a fourth wave”, which is reflected in a “change of trend in the curve”. “During the descent of the third wave, which was slower than expected, there were ups and downs. But these days the rise is being higher than those that occurred on time during that descent, “says Horcajada.

“The distinctions between the fourth wave and the reappearance of the third are of a semantic-technical type,” says the epidemiologist and Head of Preventive Medicine at Hospital Clínic, Antoni Trilla-. To speak of the fourth wave, we should have minimized the third, and it was not. But it doesn’t matter: coronavirus cases are increasing, we climb slowly but steadily, so yes: we can talk about fourth wave. ”

In hospitals, the environment is “a lot of concern”, as recognized by health workers. The british strain, already dominant in Catalonia, it is more contagious and, as infections increase, hospital and ucis admissions increase. “We are also seeing younger patients,” Horcajada says.

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Is the effect of Holy Week already noticeable?

Not yet, it will appear starting next week, about 10 days after the end of the holidays. The Secretary of Public Health, Josep Maria Argimon, warned Tuesday that during holidays, as on weekends, they are diagnosed less infections because people go less to the doctor. This would explain why the reproduction index (or Rt, which measures the potential growth of the pandemic) has fallen in recent days. But right now it is a misleading indicator, because it is at 0.93, which would indicate that the epidemic is in regression. All experts agree that the situation will get worse.

“Easter will help this rise to accelerate more. That does not mean that we are going to have a lack of control: there is vulnerable people protected already because of the vaccine, but there is still another lot that can become seriously ill “, explains Trilla. The infectologist Domingo is more pessimistic:” We will see the effects of Holy Week in seven or 10 days. We fear that the worst is yet to come. The ucis will be even fuller. And all this is raining in the wet: the toilets have been working intensely for a year, “he says.

Trilla, which recognizes that Catalonia is in a “complicated situation”, he asks to wait to see the indicators for the next few days to know if the increase in cases is “reasonable” or will force the other ordinary activity to be de-scheduled.

How are the hospitals and their ucis?

They are the great concern in this pandemic because what is at stake is the sanitary collapse. The toilets warn that each wave has started with a greater number of people with coronavirus in hospitals and ucis. For example, on October 1, when the second wave began roughly, there were 167 sick with covid in ucis. On December 24, when the Christmas that produced the third wave began, there was 337. And now there is 458. Occupation in ucis grows to 10% weekly, according to the Computational Biology and Complex Systems Group (Biocomsc) of the UPC. In total, there are currently 1,712 patients with coronavirus in Catalan hospitals. They increase every day.

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“This last week, in the Sea we have begun to have more income. The problem is that this wave comes at a time when ucis are still very busy in some hospitals. It is a bad matter, “says Horcajada.” Now, although this wave is less intense – because of the vaccine, because there is a better climate and people live outside for more – the problem continues to be the hospitals, “he adds. An example: a At the end of January, at the peak of the third wave, the Sea had three floors full of covid patients: “Now we have two full and we don’t go down. “

Between 15% and 20% of those infected with coronavirus end up in hospitals and 5% end up in ucis, where they spend an average of three weeks. Centers like Bellvitge are already having as many income as high. And in Vall d’Hebron it is starting to happen. “We give one or two discharges every day, but we have one or two daily admissions. It has been like this for 15 days. Last week there were 53 covid patients in the hospital and yesterday we had 73. Some will end up in the ucis and, in the next few days , there will be more admissions than discharges “, explains the Chief of Intensive Medicine of the Hospital de Bellvitge, Rafael Máñez. In his ICU, there are 19 patients with covid-19.

Hospitals have resources to care for many more patients than they are already treating, yes, but the problem is ordinary activity, which is what is in danger of being neglected. “In the second wave there was no deprogramming. In the third, there were one or two weeks in which we scheduled fewer complex surgeries because there were fewer beds in the ucis. We did not consider going back to a situation like March or April 2020, but what we want is that the impact is the minimum in the rest of the activities, “says Máñez. In hospitals like Sant Pau, 75% of the ICU is already occupied by patients with covid-19.

Will vaccination help fight this wave?

In Catalonia, only the 16% of the population has at least a dose of the vaccine and a 6.8% have both. Protection is very low. “The effect of vaccination is positive and undoubted, but with current levels, despite the fact that vulnerable people have been immunized, I do not think it will serve to avoid a new wave “, says Domingo. The Head of Infectious Diseases of the Germans Trias i Pujol Hospital (Can Ruti), Bonaventura Clotet, puts as an example Israel, a country where more than 50% of the population already has both doses and where “the pandemic has decreased by 94% thanks to vaccines” (although we still have to see the “duration of immunity”).

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But this is not the case neither in Catalonia, nor in Spain, nor in Europe. “Until we have vaccinated at least 60% of the population, we will continue to have outbreaks,” warns this infectologist, who in parallel defends doing rapid antigen test twice per week to the entire population to detect asymptomatic patients, as the United Kingdom does. In addition, another problem is that the vaccine protects 95% of severe disease, but “does not prevent transmission.”

“This is a very good vaccine, very tolerable. But the vaccination rate is disappointing. We are not going to stop this wave with the vaccine. And we’ll see the fifth “, Horcajada anticipates.

Should restrictions be tightened?

“Unfortunately, there is no other remedy “, Clotet says. For now, the Government has announced this Wednesday that the county confinement in Catalonia, so the population will only be able to leave the region for justified reasons. “Measures must be taken to avoid being in closed spaces”, Clotet says. “The terraces of the bars should not close, but the interiors should.”

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In Horcajada’s opinion, the current measures “are not enough” and yes or yes they have to “toughen” due to the “risk” of the ucis being “saturated”. “The post-Christmas restrictions were noticed in February. Now we have to take measures that increase social distance and reduce interaction “, says this infectologist from Hospital del Mar.

For Domingo, the situation will require “more drastic measures.” “I understand fatigue, but people must understand that restrictions prevent deaths, serious illnesses and consequences. In Italy they are fatal. Europe is much worse than us and they are 15 days ahead of us “, stands out.

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