Spain is starting to gain ground over the coronavirus. According to the latest Health Ministry report, infections remain at very high levels, coming in on Wednesday at 173 cases per 100,000 inhabitants over the last 14 days. But the progress of the vaccination drive and the restrictions that have been in place to slow the spread of the virus have softened the effects of Covid-19 on the worst parameter of the pandemic: the number of deaths.
Since the vaccination program began to take effect at the start of the year, the numbers of Covid-19 victims have fallen dramatically. The effect of the vaccines, which protect people from serious illness and death, as well as the fall in transmission due to social restrictions, have accelerated this descent. Since the end of January, weekly Covid-19 deaths have gone down by 90%.
Spain was dealing with the third wave of the virus when the first vaccines were administered on December 27, 2020. The first round of shots was more symbolic than anything else: 10,000 doses that were distributed in senior residences, which suffered the most from the effects of the virus and as such were top of the list when it came to who should get protection first.
The vaccines used at the start required two doses and the first shot did not start to take effect until 15 days after its administration. By the end of January, just when the third wave peaked with 900 cases per 100,000 inhabitants on January 27, the first injections began to have an effect and deaths, in particular in senior residences, began to fall.
According to data from the Imserso institute for seniors and social services, in the last week of January 778 elderly people died in care homes due to Covid-19. But in recent months, and with such places completely protected, the number of victims in such centers has plummeted: just six deaths between April 26 and May 2, the last week for which there is consolidated data.
“The cases that the third wave generated were seen in January and February and could not be stopped, because the infections had already taken place,” explains Daniel López-Acuña, a former director of emergencies at the World Health Organization (WHO). “Not until we started to vaccinate and the time had passed to generate immunity did infections and cases start to plummet.”
The vaccination of the general population is going slower, but the effects on the protection of the more vulnerable age groups – 89% of the over-60s now have at least one dose – is already starting to influence the global curve. As well as residences, the over-80s have already got full protection thanks to the vaccines, while the coverage of the 70-79 group is around 50%. All of this, combined with the fall in transmission thanks to social restrictions, has had an effect on the fall of Covid-19 deaths in Spain: of 3,722 in the last week of January, to 366 the week of April 26 to May 2, according to the consolidated data from the National Network of Epidemiological Monitoring.
“In the general population there is not sufficient vaccine coverage to break the infection chain, but given that global mortality is closely linked to age, when we cover the more vulnerable age groups, the impact is consolidated,” explains Amós García, the president of the Spanish Vaccinology Association. In Spain, 20.6 million doses have been administered, with 30% of the population having received at least one shot and 13.7% (6.5 million people) enjoying full protection.
The experts consulted by EL PAÍS stress that the vaccination campaign has been key to bringing down mortality rates but that it is not the only factor that has contributed to this fall. “As well as vaccination, the restrictions have had an influence, bringing down cases and as a result hospitalizations and deaths,” explains Salvador Peiró, an epidemiologist at the Fisabio health and biomedicine foundation in Valencia. After the relaxation of measures at Christmas, the regions once again took severe control measures, such as limiting meetings, reducing opening hours for bars and restaurants, and confining areas with high incidence rates, among others.
“In residences, from February onward, we clearly saw the effect of the vaccines,” Peiró continues. “In the rest of the population it is slower and we are seeing two mixed factors: restrictions and vaccines. But as vaccination advances, fewer and fewer older people are suffering from serious illness. Some 95% of the victims of this pandemic were over the age of 60. If we protect them and free ourselves of this, the outlook changes completely.”
This combination of vaccination and restrictive measures to bring down the incidence has also seen global hospitalizations fall by 77%, although in the intensive care units (ICUs), the pace is different. “ICU hospitalizations don’t have the same effect because there has been a shift to younger ages and longer stays,” López-Acuña warns. With the vaccination, the age of people with infections and who are hospitalized in ICUs has fallen from 42 to 40 for the former, and 63 to 60 for the latter, according to the Health Ministry.
“This might be linked to the fact that young people tend to resort to medical services later and arrive weaker,” explains García. “And the aggressive nature of variants [of the coronavirus] is also an element that needs to be monitored.” Peiró agrees: “We have a certain perception that the cases that are arriving in the ICU are now more serious than before, and we have been discussing whether that could be due to the British variant, but this is yet to be studied.”
The younger the age of someone who becomes infected, the lower the risk of ending up in the ICU, but the hospitalizations of younger people, the experts stress, are indeed getting longer. In some cases, they are lasting more than 100 days. And it will be difficult, they add, to empty out the ICUs. “They’re there for longer because they are candidates for everything: they’re very young and we have to fight for them until the very end,” Ricard Ferrer, the ICU chief at the Hospital Vall d’Hebron in Barcelona, told EL PAÍS several days ago. “The longer stays are a collateral effect of the mortality having fallen.”
According to the latest data from the Health Ministry, in the last seven days a total of 261 people have died after testing positive for Covid-19. That’s to say, an average of 37 victims a day. But while these figures are more immediate, they are not yet definitive due to the chance of reporting delays skewing the figures. In fact, only the data from the Carlos III Health Institute in Madrid offer consolidated and trustworthy figures. According to its latest reports, between April 26 and May 2, there were 366 deaths – around 52 a day.
Whatever the case, the trend is falling, but there is still a way to go before Spain reaches zero. “We still don’t have the over-60s fully covered and the vaccine is not 100% effective,” explains López-Acuña. “It reduces the risk, but it doesn’t eliminate it.”
An example of this was the case of an 84-year-old who was vaccinated in January in a residence in Vitoria, in northern Spain. She died from Covid-19, according to the local council in the city. A study by the Health Ministry reveals that the effectiveness of the vaccination drive in residences is between 81% and 88% – the shots have avoided 71% of hospitalizations and 82% of deaths.
Bringing the death toll down to zero will currently be an impossible task, say the experts. “The victims that are appearing [in the statistics] now are people who died some time ago and are only just being notified, or cases that have spent a month or two in intensive care,” Peiró explains. “If you look at the infection dates, the curve does indeed change.” The new deaths that the Health Ministry includes in its reports – 108 on Wednesday, for example – tend to correspond to prior days or even weeks due to delays in reporting from the regions.
“We cannot accept 80 or even 50 deaths a day,” warns López-Acuña. “We have turned the figure into a parameter and we are not seeing the people who are behind the numbers. We have become anesthetized. While the incidence is high, we will have a degree of mortality. We need to see the incidence fall below 25 cases per 100,000 inhabitants for the deaths to be reduced.”
Since the start of the coronavirus crisis, the Health Ministry has recorded more than 79,000 official coronavirus deaths. But the real figure is likely to be much higher, given that testing was limited at the outset of the pandemic and many thousands of people died before they could be diagnosed.
Source: El Pais, May 2021.