The Ministry of Health and the autonomous communities finally agreed this Wednesday at the Public Health Commission, after trying without success last winter, to treat winter flu, respiratory syncytial virus (RSV) and coronavirus.
The document, the latest draft of which EL PÁIS has had access to, plans to recommend that people with symptoms routinely wear a mask, the widespread use of face masks in health centers during the epidemic phases, and promoting teleworking for the duration of the epidemic among the population with mild symptoms that do not justify sick leave from work. Without taking into account the exceptional event of the coronavirus pandemic, the most important and frequent of the epidemic phases is that of the flu, which occurs every year and lasts about 10 weeks on average.
The main objective of the plan is to “establish epidemiological risk scenarios and propose technical recommendations at each level.” The system is based on almost real-time monitoring of the incidence of the three diseases, according to the recommendations issued after the coronavirus pandemic by the World Health Organization (WHO) and the European Center for Disease Control (ECDC).
The document proposes four scenarios. The first is the “inter-epidemic or basal situation”, that is, without relevant circulation of the viruses. This is followed by three others called “low or medium level epidemic”; “high level”; and of “very high level.
It will be the communities that, according to the data from their historical records, will finish defining the scenarios in their territories and will establish the thresholds of diagnoses and incidents that will mark the transition from one to another. In coordination with the Ministry of Health and the Carlos III Health Institute, the regional governments “will periodically review the evolution of the indicators to assess, maintain or modify the definition of the scenarios,” states the plan document.
In each scenario, “the transmissibility indicators” of the three viruses and their “impact on care capacities” must be taken into account, such as “occupancy of hospital and ICU beds”, number of consultations for acute respiratory infections and vulnerability of the susceptible population, among other variables.
In the “low or medium level” scenario, at a general level, it is recommended that people with respiratory symptoms reduce their social interactions and wear masks, especially when they are around vulnerable people.
In hospitals, the use of masks will be for all people, but only in those units with the most vulnerable patients, such as transplant and chemotherapy units. In nursing homes and susceptible groups, it is advised that workers with symptoms wear masks at all times. “The management of the centers may evaluate the risk and determine whether to make this recommendation a mandatory measure if necessary,” the document states.
In the private sphere, the document recommends that “teleworking be encouraged as long as the characteristics of the position allow it and the competent authorities consider it” among people with respiratory symptoms.
For people in this situation, and in general, the use of a mask in all situations is also recommended, reducing social interactions and “respiratory and hand hygiene measures during the days after the onset of symptoms with the aim of reducing transmission”, measures that “must be taken to the extreme if there is going to be contact with vulnerable people.”
In scenario 2, considered “high” risk, the recommended use of masks is extended to all health centers, making it mandatory in exceptional cases. In nursing homes, it is proposed to restrict visits “always taking into account the emotional needs of the inmates.”
In the health system as a whole, the plan also foresees “guaranteeing the diagnostic capacity [de los hospitales] in the face of the increase in cases” and the “review of care capacities and reserves of basic resources, including personal protective equipment, diagnostic tests and treatments.”
Finally, in scenario 3 of “very high risk” or “pandemic”, the recommendation is to reinforce the necessary measures as much as possible and, if they are insufficient, consider the adoption of “exceptional measures”.
The debate that for the second year has surrounded the surveillance and action plan against winter respiratory viruses has been accelerated by a predominant virus that presents relevant mutations compared to previous seasons.
According to the , published every Thursday, Spain entered the epidemic phase last week by reaching a rate of flu syndromes – diagnoses made in consultations, although not always with virological confirmation – of 40.1 cases per 100,000 inhabitants, when the threshold is 37. The estimate of the total incidence of the flu – an indicator that takes into account other variables – reached 112.2 cases per 100,000 inhabitants, last Thursday, day of publication of the report.
The forecasts of the Ministry of Health and the communities are that these figures will continue to grow for at least three or four more weeks, which would lead to reaching the peak of the flu at the end of the year. The most common thing is that the peak is reached in Spain about a month later, at the end of January or beginning of February.
The fact that these forecasts coincide with the Christmas holidays adds some uncertainty to the evolution of the wave, as some sources fear that family and social gatherings typical of this time could give a final push to infections.
The early arrival of the flu has been fueled by a new form of the virus. If in the last two winters the H1N1 subtype had predominated and H3N2 had played a secondary role, it has been the latter that has driven the current wave and has also done so with .
According to authorities and experts, this has caused the population’s natural immunity to decrease and also the vaccine, prepared with strains without these mutations, to have lost some effectiveness in preventing some infections. However, he recalled that vaccines remain effective in preventing serious cases, hospitalizations and deaths, and has urged governments to accelerate flu vaccination campaigns in recent weeks.
Several communities have altered their campaigns to deal with the spread of the flu. The Basque Country, for example, installed in Bilbao, while Catalonia advanced one month – from mid-October to mid-September – the vaccination of children, who play an important role in the spread of the virus.
The flu vaccine is recommended for everyone over 60 years of age, pregnant women, children between six months and five years (some more in several communities), and patients with some diseases. Also for healthcare workers. The first data available, still provisional, point to an improvement in coverage in all groups this year.
