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COVID-19 RULES

How Spain wants to lead global shift in Covid-19 surveillance

With governments and populations worldwide desperate for an end to the pandemic, talks over when the virus might be reclassified have intensified. Spain has stepped up and wants to lead an international push for Covid-19 to be monitored in a similar way to seasonal flu.

spain covid surveillance
A healthcare worker tends to a Covid-19 patient in the ICU in Barcelona. Spain has seen a surge in Covid-19 infections since December and prevalence is currently among the highest in Europe. (Photo by Josep LAGO / AFP)

“Spain wants to lead this debate because it is timely and necessary to do so,” Health Minister Carolina Darias has said, adding that Spain asked the European Centre for Disease Prevention (ECDC) to “study new strategies” to deal with Covid.

Spain is in a good position to open the debate, having one of the world’s highest vaccination rates with 90.5 per cent of its population over the age of 12 fully immunised.

But the question has sparked disagreement between governments seeking some sort of normality and some parts of the medical community which advocate keeping its guard up.

READ MORE: Spain’s health experts divided over whether Covid-19 should be treated like flu

Spain’s left-wing government has been a prominent advocate of reclassifying Covid as an endemic disease with milder seasonal outbreaks that humanity can live with, like the flu.

The country is working with the scientific community to eventually shift from “managing a pandemic to managing a disease which we hope science will reclassify as an endemic illness”, Spanish Prime Minister Pedro Sanchez said this week.

Although Omicron has triggered a surge in infections, there have been fewer deaths and lower rates of hospital admissions, with many governments easing restrictions, reducing isolation times and loosening border controls.

“As Covid becomes endemic, we will need to replace legal requirements with advice and guidance,” British Prime Minister Boris Johnson said Wednesday, announcing that restrictions were being lifted in England.

Arguing “we must learn to live with Covid” in a similar way to seasonal flu, British Health Secretary Sajid Javid said the government would set out a long-term plan for living with coronavirus within months.

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‘False hope’

On Tuesday, however, World Health Organization chief Tedros Adhanom Ghebreyesus insisted that the pandemic was “nowhere near over”, warning that new variants were still “likely to emerge”.

The UN health organisation also warned against the temptation to play down the seriousness of an endemic disease.

“Endemic in itself does not mean good — endemic just means it’s here forever,” the WHO’s emergencies director, Michael Ryan, told the Davos Agenda roundtable on vaccine equity, citing malaria as an example.

Fernando García, an epidemiologist and the spokesman of a public health association, warned that talk of treating Covid-19 as an endemic illness at this stage was “creating false hope”.

“We are indeed moving towards the virus becoming more endemic, but we cannot say we have already reached that status,” said Marco Cavaleri, head of the European Medicines Agency’s (EMA) vaccination strategy.

There is no numerical threshold that distinguishes between an epidemic and a disease which is endemic, Garcia told AFP.

“An epidemic is when there is a very significant outbreak of cases, above the normal, which is what we have experienced since the beginning of 2020,” he said.

“And endemic diseases may have a seasonal trend but do not put pressure on the health system.”

Nor is it a foregone conclusion that the virus will evolve to cause less harm.

‘Mild symptoms’

“Future severity remains a big unknown. There is no law dictating that a virus must become milder over time,” Antoine Flahault, director of Geneva’s Institute of Global Health, wrote on Twitter.

“It is very hard to predict the evolution of virulence.”

When Covid-19 becomes endemic, “most people who become infected will have mild symptoms”, Garcia said.

“There will be a few who suffer complications that mean they end up in hospital and die,” he added.

“But you’ll never see one in four intensive care beds occupied by Covid-19 patients, not even five percent of them. Cases will probably be handled by primary care.”

In Spain, more than 23 percent of intensive care beds are taken up by Covid patients and more than 91,000 people have died since the pandemic first took hold in March 2020.

Of that number, 2,610 died between December 17 and January 18.

Some healthcare professionals have backed the Spanish government’s approach.

“Let’s stop visiting and testing healthy people with mild symptoms, or tracking and testing their contacts, let’s abandon self-isolation and quarantine,” urged a recent article by SemFYC, which represents around 19,000 family medicine specialists.

“All these activities… have been rendered meaningless with acquired immunity (both through infection and through vaccination) and the arrival of Omicron,” it said.

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COVID-19 RULES

Covid-19: Spain to scrap face mask rule for hospitals and pharmacies

The Spanish Health Ministry has announced that masks will no longer be required in certain healthcare settings, including hospitals and pharmacies, with a couple of exceptions.

Covid-19: Spain to scrap face mask rule for hospitals and pharmacies

The Ministry of Health, along with representatives of each autonomous community in Spain, decided at the Interterritorial Council of the National Health System (CISNS) on Friday June 23rd that it would no longer be mandatory to wear masks in hospitals, pharmacies and other clinical settings.

Spain dropped the mask rule on public transport in February 2023, but since the very early days of the pandemic in 2020, they have been required in health centres, hospitals and clinics.

Where will masks no longer be mandatory?

You will no longer need to wear a mask when you visit these places:

  • Pharmacies
  • Physiotherapy clinics
  • Dental clinics
  • Health centres
  • Nursing/Care homes
  • Hospitals

Are there any places where masks are still required?

Yes. Spanish Health Minister José Miñones has confirmed that the use of masks will still be required in areas with vulnerable patients and some places where they were mandatory before the pandemic too. These include:  

  • Operating rooms
  • Intensive care units
  • Areas where there are immunocompromised patients
  • Cancer wards
  • Emergency rooms

When will it enter into force?

This measure was expected to be approved by the Spanish Cabinet on Tuesday, June 27th and enter into force the next day on Wednesday, after its publication in the Official State Bulletin (BOE). But on Monday Spain’s Health Minister said the date would have to be pushed back as the matter wouldn’t be addressed in the Spanish cabinet on Tuesday, adding that mask removal in hospitals and health centres will happen “as soon as possible”.

Masks first became mandatory in all indoor and outdoor spaces in Spain in May 2020 as the country emerged from a two-month national lockdown in the early days of the Covid-19 pandemic.

The outdoor mask rule was scrapped in February 2022 and in April 2022 it was the turn of the indoor mask rule, with the only exceptions being health centres, care homes and pharmacies.

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