Covid cases are skyrocketing: what should we do

Start date of the flu and Covid vaccination campaign in each community

The transmission of Covid-19 has been progressively increasing since the end of spring, after the flu season subsided. Specifically, we have gradually gone from an estimated rate of 16 cases per 100,000 inhabitants, at the beginning of May, to an incidence of 91/100,000at the end of September, according to the latest data published by the Carlos III Health Institute (ISCIII).

This means that the prevalence of the disease was 140% higher at the end of last month than five months ago.

An endemic virus?

However, just because there are more cases does not mean that they are having a greater clinical impact. Angela Dominguez, coordinator of the Working Group on vaccination of the Spanish Society of Epidemiology (@seepidemiologia), explains to this newspaper that the current level of hospitalization and care is limitedalthough it calls for continuing surveillance.

Specifically, in summer it has been registered a maximum peak of 2.1 hospitalized cases with covid per 100,000 inhabitants, while in 2023-2024, 5 cases/100,000 were exceeded during the summer or 3.6/100,000 in 2022-2023, at the end of the summer period. Some incidents, however, are very far from those recorded between 2021 and 2022 or, of course, compared to the most complicated moments of the pandemic in 2020.

In that sense, for the immunologist and professor of parasitology at the University of Valencia, Rafael Toledo (@alfwarrior), this fluctuation of Covid-19 should not be considered as “a peak” similar to that which occurs with the flu, with the implication it has for the health system – saturation of emergency rooms, lack of beds, etc. – but as the normal variations of a virus that is already established “almost endemically in a population”.

In these cases, he argues, the prevalence does not remain stable, but rather experiences “small alterations” induced by multiple variables.

Why have cases increased?

Of course, it is still not very clear why these increases occur. The expert identifies several potential factors that could explain the increase in transmission in recent months. Firstly, he comments, the absence of a prior “peak” prevented the population from renewing its immunity.

Secondly, he adds, there are variables of character social and environmental that can contribute to the multiplication of infections. For example, recently, “back to school” took place and there has been an increase in interactions in closed places, such as “workplaces.”

Furthermore, it suggests that this rise may also be linked to the fact that “the flu has not yet taken hold”, That is, some type of viral interference may occur.

New variants?

For his part, the head of Immunology at the Virgen de la Arrixaca University Clinical Hospital, Manuel Muro (@manuelmuro5), remembers the role that new variants may have had, such as Nimbus either Stratuswhich have been imposed in recent months and which “increase transmissibility”, although not gravity.

“There is no cause for alarm or concern not at all in front of them. They will continue to emerge in the future, according to their evolution,” he recalls.

As for the symptoms of these sublineages, they would not be very different of the classics of the Ómicron strain –fever, headache, cough, general malaise…–, and it has also been described that it occurs with an increased sore throat or hoarseness.

Daniel López Acuña (@lopezacunad), Former director of health action in crisis situations at the World Health Organization (WHO), he also believes that the variants may have played an important role, especially in the summer, when the rebound was due, “fundamentally”, assures, for this reason.

“And now we begin the autumn winter season with an increase in the incidence of acute respiratory infections and Covid, in particular,” he adds. An epidemic wave, which would be affecting “all ages, but particularly older people.”

Vaccination of the vulnerable

Taking all this into account, the former WHO director calls to influence vaccination against Covid, but also against the flu and the Respiratory Syncytial Virus (RSV) – in some autonomies it will make the elderly vulnerable. “Unfortunately, it has only just begun and “Coverage in the last three years has been very low”he laments.

Therefore, calls to “actively promote” immunizationespecially from risk groups. “If we want to avoid or mitigate a tripledemic this fall-winter “we have to vaccinate now”he stated.

In addition, it asks to influence measures such as “the use of masks in risk spaces such as hospitals, health centers and residences”, as well as for those who have an active infection or in “large agglomerations, closed spaces and public transport.”

Manuel Muro also believes that it is important, given the current transmission context, “promote vaccination of the vulnerable”, of the “older people” and of those who have “chronic diseases.”

Of course, more important, he adds, is that they also be immunized against the flu, which “can cause serious health problems for people with heart disease, diabetes or asthma, which sometimes leads to hospitalizations and even long-term complications.

“They have to understand that it can be much more dangerous than many believe. “It’s not just a bad cold,” points out.

Finally, Angela Dominguez It also affects the importance of immunization, which has already started in the different autonomous communities, starting with nursing homeswhere the risk is higher – closed spaces and vulnerable people. “It is the main preventive instrument we have”confirms.

And recommends that, in higher risk environments, certain measures be followed non-pharmacological measures, such as hand hygiene, frequent ventilation and the use of a mask in infected people.

Who should get the vaccine?

It should be remembered that the 2025-2026 vaccination campaign against flu and Covid-19 has started this fall with news.

The Public Health Commissionof which the Ministry of Health and the community health departments are part, has decided to change the criteria and target groups that can be inoculated with these doses.

Specifically, they have published two technical documents, one for each virus – before it was done in the same one – detailing who is recommended to be immunized with each vaccine.

In the case of Covid-19, according to the documentis proposed to the following groups:

• People 70 years of age or older –before it was for people over 60–.
• People with special vulnerability due to immunosuppression.
• Internal people in disability centers, nursing homes and residents in closed institutions.
• People from 12 years of age belonging to risk groups or with severe immunosuppression:

– diabetes mellitus.

– morbid obesity.

– chronic cardiovascular, neurological or respiratory diseases.

– chronic kidney disease in stages 3, 4 and 5.

– nephrotic syndrome; hemoglobinopathies and anemias.

– hemophilia, other coagulation disorders and chronic bleeding disorders, as well as recipients of blood products and multiple transfusions.

– asplenia or severe splenic dysfunction.

– cancer and malignant hemopathies.

– chronic liver disease; serious neuromuscular diseases.

– disorders and diseases that lead to cognitive dysfunction.

• All pregnant women in any trimester of pregnancy.
• People 6 months or older with conditions associated with a significantly increased risk of serious illness.
• Staff of public and private health and social health centers and establishments.

The changes in the vaccination groups and the preparation of two separate documents, sources from the Ministry of Health explain to 65AND MOREwould have been carried out due “to the drastic reduction of cases and deaths from Covid-19.”

Set of respiratory infections

It should be noted that, according to the latest report from the Carlos III Health Institute, all acute respiratory infections also has skyrocketed in recent weeks.

Specifically, according to the latest report published by the Acute Respiratory Infection Surveillance System of the Carlos III Health Institute, with data up to September 28, the “epidemic threshold” would have been exceeded, going from 254 cases per 100,000 inhabitants detected in Primary Care to 441, in just two weeks.

In parallel, there would also have been an increase in infections in children of Respiratory Syncytial Virus (RSV), the main cause of bronchiolitis. In this case, the rates in Primary Care would have increased from 76 cases/100,000 to 180/100,000, in two weeks.

For now, the flu would remain at very low levels, waiting for infections to begin to increase, predictably, in the coming months.