Catalonia is confident of receiving 350,000 doses of Pfizer's covid-19 vaccine out of the 2.5 million allocated to Spain. According to the Spanish government's calendar, the first vaccinations will take place in late January. However, given that it is a vaccine that requires two doses, which are administered 28 days apart and takes between 10 and 15 days to generate immunity, the Catalan Government expects 175,000 people to be vaccinated by mid-March.
This has been confirmed this Monday by the Minister for Health, Alba Vergés, who has also announced that her department had already acquired 10 million syringes for health centres in preparation for the start of the covid-19 vaccination. Despite the fact that the vaccination strategy will be decided by the State with the different regions, it will be the latter who will be in charge of supplying the material. "We have been preparing the strategy for weeks with a stable group and in coordination with the Spanish ministry," said Vergés.
Vergés has claimed that the department will have "everything ready" to start the vaccination campaign, probably in January, when these 350,000 initial units expected for Catalonia arrive, according to the information sent to them so far by the Spanish government. "We will use primary care as the main vaccination strategy", confirmed Vergés, although she acknowledged that in some settings other strategies could be implemented depending on needs or available doses. According to Vergés, the Department will put the "necessary" staff reinforcements for the covid vaccination campaign in place, which may still coincide temporarily with the flu campaign.
Shortly before the Vergés's appearance, the Secretary of Public Health, Josep Maria Argimon, said in an interview with RAC1 that the goal was to have 70% of the population immunised by the end 2021. This is a milestone very much in line with the idea of the Spanish executive but, unlike the ministry, Argimon believes that it will not be possible to achieve before summer and that these forecasts must always be interpreted "on a conditional basis", as the vaccine trials progress. However, he has anticipated that the next summer season will be very different from this year's, precisely because of the scope of the vaccination.
Four levels of vaccination
The Health Department anticipates that the first group to be vaccinated will be those living in nursing homes and their carers. Argimon has pointed out that health professionals will follow, starting with those working in primary care and in front-line units. He was joined by the coordinator of the covid-19 monitoring unit in Catalonia, Jacobo Mendioroz, who explained that all the autonomous communities are working in coordination with the Ministry of Health to agree on the criteria for implementing the covid-19 vaccination plan.
"We still have to define the settings and it will depend on the number of doses that arrive", explained the epidemiologist, who has advanced the four levels of vaccination that could be followed, without specifying the order of the phases. As for the most protective vaccination, priority would be given to the most vulnerable people and those with the most pathologies, such as the elderly who live in geriatric residences, and who are those who can have the most complications. This strategy does not only work for the coronavirus, but it is also the usual use of vaccines," said Mendioroz.
In addition to protective vaccination for the groups most at risk, he stressed that with vaccines, two strategies can also be followed to contain community transmission: on the one hand, immunising people with more social interaction, because they can spread the virus more;on the other hand, using vaccines early where outbreaks are detected. This also applies to close environments, such as families, which is what is usually done with other infectious diseases such as pertussis and measles, according to Mendioroz.
Argimon, who suffered a bilateral pneumonia due to coronavirus, spent seven days in hospital and one month away from the media spotlight, has pointed out that Catalonia, due to its population density, should be given one in every seven doses of the vaccine that Spain receives. He added that people who have already passed the virus will not be excluded from the vaccination, although it is possible that they will receive it later: "Immunity is an uncertainty, and we do not know what sort of immunity the vaccine will give us. We don't know how long it will be okay," he said.
Health and essential services first
There are some experts who have issued a first report on what the prioritisation for immunisation should be, and the main conclusion is that the first group should be health personnel in contact with patients, workers in old people's homes and first aid personnel such as firefighters and police. Next comes the turn of people over 80, especially those living in residential settings, according to a report by the Grup Col·laboratiu Multidisciplinari per al Seguiment de la Covid-19 (GCMSC), an independent platform of scientists jointly promoted by the Institut de Salut Global de Barcelona (ISGlobal) and the Col·legi de Metges de Barcelona (COMB).
Once the availability of vaccine doses is less limited, the document continues, the rest of the groups most likely to become seriously ill should be vaccinated: people between 65 and 79 years of age, those with chronic conditions such as type 2 diabetes, pulmonary or cardiovascular diseases, and people with obesity. In a hypothetical fourth phase, it would be the turn of essential groups such as public transport personnel, teachers and workers in the education sector or employees in the food sector, as well as people living in environments where the capacity for isolation is limited, such as prisons and refugee centres.
The rest of the adult population could be vaccinated at the penultimate stage, when the vaccine is accessible, always giving priority to those over 55 years of age. In contrast, children and those who have already overcome the virus could be considered non-priority for vaccination, at least in the early stages.
Argimon opposes a immunity card
In any case, the Secretary of Public Health has stressed that it was "important" to note that the person receiving one dose of the vaccine will be guaranteed the second dose before moer people are vaccinated. Argimon also stressed that he was not in favour of making the vaccine mandatory and was strongly opposed to the idea of creating an immunity card, because it would differentiate between the population. In fact, he has claimed that if this strategy, which the Community of Madrid wants to deploy - and which, after having been addressed on several occasions in Catalonia, has always been discarded - were to be implemented, he would "leave".
On the evolution of data, Argimon has assured that the latest data show that the epidemiological curve is "in the right direction", but he added that "there is still a long way to go". Currently there are still 400 infections per 100,000 inhabitants and in the last seven days 385 deaths have been recorded. However, it is true that these indicators have dropped considerably in two weeks: the first week of November there were twice as many positive cases per 100,000 inhabitants (800) and a hundred more people died in just seven days. "We have to be very careful: if we all go out now in disorder, with maximum mobility, we will have problems," warned Argimon, who celebrated the reopening of the hospitality sector to find a balance between health and the social and economic dimension.
The coordinator of the covid track and trace unit in Catalonia has insisted that the restrictions that were imposed seven weeks ago and that this Monday are starting to be gradually lifted have worked. Specifically, the epidemiologist stressed that the number of daily infections has been reduced to 1,800 diagnoses. In addition, most territories have an infection rate, or R number, which measures the speed of spread of the virus, below 1. The country as a whole keeps it below 0.8, and this means that not all people who are infected are transmitting the virus.
"The drop in indicators is widespread, but we still have a lot of people in hospitals," Mendioroz admitted. There are currently 2,117 people in hospital in Catalonia, 514 of whom are in ICU, far from the threshold of 300 critical patients that would allow hospitals to breathe. "We have to be aware that the virus is still here, that indicators can be back up in ten or fifteen days and that if it goes back up we will have an extremely complex situation for the next few days and for Christmas", warned Mendioroz, who added that it is very important that all the activity that has to be done is done outdoors and that social interaction is avoided as much as possible.
Mass screening begins
Coinciding with the start of the de-escalation, Catalonia is resuming this Monday the strategy of mass screening in six municipalities in the northern metropolitan region and nine towns in the region of Lleida. The aim is to break the possible chains of virus transmission by isolating the asymptomatic positives.
For one week, the Health Department will perform PCR and antigen tests on asymptomatic people over 16 years of age in Badalona, Mataró, Santa Coloma de Gramenet and Sabadell. While in these municipalities the search is focused on a couple of basic health areas, in La Llagosta and Mollet the whole population will be called. On Tuesday, the strategy will also start in Rubí and on Friday in Terrassa.
In the case of mass screening in the health region of Lleida, which this week will be carried out in the city of Lleida, Guissona, Agramunt and Almacelles, Salud has confirmed that antigen tests will be used, but has not clarified in what general contexts PCR or rapid testing will be used.
"As we did with PCR, we will have to test and evaluate in which settings and in which epidemiological situation it is more interesting to use one instead of the other because it provides better results," said Mendioroz. Thus, he added, PCR would be maintained as a reference test in those settings where there is more risk of obtaining false negatives and antigen tests would be used at a community level.