The Perfect Storm: Factors Behind the Spectacular Increase in Flu Cases During the Cold Wave

The respiratory infection season began almost at the same time as the fall, but it has been in recent weeks that the flu has accelerated, saturating primary care emergencies, first, and hospital emergencies, later. Although it is true that before the SARS-CoV-2 pandemic the panorama was very similar, there are factors that explain the ‘perfect storm’ of cases that we have been experiencing since mid-December.

According to the latest data from the Carlos III Health Institute, corresponding to the week before Christmas, The incidence of respiratory infections was 908.6 cases per 100,000 people, 12.7% more than the previous seven days.

Hospitalizations have grown in a similar way: 13.5%, from 18.5 per 100,000 inhabitants to 21 in one week. In the entire month of December, without counting the last week, 32% have done so. These are the reasons for the spectacular increase in recent weeks and the saturation of emergency services.

The cold wave

This is the first year, after the SARS-CoV-2 pandemic, in which the flu has once again behaved in a typically seasonal manner. Even so, it is normal for the peaks of infections, emergencies and admissions to occur after Christmas, around mid-January.

“In recent years that peak has been delayed,” he comments. Daniel Troncoso, spokesperson for the Spanish Society of Preventive Medicine, Public Health and Health Management. This year, however, he has gone ahead for one fundamental reason: “The onset of colder temperatures has caused people to take refuge at home.”

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The constant record of maximum temperatures that we have experienced throughout 2023 and a summery autumn predicted a last month of the year of mild temperatures and that has not been the case. December has been dominated by mid-winter temperatures, with unusual cold and snow for these dates.

This was commented by David Andaluz, coordinator of the infectious diseases group of the Spanish Society of Intensive Medicine, in an interview for EL ESPAÑOL. “There has been practically no autumn, with very mild temperatures in October and November and, suddenly, intense coldand that perhaps has caused these germs to appear in a more abrupt, less staggered way.

The abandonment of ‘respiratory etiquette’

It’s not just about the mask. All those good habits that we learned with Covid – covering our mouth and nose with our arm when coughing, using disinfectant gels, etc. – seem to have disappeared once we assumed this new normal.

“It is the abandonment of basic hygienic measures in all symptomatic patients,” says Troncoso. Almost a year after the end of the mask requirement on public transport, it is not difficult to find people coughing or sneezing on the bus, Cercanías or the subway without covering up or wearing a mask.

In health establishments, the end of the obligation came later but many people continue to wear them, especially health professionals, who have assumed the mask as another work tool.

Vacations and family gatherings

No one is aware that Christmas is an important factor in the spread of viruses, not so much because of the crowds on commercial streets but because of the sumptuous lunches and dinners where no one can miss.

Who more, who less, has seen this year how someone close to him showed up at the agape with a cold. Added to this is that children are major sources of flu transmission: age groups up to 4 years old are the ones that are reporting the most cases, according to the Carlos III Health Institute.

Thus, school (and daycare) holidays put a stop to the peak of respiratory syncytial virus, which is more serious than the flu in children, but the increased time at home with parents and grandparents facilitates the transmission of infections.

Vaccination coverage

The flu vaccine is always the subject of controversy. Its effectiveness is not the highest and, if the predominant strains are different from those recommended by the WHO, it drops even more, but it is an important tool to make it difficult for infections to worsen.

“After the declaration of the end of the pandemic by the WHO, there has been a relaxation in one of the main measures, such as vaccination,” says Troncoso, who regrets the misunderstandings regarding the flu vaccine: “We have the idea that only at-risk people have to be vaccinated and that is not the case.

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The flu vaccine coverage objectives are 75% of the susceptible population (the elderly, chronically ill, pregnant women, etc.). There is no official data yet, but a survey conducted by Sanofi of nearly 20,000 people indicates that Only four communities would be close to that number, at least in those over 65 years of age.: Galicia, Navarra, La Rioja and Extremadura.

The majority of communities are in ranges of 60 to 65%, while there are three that barely exceed 50%: Catalonia, the Balearic Islands and the Canary Islands. However, this year’s vaccine coverage is generally lower than in previous years: after the success of vaccinations during the pandemic, laziness has returned.

Covid is still present

The flu has reached the normality of years before the pandemic, but that does not mean that Covid no longer affects it. Although the vast majority of people who go to the emergency room do so because of the flu, there are still people who arrive infected with SARS-CoV-2.

In fact, Covid cases have been high since late summer and have continued into the fall. “He has gone to alternate peaks,” he explained Lorenzo Armenteros, spokesperson for the Spanish Society of General and Family Physicians, to this newspaper. “There have been more moments of Covid and then more of flu, although there is still Covid.”

In fact, in primary school, the tests carried out by the sentinel centers – those with which the Carlos III Health Institute prepares the incidence figures for respiratory infections – continue to give positive results for SARS-CoV-2 in a high percentage: 10. 8% in the last week, 12.7% so far this season.

Bad immunity

Armenteros also highlights a factor that may have gone unnoticed. The intensity of the flu this year can also be explained by its absence since the pandemic began. In 2020 and 2021 there were hardly any cases, while in 2022 it began to increase until reaching pre-pandemic levels in 2023.

“The intensity depends on immunity, and we have lost immunity to the flu in these years, [el virus] has circulated little, That immunity that was produced by contact has not existed and, then, it may give the impression that the flu behaves more aggressively this year.

Despite this, he states that the duration of the disease is similar, about 7 days, although in people with low immune protection it can last up to 10. In addition, there are persistent symptoms, such as cough, which can last up to a month. after.

The ‘perfect storm’ of the health system

To all these factors to explain the peak in Christmas cases, another is added: a health system in permanent crisis. The closure of health centers during the holidays ‘puts pressure’ on consultations on the rest of the days and hospital emergencies, while professionals must use up their vacations and accumulated hours, when they are not on sick leave for the same illnesses for which their patients come.

Added to this is the lack of plans to make up for these absences because administrators consider that this is a specific increase in the incidence of respiratory infections, on the one hand, and the lack of doctors and nurses to make substitutions, on the other.

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“We have a health system that has passed Covid and continues with the same deficiencies,” he explained. Victor Pedrera, deputy secretary general of the State Confederation of Medical Unions to EL ESPAÑOL recently. “The primary is at minimum levels, there are structural deficiencies. We are waiting for a national plan to be applied [para resolverlas] but, today, there are no concrete measures to solve them.”

In many health centers there are records of patients treated in marathon days, to the detriment of the quality of care. Pedrera exemplifies this: “Each doctor has around 1,500 people assigned to his quota. By hache or by be, in a health center with 12 doctors, Generally, one is missing every day, so the rest add up to 200 or 300 patients. If you add to that that, at Christmas, there are usually not one but four or five doctors missing, that the center is closed on holidays and the increase in respiratory pathologies, the problem is already set up.”

The situation also ends up affecting hospital emergencies, the “ATMs” of healthcare, in the words of the vice president of the Spanish Society of Emergency Medicine, Pascual Piñera.

“We are the health ATM, 24 hours a day, 7 days a week, 365 days a year,” he points out, “when the patient thinks that their matter is urgent and is not available to access the usual procedure in their tomorrow’s ‘schedule.’ Now imagine that everyone wanted to withdraw money from the ATM at the same time.

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2024-01-04 01:14:16
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