Spain is preparing to stop counting COVID case by case: a “good news” that hides another missed opportunity

It was a matter of time, but that does not make it less controversial and conflictive. Spain is preparing a new system to monitor COVID-19 that abandons “comprehensive case reporting” Y, as Pablo Linde advanced in El País, it will look a lot like the current influenza surveillance system. In the middle of the sixth wave and with maximum levels of incidence it may seem like a bold move, but as pointed out by the Spanish Society of Family and Community Medicine, “This wave has been different from all the others” and it is these differences that begin to draw the true end of the pandemic.

Government and communities have been working on this new approach since the summer of 2020 and, although the different waves have been delaying its introduction, it seems that now when it is being finalized and when a date will be set to implement it. What does this new way of monitoring the disease consist of and what does it tell us about the future of the pandemic?

What is the new system?

Let’s get to the substantive. We have already discussed the famous transition from “pandemic” to “endemic”; that is, from the moment when our ability to anticipate and control the evolution of a disease converts what used to be a public health problem into a health management problem. A problem that can be serious, but that means the end of the exceptionality. That step involves many things, and traditionally among them come accounting changes.

The idea in which the Government and communities work entails progressively abandon universal surveillance of COVID-19 and switch to using a sentinel network. At a basic level, this means stopping the number of cases one by one and putting in place a sampling system (statistically significant). A group of doctors, health centers and hospitals will be selected thanks to which (with the information they provide) the evolution of the disease can be followed.

It is the system that, for example, we use today with the flu and, therefore, it is not something difficult to implement. In fact, there are five communities that “have already started in a pilot mode the surveillance with this system in primary schools, and nine in hospitals” to determine which centers and hospitals are the ones to monitor in the future, Linde explained.

A missed opportunity?

The change from a comprehensive counting system to a sampling one is thus good news. It is one of the clearest signs that for health authorities the pandemic is progressively coming to an end. However, it makes us wonder several fundamental questions about how the country’s health data is managed. That is to say, Does it make sense to use sampling methods when we have on file (and could examine statistically) the medical records of all citizens of the country? Wouldn’t it be better to know in real time how many flu, covid or colds are diagnosed and treated in Spain? Wouldn’t it give us a more precise, more powerful, more truthful image?

In other words, Are we not losing the opportunity to adapt epidemiological surveillance systems to new data management technologies? It is true that changing from one system to another involves more changes than just the counting method. Without going any further, it entails the end of massive testing. In an endemic context such as the one we seem to be approaching (and in the absence of knowing what happens with oral antivirals) determining the respiratory disease that each patient has only has clinical relevance for the health system when a specific treatment has to be applied; that is, when the case is serious and, normally, you are already hospitalized.

Nevertheless, the sense of missed opportunity is hard to dispel. Above all, because none of these organizational and diagnostic issues is in direct contradiction to improving our health monitoring systems. Little by little, the idea that the pandemic was going to serve us as a critical moment to update the health system and take it into the 21st century is getting further and further. There is some good news (and changes that, like it or not, have come to stay), but the foundations of the system remain anchored in the same technological moment as before the pandemic. It is, we look at it how we look at it, one of the great missed opportunities.

Image | Omar elsharawy