When the coronavirus pandemic was first declared, Spaniards were ordered to stay home for more than three months. For weeks, they were not allowed outside even for exercise. Children were banned from playgrounds, and the economy virtually stopped.
But officials credited the draconian measures with preventing a full collapse of the health system. Lives were saved, they argued.
Now, almost two years later, Spain is preparing to adopt a different COVID-19 playbook. With one of Europe's highest vaccination rates and its most pandemic-battered economies, the government is laying the groundwork to treat the next infection surge not as an emergency but an illness that is here to stay. Similar steps are under consideration in neighboring Portugal and in Britain.
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The idea is to move from crisis mode to control mode, approaching the virus in much the same way countries deal with flu or measles. That means accepting that infections will occur and providing extra care for at-risk people and patients with complications.
Spain's center-left prime minister, Pedro Sánchez, wants the European Union to consider similar changes now that the surge of the omicron variant has shown that the disease is becoming less lethal.
"What we are saying is that in the next few months and years, we are going to have to think, without hesitancy and according to what science tells us, how to manage the pandemic with different parameters,” he said Monday.
Sánchez said the changes should not happen before the omicron surge is over, but officials need to start shaping the post-pandemic world now: “We are doing our homework, anticipating scenarios."
The World Health Organization has said that it’s too early to consider any immediate shift. The organization does not have clearly defined criteria for declaring COVID-19 an endemic disease, but its experts have previously said that it will happen when the virus is more predictable and there are no sustained outbreaks.
“It’s somewhat a subjective judgment because it’s not just about the number of cases. It’s about severity, and it’s about impact,” said Dr. Michael Ryan, the WHO’s emergencies chief.
Speaking at a World Economic Forum panel on Monday, Dr. Anthony Fauci, the top infectious diseases doctor in the U.S., said COVID-19 could not be considered endemic until it drops to "a level that it doesn’t disrupt society.”
The European Centre for Disease Prevention and Control has advised countries to transition to more routine handling of COVID-19 after the acute phase of the pandemic is over. The agency said in a statement that more EU states in addition to Spain will want to adopt "a more long-term, sustainable surveillance approach.”
Just over 80% of Spain's population has received two vaccine doses, and authorities are focused on boosting the immunity of adults with third doses.
Vaccine-acquired immunity, coupled with widespread infection, offers a chance to concentrate prevention efforts, testing and illness-tracking resources on moderate- to high-risk groups, said Dr. Salvador Trenche, head of the Spanish Society of Family and Community Medicine, which has led the call for a new endemic response.
COVID-19 “must be treated like the rest of illnesses,” Trenche told The Associated Press, adding that “normalized attention” by health professionals would help reduce delays in treatment of problems not related to the coronavirus.
The public also needs to come to terms with the idea that some deaths from COVID-19 ”will be inevitable," Tranche said.
“We can't do on the sixth wave what we were doing on the first one: The model needs to change if we want to achieve different results," he said.
The Spanish Health Ministry said it was too early to share any blueprints being drafted by its experts and advisers, but the agency confirmed that one proposal is to follow an existing model of “sentinel surveillance” currently used in the EU for monitoring flu.
The strategy has been nicknamed “flu-ization” of COVID-19 by Spanish media, although officials say that the systems for influenza will need to be adapted significantly to the coronavirus.
For now, the discussion about moving to an endemic approach is limited to wealthy nations that can afford to speak about the worst of the pandemic in the past tense. Their access to vaccines and robust public health systems are the envy of the developing world.
It's also not clear how an endemic strategy would coexist with the “zero-Covid” approach adopted by China and other Asian countries, and how would that affect international travel.
Many countries overwhelmed by the record number of omicron cases are already giving up on massive testing and cutting quarantine times, especially for workers who show no more than cold-like symptoms. Since the beginning of the year, classes in Spanish schools stop only if major outbreaks occur, not with the first reported case as they used to.
In Portugal,with one of the world's highest vaccination rates, President Marcelo Rebelo de Sousa declared in a New Year's speech that the country had “moved into an endemic phase.” But the debate over specific measures petered out as the spread soon accelerated to record levels — almost 44,000 new cases in 24 hours reported Tuesday.
However, hospital admissions and deaths in the vaccinated world are proportionally much lower than in previous surges.
In the United Kingdom, mask-wearing in public places and COVID-19 passports will be dropped on Jan. 26, Prime Minister Boris Johnson announced Wednesday saying that the latest wave had “peaked nationally.”
The requirement for infected people to isolate for five full days remains in place, but Johnson said he will seek to scrap it in coming weeks if the virus data continues to improve. Official statistics put at 95% the share of the British population that has developed antibodies against COVID-19 either from infection or vaccination.
“As COVID becomes endemic, we will need to replace legal requirements with advice and guidance, urging people with the virus to be careful and considerate of others,” Johnson said.
For some other European governments, the idea of normalizing COVID-19 is at odds with their efforts to boost vaccination among reluctant groups.
In Germany, where less than 73% of the population has received two doses and infection rates are hitting new records almost daily, comparisons to Spain or any other country are being rejected.
“We still have too many unvaccinated people, particularly among our older citizens,” Health Ministry spokesman Andreas Deffner said Monday.
Italy is extending its vaccination mandate to all citizens age 50 or older and imposing fines of up to 1,500 euros for unvaccinated people who show up at work. Italians are also required to be fully vaccinated to access public transportation, planes, gyms, hotels and trade fairs.
Associated Press writers Maria Cheng, Danica Kirka and Sylvia Hui in London, Raf Casert in Brussels, Colleen Barry in Milan, Italy, and Geir Moulson in Berlin contributed to this report.