The fifth wave is already reaching a tipping point and could be stabilizing in many of the most affected communities. However, containment measures may be necessary to stop it completely and bring the curve back under control, for the fifth time in this pandemic.

In this way, the restrictions should go through, once again, limiting internal freedom of movement or the closure of certain sectors where the unvaccinated population – mostly young people – is being infected massively and creating large outbreaks.

This is how the epidemiologist at the University of Oviedo, Pedro Arcos, understands it, who thinks that the country was deconfined too soon, before reaching a sufficient percentage of vaccination that allows, whether or not there are infections, to resume a certain normal life and live in a certain balance with the virus.

Question - How would you define the current wave that we are experiencing in Spain?

Answer - What there is today is a new wave of infection, but not disease and mortality. And a wave that affects a specific percentage of the population.

It has been produced by two phenomena. One is caused and the other is natural. The first is the opening of nightlife and the crowds of young people. The other has to do with the fact that when you remove a part of the population exposed to risk, because it has already been vaccinated, the virus is going to move to the segments that have not yet been protected and are vulnerable. But the impacts are very low in young people, despite the fact that now it is very important that an adolescent has been admitted to the ICU, but they are one, or two.

Q.- Why has the expansion of this wave also been explosive in terms of infections?

R.-Nightlife should never have been opened until reaching 70 or 80% of the vaccinated population. It has been a mistake. And authorize tourist mobility and crowds, too. We have repeated the same story, because of the summer theme. Now, we have a new wave.

Q.- Can the spread of the virus be controlled if this younger population is already vaccinated?

A.- The priority should not be to vaccinate young people. Half of the population is still missing. With the new Indian variant, having a single dose confers protection that goes from 70% to 30%. And now, the first thing would be to complete the vaccination in people in general. We are still close to 50% of the complete guideline and we need 85% with the new variant. So the priority is not to vaccinate 20-year-olds, because if they get infected, they probably won't get sick, but a 45-year-old or 65-year-old might.

Q.- So, are people who have not yet received the two doses and are older at risk?

A.- With the Indian variant, the protection is very low. They would be priority number one. Of course, if we have enough doses to do both, then perhaps we could start vaccinating young people.

Q.- Taking into account pandemic fatigue, what measures should be taken in the short term to reduce transmission, that are realistic and will be fulfilled?

A.- I think that first it would be necessary to get the Ministry to take responsibility for the situation, because now it is missing. Currently, there are communities that do different things in terms of vaccination. Some inject doses into young people, others still don't. But that doesn't make sense, because the infection doesn't stop at the limit of a CCAA. I think there is neglect on the part of the Ministry of Health. So we are not going anywhere. One thing is to transfer part of the responsibility and, another, for each region to decide who it immunizes.

And the measures: the nightlife should not have opened and it should be closed. Then they would have to control mobility and the complete opening of tourism, which now makes no sense. We will also have to return to a mobility restriction system in certain places. And it will be necessary to control the crowds in public spaces, something that is not just a health problem, but a public order problem, from before Covid. There, the municipal authorities should have some kind of control. Finally, it would be interesting to control the capacity of the interiors of the hotel industry, which I do not know if it is being done.

Q.- And open leisure to vaccinated people, as they want to do in France to control infections and encourage vaccination, what would you think?

A.- The context is different and so is the epidemiological situation. Here, the goal has to be to vaccinate and inject the entire regimen.

The theme of saying: 'You only enter this site with the vaccine', well, it could be contemplated. But you have to look not only at individual measures, but also at the control strategy as a whole. And right now, it seems there isn't. Each one goes a little for free. The Ministry should exist again and appear somewhere.

Q.- How long will the wave last and what will it depend on?

A.- Due to the appearance of the evolution of the curve, it is probably reaching a maximum peak of infections and it is likely to last another month.

Q.- Will there be two wave months in total?

A.- Yes. Between one or two if things are done reasonably well. But the important thing is not whether it lasts more or less, but what we do. That is, that there is a coherent strategy. If the curve goes down again, but in a month we go up again, it is tumbling, both with vaccination and with measures related to leisure. We tighten when it overflows and loosen when it doesn't. It is what it is. But maybe we have to be more consistent.

Q.- And after the fifth wave, what will happen? In the United Kingdom they have vaccinated more than 85% of the adult population with one dose and more than 60 with two, and even so, the cases are increasing, will the same happen in Spain?

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A.- You have to forget that there will be zero cases. It will pass as with any other respiratory virus. Even if 85% are vaccinated, there will be 15 that have not been vaccinated and, furthermore, the doses do not protect 100%. So there is going to be, permanently, a 20% susceptible population and some outbreaks. That is part of normal life and it is like it happens with other diseases.

The idea that by vaccinating 85% the problem is over is something that makes no epidemiological sense. But that doesn't mean you can't get back to normal. In the future, these cases will have to be treated individually, analyzing the outbreaks, and nothing more. But we are not yet at that stage.

Q.- Has it gone too quickly to a scenario of coexistence with the virus?

A.- We have given the problem as solved and people have begun to circulate from Santander to Cádiz, from Madrid to Barcelona and nightlife has opened up. We have eaten the last phase, whole. For example, the English are opening up now.

Q.- So, doesn't it make sense to think that the virus will be able to be eradicated? Is it a wrong approach?

A.- It is totally naive. This is a coronavirus. There are loads of them and it mutates two or three times every month. The goal is not to kill the virus. Nobody in their right mind, who is a professional epidemiologist, can propose that. The goal is to keep the level of risk and the death toll low. Eradication has only been achieved once in history: with smallpox. It has not been achieved with polio or measles.

Q.- Will the countries that have opted for Covid Zero have to change their objective?

A.- It is absurd, because you also cannot close a country permanently. Public Health is global.

Q.- Should the elderly be vaccinated periodically in the future?

A.- The reasonable thing is that, when the virus circulates little, it is no longer necessary to vaccinate everyone, but only the most vulnerable, as happens with those over 65 years of age. Identify which groups are most at risk.

Q.- Will we really be able to live with this virus with the vaccines and return to normal life or since it is so infectious it is not possible?

A.- The natural evolution is that it becomes less serious. The softening of the virus is normal. In the initial stage, when it infects humans for the first time, they are very virulent, because they do not recognize it and almost any type of symptom occurs: loss of taste, loss of smell... But as more people are vaccinated, the immune system will recognize it and the impact on health will be less.

Then, it is an issue that has to do with perceived and acceptable risk. The perceived is variable. In a few months, society will realize that wanting zero risk is absurd, because we are not Martians and we are part of a group of species exposed to viruses.

In parallel, the acceptable risk will change. In terms of perception, it will end up looking like respiratory viruses in general, like the flu. Every year we will have cases, some tens of thousands and thousands of deaths. And it will be part of the general dynamics of population mortality.

Q.- If we had to set a date, when would it be prudent and socially acceptable to return to normality?

A.- More than a date, it is a percentage of vaccination. We have started injecting doses on December 27 and we are halfway there, so the date would not be worth anything. But I think that when we have vaccinated 85% of the population it would be ideal. Or, at least, of those over 25 or 30 years old.

Q.- Will there be persistent Covid with future variants?

A.- Those types of rare effects, such as persistent Covid, the logical thing is that they end up disappearing and that the virus is focusing on being a classic respiratory infection.

Q.- How can we get the population to lose their fear of the virus when we have to live normally with it, once we are vaccinated for the first time?

A.- Our fear will be less when we have 85% of the population vaccinated. People's perception of the risk of the virus depends on the media. It is a social construct. If you never talk about meningitis or Nile fever, nobody knows if they exist, but if you beat people up every day, the perception of risk increases. It is purely variable. It has nothing to do with the real epidemiological risk.

Q.- Some countries imagine a future in which there are no data on the daily incidence of Covid and coexistence, with caution, but normally, with the virus. Will being infected with Covid end up being normalized?

A.- Whenever there is an excess of information and here there has been, both quantitatively and qualitatively, that generates noise and saturation. It happens with any subject. Epidemics are social phenomena and the perception of risk is changing.

And it is easy to change: it is enough for the President of the Government to say that this has been resolved for the media to repeat it in two weeks and the population to accept it. There are no more variable things than fashion and the perception of risk.