Is it time to treat COVID like the flu?

Spanish Prime Minister Pedro Sánchez, for one, thinks the moment may have arrived. The leader of Spain’s government on Monday became the first leader of a major European country to call on the European Union to debate the possibility of treating COVID-19 as an endemic illness akin to the flu.

“The situation is not what we faced a year ago,” Sánchez said in a radio interview with Spain’s Cadena SER. “I think we have to evaluate the evolution of COVID to an endemic illness, from the pandemic we have faced up until now.”

Such a move, which would trade harsh lockdowns and daily infections counts for a system that would track COVID waves like it currently tracks the flu, runs in sharp contrast to the direction taken by COVID-zero proponents like China, which essentially isolated the 5 million residents of Anyang Tuesday from the rest of the country after discovering some 60 Omicron cases there.

Spain’s push could also run into resistance from European countries facing higher vaccine hesitancy, like Germany, which is aiming to introduce a tough vaccine mandate, and France, where President Emmanuel Macron said he wanted to “piss off” the unvaccinated by making it nearly impossible to engage in public life.

Citing Spain’s “exemplary” vaccine uptake—90.4% of Spanish residents over 11 have been fully vaccinated, and 85.3% of those over 60 have gotten a booster shot—Sánchez noted that with a fatality rate of 1% (down from 13% at the beginning of the first wave), it was time to respond to COVID with “new instruments.” These would include adding Pfizer’s antiviral pill Paxlovid—of which Sánchez announced Spain’s purchase of 344,000 doses—to vaccines and “self protection” measures like masks.

Please read: Is Omicron the beginning of the end-emic? Some countries ease COVID restrictions even as infections surge

The “sentinel” COVID monitoring system being developed by Spain’s health ministry mirrors the one used to monitor flu outbreaks in the country. It uses sample data from selected doctors to predict and respond to disease waves instead of trying to count every case with the test-and-trace system that can overwhelm health systems.

“Now, given [Omicron’s] enormous transmissibility, it is a huge challenge to strictly comply with universal surveillance protocols. It’s becoming impossible,” Amparo Larrauri, who heads the surveillance group for influenza and other respiratory viruses at Spain’s National Epidemiology Center, told the El País newspaper.

Professor Fernando Rodríguez Artalejo, an epidemiologist at the Autonomous University of Madrid, notes that Spain has for months been using the “sentinel” system to supplement cases counts, but that while the idea is “reasonable” it is “not clear” when it should begin to put less emphasis on hard case counts.

In recent weeks, Spain has approached Omicron—the country’s sixth COVID wave—with less severity than many other countries. In a bid to soften COVID’s blow to the economy and school system, it cut the isolation period for the COVID infected from 10 to seven days, and decided to quarantine students from classrooms only when five cases were found.

Not all epidemiologists are in agreement with Sánchez’s push to reconsider COVID, however.

“It’s premature to talk about the ‘flu-ization’ of COVID,” said Daniel López-Acuña, a former director at the WHO, in a TV interview Monday. “It is inappropriate to trivialize the sixth wave and think that we are in an endemic phase. This type of discourse does not obey a rigorous epidemiological analysis. It will happen in many months, not now.”

Spain has a vested interest in other countries adopting milder restrictions that allow for travel, as before the pandemic more than 12% of its GDP came from the tourism industry.