When does a pandemic end now that the evidence suggests that the virus will not completely disappear? What is the long-awaited normality and when can it be said that we reached it? If last week the autonomous communities began to withdraw the toughest restrictions to avoid infections, in recent days the regional governments have been announcing the end of all or almost all the measures that depend on their powers. The incidence has fallen an average of 30% throughout Spain in the last 7 days and is already below 100 cases, the lowest figure in the last year.
Incidence falls below 100 cases for the first time since June
Some Health Councilors, such as that of Castilla y León, already advance that “it is getting closer and closer to being able to start a completely normal life.” When? “In the next weeks”. The mask, regulated at the national level, still has a while. All the epidemiologists consulted agree that it will be the most lasting testimony of what the world has experienced in the last year and a half. And they warn that this has not ended. “We health workers are not exaggerated when we ask for caution. We do not have the domesticated coronavirus. We understand that the population wants to return to normal and think that the nightmare is over,” says Javier Segura, vice president of the Madrid Public Health Association.
The fall in restrictions has occurred in cascade with open complaints from some regions that consider that we are facing a new “race” in this second de-escalation. The Community of Madrid, whose government of the PP has distinguished itself by having the most lax measures in all of Spain, makes the closing hours of nightlife disappear from Monday. The clubs will be allowed to open until 6 in the morning, although it is still forbidden to use the dance floors. “We are going to be doing a permanent review, the downward behavior invites us to optimism and if it continues like this the decision on new measures will come sooner rather than later,” said the Madrid councilor, Enrique Ruiz Escudero.
The Basque Country will allow dancing in discos but only until three. It is the first time that the Basque Government has opened this type of establishment since the declaration of the state of alarm in March 2020, although it remembers that the current incidence (147) is double the one it considers optimal to deactivate more preventive measures, such as traffic gauges. of commerce, cinema or culture to 75%. Extremadura, Madrid and Castilla y León are already leaving behind the limitations to the capacity of the premises. The maximum number of diners allowed in the same group also grows: in Aragon there are up to 15 on a terrace; in Madrid, 10. Hugs, physical contact, with family members return to the residences for the elderly in the Valencian Community, although always with a mask and correct hand hygiene.
The traffic light review
The Minister of Health, Carolina Darias, launched a message to the communities after the Interterritorial Council this week. “It would be desirable to relax measures progressively and gradually, always within the shared scope of the council,” he said. But there is irrefutable evidence that shows that the control of the pandemic is much more solid than a few months ago and that we are one step away from the desired normality.
One is vaccination coverage, which reduces the chances of infection and the danger of serious illness. The other, the revision of the semaphore of risk levels to adapt it to the current situation, with 75% of the population immunized. The modification of these parameters confirms, on the other hand, that coexistence with the virus will be long, since it will serve to act in cases of rebound. Epidemiologists assume that there will be peaks and valleys, but never as severe as those experienced so far.
The Madrid Public Health Association asks the Government to consider in its review with the technicians “the overload of Primary Care”, in addition to “the occupation of beds in hospitals” as factors to take into account. “It is going to determine a lot if a dam is put in front of the new transmission,” says Segura. The so-called “COVID-19 traffic light”, approved in October 2020, includes five alert levels – including the new normal – and being at one or the other depends on the following indicators: cumulative incidence in 14 and 7 days in the general population and in people over 65 years of age, traceability, positivity and occupation of ICU beds.
Nightlife, the last frontier
The last barrier in de-escalation is nightlife. The experience of last summer, with reopening that had to be reversed in a few weeks, has kept the premises closed in most communities during the last year. Nobody wanted to risk it again and the COVID certificate has been put back on the table of the Ministry of Health to be able to access the bars.
The PP communities, taking advantage of the Supreme Court ruling that endorses the measure in Galicia, pressure the Government to draw up a national regulation that exempts them from having to go through the judicial filter, although some privately recognize that now it makes little sense for the high percentage of vaccinated population. The nightlife employers’ association demonstrated this week in front of the Ministry of Health: it demands that the locals recover 100% of their activity (capacity, schedules and dance floors) before October 1.
The new stage will require significant control of outbreaks through tracing, according to epidemiologists. “It is important to avoid them, because it means that in a specific situation many people are suddenly infected. Those who are exposed to a source of infection must be investigated quickly and quarantined”, indicates Pere Godoy, president of the Spanish Society of Epidemiology. It is almost a consensus that the virus will continue with us with the available vaccines. “Eliminating it is not feasible, which does not mean that having a highly vaccinated population does not achieve a barrier immunity that helps to keep transmission at low levels,” he says. “Decisions must be made taking into account the ability to respond to outbreaks,” adds Segura, who agrees that “tracking has always been important and now too.”
Even more so taking into account one of the most relevant changes in the protocol of the Ministry of Health in case management: the exemption from quarantine for close contacts of those infected for vaccinated people. The guidelines recommend PCR, but not system isolation. “The close contacts vaccinated are candidates to monitor and verify that they have not been infected. But if tests are done, it would be enough,” argues Godoy, who does not rule out going back to more drastic measures. “Experience will tell us,” he concludes.
There is also consensus among experts on what will be the last measure to be removed: the indoor mask. The vice president of the Madrid Epidemiology Association considers that until 90% of the vaccinated population is reached, it should be maintained. “From there, as long as there is an incidence of less than 25 and worrying variants are not circulating, we can experiment by controlling what the result is. We must take into account precedents that teach us, such as what has happened in the United Kingdom,” he says .