Spain had prepared for a summer without restrictions, without masks and without limitations to mobility or nightlife. But the picture has turned upside down. With 644 cases per 100,000 inhabitants, the current incidence triples the maximum reached in April during the fourth wave (230 cases) and has begun to impact hospitals and ICUs. The former register 62% more occupancy this week compared to the previous one and the number of patients in intensive care has grown by 50% in just seven days.
Upper-class contagion: the fifth wave begins in the ‘rich’ neighborhoods linked to leisure
Another rising indicator that worries Health is the positivity of diagnostic tests, which has gone from 4% to 16% in one month and in the younger population segments is around 20%. For comparison, at the worst moment of the third wave, 18% was reached and the WHO sees any percentage that exceeds 5% as worrying. This meter is useful to check the speed of increase in infections, but also to evaluate the tracking efforts of the autonomous communities, much less than last summer.
The reality is that many cases are being detected – not like at the beginning of the pandemic – and that the tests continue to multiply. Specifically, they have doubled to 1.2 million in one month. A high percentage of positivity can indicate that a good part of the close contacts of a positive have been infected; that there is a selection bias in people who undergo PCR because they have symptoms or suspicions of having contracted the disease; and that it is not being tracked as comprehensively as at other times in the pandemic.
Reconstructing the steps of each confirmed case and searching for the people it has been with is the laborious task of so-called trackers. “Last summer they were essential because the wave of infections impacted on an unimmunized population,” says José Martínez Olmos, former Secretary General of Health and professor of Public Health in Granada. They were in charge of stopping the sprouts in a time as delicate and with as much mobility as the summer. Although they already faced great challenges then, neither the teams were as depleted as they are now and their work was not as difficult. “This tracking is very different from last year and above with less staff”, summarizes Pedro Gullón, member of the Spanish Society of Epidemiology (SEE) and co-author of the book Epidemiocracy.
The big difference is the profile of the infected person, that is, “younger people who can generate between 50 or 60 contacts,” says the epidemiologist. “The objective of the tracing is to mitigate community transmission and now it is much more difficult because outbreaks occur in crowds, Primary Care is saturated and because complying with quarantines requires a certain will,” adds Martínez Olmos.
The Ministry of Health made a thousand Army trackers available to the communities two weeks ago to support health centers, but it has been insufficient with a daily average of 25,000 infections. For this reason, many authorities are opting for other types of measures that redraw an uneven map of restrictions.
Tracking, the least popular measure
Catalunya, Comunitat Valenciana and Cantabria are the strictest and have imposed curfews in the municipalities with the highest rates of infection. Others do not call it that, but for practical purposes it is similar. Euskadi, for example, has limited meetings between non-cohabitants from midnight to 6:00; and Andalusia has limited mobility from 2:00 in the morning, the closing time of nightlife, until 6:00. In the Canary Islands and Extremadura, justice has overturned the curfews, but it is not the only ace that governments have up their sleeve to stop the fifth wave.
To access the interior of the hotel industry, pubs or discos in Galicia, it will be necessary to have a negative PCR or the vaccination certificate. Indoor groups in the areas with the highest incidence have also been limited to six. Catalonia and Asturias have banned nightlife throughout the community, and Murcia all that is held indoors. The vast majority have advanced their closing time except Madrid, which continues to allow it until 3:00 in the morning and does not consider taking other types of measures.
This week the debate on imposing masks abroad again after the Balearic Islands decreed it and the Basque Country and Andalusia supported the motion. The Congress of Deputies, however, has voted in favor of the royal decree that made its use more flexible in the streets a month ago.
It is not correct to impose curfews, which in the end are confinements for hours, if at the same time Primary Care is not reinforced and trackers are not hired
“It is not correct to restrict mobility or impose curfews, which in the end are confinements for hours, if at the same time Primary Care is not reinforced and trackers are not hired,” defends Pedro Gullón. “The measures make sense when they are proportional to the rest of the assistance efforts. Tracing cannot be underestimated, especially when the disease is behaving in huge outbreaks and it is necessary to cut the transmission chains”, explains the epidemiologist.
Martínez Olmos, on the other hand, thinks otherwise. “Tracing right now is an absolutely insufficient operation. It is not an effective weapon against the pandemic because the magnitude is not the same nor does it have the same impact on health,” says the Public Health expert. In his view, “the only way to stop transmission is to avoid interactions.” “The overload of the Primary and the high rate of contagiousness lead us to new restrictions such as curfews and limitations on nightlife,” he lists. On the other hand, it defends that it is a way to avoid what already happened last year: the breach of quarantines and the recommendations of the trackers.
More disobedient than last year?
Saray is a nurse and tracker in Aragon, the third community with the worst epidemiological data after Catalonia and Navarra. With an incidence of 800 cases per 100,000 inhabitants, he acknowledges that his agendas are fuming. In fact, the Aragonese Government has announced this Wednesday that it will again request the help of the Army troops that the Government has made available to the autonomies. “I have been in this position since June 2020 and now we have reached the records of making between 200 and 250 calls daily, when the normal between waves is about 20 or 40”, compares the utility.
“Every time I find more people who do not know the name of the people they have been with or who forget to notify,” he says. He acknowledges that he also has to face all those who doubt the reliability of his postive because it coincides with the holidays, “they insist that they repeat the test and slow down the whole process.” “In summer, the percentage of people who are difficult to locate, who are out of town when you call, or who have more difficulties when it comes to isolating,” he admits.
In summer the percentage of people who are difficult to locate, who are out of town when you call or who have more difficulties when isolating increases
– Nurse and tracker in Aragon
Gullón identifies two factors that make quarantines more difficult to comply with than last year: “On the one hand, people are very tired and, on the other, there is a lot of confusion about the results of diagnostic tests.” Regarding the first, he believes that isolations can be facilitated through employment guarantees or housing alternatives. Regarding the second, contrary to epidemiological evidence, there are still close contacts with negative PCR that are believed to be safe or that they cannot infect. The most paradigmatic case was that of the macro outbreak in Mallorca, where justice overturned the quarantine for all those who had tested negative.
“The most frustrating thing is repeating the same thing over and over again and seeing that the messages do not penetrate the population, that many people still do not know how they have to protect themselves or others,” shares Saray, the Aragon tracker. On the other hand, “purely telephone service is very impersonal and many times people respond fatally to you because you are spoiling their vacations, a wedding or preventing them from visiting a relative.” That is why Gullón insists on the importance of the work of these teams when it comes to “communicating in a calm way”. “We try to be tactful with all situations, but many people do not take responsibility for their actions,” concludes the nurse.