Wednesday, July 6

The autonomous communities try to combat the rise of infections with more tests and limitations to nightlife

Downshift in the de-escalation. The epidemiological panorama has turned upside down in just two weeks: on June 21, Spain celebrated having reached the lowest incidence since last summer, with 92 cases per 100,000 inhabitants, and this Monday it has multiplied to 204. The explosion of infections among young people has ushered in another different phase of the pandemic. Its impact on ICU admissions and deaths is less due to vaccination, but it is not without consequences.

The explosion of infections among young people complicates the summer in Spain

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Primary Care is going to receive the hardest blow from this rebound as it faces a summer with low workforces and tempers touched. The more infections, the greater the work of diagnosis, tracking and monitoring of COVID and the less attention paid to other pathologies that have been relegated for a year and a half. Although the healthcare pressure is still under control, some hospitals, such as the Catalans or the Canaries, have already noticed a rebound in patients that also reflects the Health data: the number of hospitalized has gone from 2,495 last week to 2,723 in this Monday.

Fernando Simón, director of the Center for Health Alerts and Emergencies, said that these are the indicators that we should start looking at from now on. “The one that should concern us most right now are vaccines,” Simón pointed out. The danger of overloading the health system is in Public Health, “which has not stopped at any time, since January 2020, even before the state of alarm, from working with enormous intensity and dedication”, and in Primary Care, “which It has had a very important pressure since March 2020 and that, due to the current type of transmission, has an increasing pressure every day “. “Summer implies vacations, and although some may not believe it, health professionals need to rest,” the spokesman snapped.

Furthermore, this rise has also had an immediate effect on Spain’s image abroad. Germany has included Catalonia and Cantabria among the risk areas for tourism. The first has added more than 21,658 infections in a week and the second has tripled its incidence. The ECDC map paints half of Spain red and the other half orange. Two colors that do not favor the perception of control of the pandemic at the beginning of the tourist season.

Communities must face a dilemma that cannot be solved without sacrificing something. The opening of the economy and the relaxation of measures in certain sectors is a claim for tourism, and also a detriment to the figures of the pandemic, which ends up having vetoes or negative recommendations such as those of Germany. The macro outbreak in the Balearic Islands, a product of end-of-year trips with hardly any sanitary restrictions, has been the proof. The national and foreign media spots have settled on a community that lives off tourism and that has been the origin of an outbreak with almost 2,000 infections at once.

“The issue is complex and what it shows is the false dichotomy that still exists between health and finance. The summer economy is highly focused on foreign tourism, but it was a bad strategy to advance the abrupt relaxation of the measures,” he says Javier Segura, vice president of the Madrid Public Health Association (AMaSaP). The health worker was part of the Ministry’s de-escalation committee last year and believes that some errors and trends are being repeated, with the notable difference of vaccination. “Last year the situation exploded with outbreaks of seasonal workers and this year it has been with end-of-year trips,” he compares, but believes that the effect will be similar: a rise in infections as a result of interactions and mobility.

The issue is complex and what it shows is the false dichotomy that still exists between health and finances. The summer economy is very focused on foreign tourism, but it was a bad strategy to anticipate the abrupt relaxation of the measures

Javier Segura
– Vice President of AMaSaP

Faced with this, the regions are reacting with different severity. The Balearic Islands has slowed down its complete de-escalation for a few weeks and has somewhat limited the capacity of the hotel industry. The entertainment venues can accommodate 100 people indoors and 200 outdoors, and in bars the maximum occupancy of tables is once again 6 indoors and 10 outdoors. On the other hand, Cantabria has closed its discos in 16 municipalities and has advanced the closing time in the rest to 2:00 in the morning, when until now it was until 6:00. Catalonia has also advanced a package of “surgical” measures that will be discussed with the most affected sectors and proposes that antigen tests be carried out to enter the nightlife. Navarra has also advanced the closure of cocktail bars and locals at 1:00 in the morning for 15 days.

Madrid, Murcia, Euskadi or Andalusia have confirmed that they are also studying taking measures in the face of the rebound. “We are in a season of adjustment and we must continue to preserve public health, which will always be the objective but maintaining a balance with economic activity,” said Enrique López Escudero, Minister of the Presidency of the Community of Madrid. Fernando López Miras, president of Murcia, has asked the population for responsibility or, otherwise, July and August will be very different from what we proposed a few weeks ago. ”

Restrictions on nightlife are the route that has the most consensus among the autonomous communities, but it should not be the only thing, according to epidemiologists. “Most are choosing not to advance in the de-escalation of nightlife or even to climb a little again because it is a place that concentrates people of the most exposed age range and where supercontagating events are more likely to occur”, understands Pedro Gullón , member of the Spanish Society of Epidemiology (SEE). “Some have gone their own way and have affected the entire sector”, shares Ildefonso Hernández, spokesperson for the Spanish Society of Public Health SESPAS. “Whatever they say, it is a high-risk activity,” Javier Segura ditches.

I recommend three things: put limitations on sectors that violate the rules or are the direct cause of problems; no vaccine remains in the fridge; and increase control over interiors

Ildefonso Hernandez
– Spokesperson for the Spanish Society of Public Health SESPAS

However, all are committed to limiting closures only to sites that have very triggered incidents. “There is no urgent need to take global restrictions,” acknowledges Hernández. But yes “local measures that include several things: putting limitations on sectors that violate the rules or are a direct cause of problems; administer all the vaccines and not leave any in the fridge; and increase control over the interiors, both in the leisure as in the workplace “, lists the epidemiologist.

Segura, from AMaSaP, emphasizes the latter so as not to fall into “crude analysis”. “Targeting the youth, as a whole, is a way of escaping from finer analyzes and studying how many of these young people are also being infected in their work environments,” says the expert. A good part of the sick leave due to COVID in 2020 occurred in the most precarious trades, such as seasonal workers or waiters.

In assuming responsibilities, the work of politicians and businessmen also stands out. “If it has already been seen that the fuze is the massive study trips and they continue to be advertised on the webs. What has changed?” “The responsibility also exists on the part of the administration.” In fact, this Monday Fernando Simón has broken a spear in favor of young people – “it is not because they are young, it is because they are groups that are not vaccinated” – and he has taken the opportunity to thank them for their behavior during the 17 months of the pandemic.

Screening, tracking and strict confinements

The pending issue of the health authorities for this summer is once again the tracking of cases and early detection. For the experts, this is the reason that the data has exploded in a matter of two weeks: it had stopped being tracked. “We must go back to doing massive screening and tracking of outbreaks”, bet Ildefonso Hernández.

“It is important to opt for teleworking, avoiding indoors and limiting crowds in contexts of leisure and worship,” he adds. In a context in which summer parties bring together hundreds of people, epidemiologists point out that it makes no sense to limit them outdoors if they are later to gather indoors in less salubrious conditions. A clear example is what has happened in the festivals of the Basque town of Hernani, which multiplied the incidence tenfold in one week.

More than mass screening, it is urgent to expand the concept of “close contact” so that the same thing as in Palma does not happen

Pedro Gullon
– Epidemiologist and member of the SEE

Regarding mass screening, Pedro Gullón recalls that not everything goes: “If you do them but you don’t make it easier for people to quarantine or you don’t have systems to track positive ones, it doesn’t make any sense.” The SEE epidemiologist opts for selective or targeted screening, for example, of people returning from study trips. This is what Pamplona has done and has registered 50% of new positives. It is also urgent to expand the concept of close contact so that what happened in Palma does not happen and includes all those who go to a nightclub, if necessary. In this sense, Gullón recommends the United Kingdom’s triple strategy: trace (search), test (diagnosis) and isolate (quarantines). “Everything else is to stay half”, he assures.

To find the difficult balance between economic recovery and sanitary control, Ildefonso Hernández opts for “strong sanitary measures”. That is to say, “to give the feeling that the outbreaks are controlled quickly, to make screening and to increase the perception of the security of the population avoiding the visible massive agglomerations”.