Wednesday, January 19

The explosion of cases increases the pressure to return to old restrictions

26,136 new cases one day, 27,140 the next, 28,900 more the next, 33,359 the next … The daily infections of coronavirus notified by the autonomous communities to the Ministry of Health during the last week reveal a growth of the sixth wave that seems unstoppable and which is redoubling the pressure on governments to return to old restrictions, such as the closure of nightlife, the reduction of seats in the interiors of the hotel industry or the limitation of the number of diners per table. It is the first time that the country faces a significant wave of infections with the shield granted by vaccination, a fact that is delaying, according to several epidemiologists consulted, the implementation of more severe measures to curb the spread of the virus.

Two doses or a previous infection barely prevents infection with omicron, according to data from the United Kingdom

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All agree that Spain “is late” to stop the rise in infections that began at the end of October and that in recent weeks has accelerated, and that despite the feeling that the official statistics are leaving many cases out of. “It is possible that there is underdiagnosis”, reflects the professor of Preventive Medicine at the Autonomous University of Madrid Fernando Rodríguez Artalejo. “Another thing is what the magnitude is. Throughout the pandemic it has been underdiagnosed: at first a lot, because there were no tests. Now there is a lot of self-diagnosis not confirmed by PCR and therefore not reported to the health system”, which does not appear in the figures reported by Health.

The Government of Cantabria has been the first to take a step forward to close the nightclubs before, but it has run into the refusal of the justice, which has accepted the precautionary measures of the hotel management association, claiming that the measure is not “essential” due to the epidemiological situation. The Generalitat de Catalunya opens to study new restrictions next week and, given the advance of omicron, has already decreed a mandatory quarantine for all close contacts. Also vaccinated, who in the national protocol are still exempt from doing it. Meanwhile, the Community of Madrid advances that “complicated weeks” will come, although it has not anticipated measures. The “normality” speech of the regional president, Isabel Díaz Ayuso, has turned in just a few days. “We have to prepare to see news of new infections and new outbreaks,” Ayuso warned this Friday. Finally, Navarra has limited itself to recommending to its citizens that they limit to ten groups for Christmas lunches and dinners.

These territories begin to move on their own, and it was this Saturday, a few days before Christmas Eve, when it was learned that Sánchez will convene this week a Conference of Presidents to “analyze and evaluate the situation” and “share possible solutions always from the co-governance “. Spain is at the maximum level of contagion risk, with more than 500 cases per 100,000 inhabitants in the last 14 days and, in the Alerts Report, made up of epidemiologists from the Ministry and the communities, they have been working on several documents with measures, as confirmed by sources close to the technical body. A conflict with the communities over the implementation of restrictions with Christmas just around the corner would be a significant drain on the Government and, indirectly, would send a reverse message that would counter the optimism generated by a very successful vaccination campaign, which It has earned it the recognition of international organizations such as the WHO or the European Union.

Fernando Simón, director of the Center for the Coordination of Health Alerts and Emergencies, asked on Friday about restrictions on mobility and schedules, said that they are “options that must be kept in mind, depending on the epidemiological situation,” of which he affirmed that “we are in a phase of clear ascent”, and recalled that Spain is behind other European countries that have already applied them.

The president of the Community of Madrid, Isabel Díaz Ayuso, has closed to take new restrictions hours after Moncloa’s announcement of a new conference of presidents: “There are weeks of a lot of contagion due to the new variant of Covid but this is not like the For this reason, we consider that we must continue with the same policies. Caution, massive vaccination and without closures or more prohibitions. ” Madrid accumulates a cumulative incidence of 484 cases per 100,000 inhabitants in the last 14 days.

Medium-term healthcare consequences

But letting the virus circulate without restrictions – beyond the COVID passport, widely established in Spain – is going to have consequences in the medium term at the healthcare level, epidemiologists such as Fernando Rodríguez Artalejo assume. “The feeling is that the administrations are trusting that vaccination will be sufficient because it helps to control the problem and that in most communities the care pressure has not yet been overwhelming, although there are some with an ICU occupation level more than 20%. With the increase in incidence, there will end up being more hospitalized “, summarizes the professor of Preventive Medicine at the Autonomous University of Madrid, in favor of implementing restrictions” in all those areas where we know that there will be unprotected social interaction “, such as nightlife or hospitality, because “we know they are a source of contagion.”

Seven communities have more than 15% of their ICU beds occupied with COVID-19 patients, with Catalonia and the Basque Country leading the way. In these two territories, the occupation exceeds 20%, according to the latest Health data. After the collapse of Primary Care that communities like Madrid are already experiencing, the next step is the hospitals. Although immunization substantially reduces the possibility of ending up hospitalized for COVID-19, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) already warns that in the regions with the highest incidence, such as Euskadi or Navarra, there are beginning to be some problems and it is urgent to act.

How is the epidemic evolving now?

Evolution of the cases and deaths reported, those hospitalized and those admitted to the ICU each day and the variation in the last 7 days

Source: Ministry of Health

Pedro Gullón, epidemiologist and professor at the University of Alcalá de Henares, recalls that the “current incidence will be seen in two or three weeks in hospitals.” “It is already happening a little in provinces with the aging population and without much hospital capacity, such as Castilla y León or Asturias,” he explains. Rodríguez Artalejo adds another factor that would push us to act now: “It is not just a health issue, but a social disruption. COVID cases, despite being mild, are socially destructive. Families have to stay with the children if they don’t go to school because they are isolated, students cannot examine themselves if they have been positive, sick leave … ”

“The discourse that the vaccine was going to solve everything is not like that. We must undo the constant appeals to the occupation of ICUs and vaccines because the reality is complex. Increasing the incidence is a problem,” says epidemiologist Anna Llupià , a researcher at the Barcelona Institute of Global Health, who considers that the current approach is aimed at “reducing mortality” but accepts “living with some damage”, which leads to fatigue and mistrust. Both she and Gullón, with hindsight, have been warning for weeks that in order to avoid reaching the point we have reached, “less aggressive” measures with “less impact” should have been taken, such as promoting teleworking or improving the tracking system. a problem that Spain has dragged on since the beginning of the pandemic and that is now manifesting itself again with the rise in cases.