The Community of Madrid is going to retest the close contacts of people who have tested positive for the coronavirus. In a new modification of the protocol, dated November 20, the Ministry of Health has incorporated the "social field" and exemplifies with "non-living relatives, friends, others" to the list of people who from now on are they should be given a PCR or rapid antigen test. Thus modifies the previous protocol, approved on September 28, and that it had restricted the tests only to certain cases and people with symptoms, who once identified go on to be treated as suspected cases.
"In the current epidemiological situation, performing a diagnostic test for acute infection in close contacts is indicated in: partners, vulnerable people, people who care for vulnerable people, social environment (non-living relatives, friends, others), health environments and socio-sanitary and in situations of special risk that establishes public health ", establishes the new document. In the previous one, the social sphere was excluded, so that if, for example, from a lunch or dinner with friends, an assistant was confirmed as a COVID-19 case the next day, none of the companions was subjected to a test. In any case, all close contacts of a positive must be quarantined for ten days regardless of whether they are diagnosed or not, the text recalls.
As specified by the Ministry of Health, this update of the protocol is not applied in educational centers, which has its own strategy and where tests have also been restricted since last September. Since then, when a student or teacher tests positive, the rest will not be tested, unless they show symptoms. Of course, all of them must continue to do, as before, the ten-day quarantine.
The protocol change two months ago not only served to stop testing close contacts, but also indicated as a priority test for those who did meet the requirements, a rapid antigen test and only "depending on availability and operability", a PCR. With the new document, this is the same as before and PCR is prioritized over antigen, except in residences and healthcare settings. In September, these modifications coincided with a sharp drop in infections, and at the same time with a huge decrease in PCRs performed and a massive escalation of cheaper and faster antigen tests. The community gradually replaced the use of PCR with these rapid tests and infections continued to decline, although at a much slower rate than after the first fall.
The Ministry of Health acknowledges that the previous protocol of September 28 that stopped testing close contacts of people without symptoms –except for some exceptions– was due to the "significant demand" for tests that forced them to "establish priorities." "In our case, the priority to carry out a diagnostic test for active infection (PDIA) are severe or vulnerable symptomatic patients, followed by patients who need hospital admission for other pathologies and other patients with symptoms, in addition to outbreaks in areas such as health, social or educational centers ", they add from the department headed by Enrique Ruiz Escudero.
At a time of saturation due to the increase in infections such as the one that the region has experienced, restricting the tests that are done to close contacts is one of the possibilities to relieve pressure in laboratories, but it implies less detection of cases and , in short, seeing only "the tip of the iceberg" of the coronavirus. The incidence figures depend to a large extent on the diagnostic strategy that is carried out, so when the Government of Isabel Díaz-Ayuso made the decision, epidemiologists and public health experts warned that Madrid would miss at least part of the virus transmission in the community because many cases would never be tested. But, in addition, at the same time, massive screening began in areas that had a high incidence of coronavirus in September.
A strategy contrary to the recommendations, which prioritize looking for cases where there are more chances of finding them (for example, close contacts) compared to random tests that end up identifying few infections: from September 29 to November 12, Madrid did 319,283 test in these massive screenings, but only found 1,243 positives.