Spain is close to the 260,000 confirmed cases of COVID-19 since the start of the pandemic, but more than four months have passed and what we saw in March is not the same as what we see now. Many more tests are done than then, positives and their contacts are tracked and the system has more information about them. What do we know about the infected? The Carlos III Health Institute has just prepared an analysis of the 23,000 cases since May 10, when the notification system changed coinciding with the start of the de-escalation. Since then, he had not published such reports, previously newspapers.
In total there are 22,997 cases reported by the autonomous communities to the National Network of Epidemiological Surveillance (RENAVE), which is in turn where Health now drinks to communicate its daily balances. As happened before May 10, 56% of the positives are still women, but the median age (the central number of the fork) has changed and has gone from 60 to 48 years. In these two months , the proportion of cases in lower age ranges has increased, while it has decreased in the older ones: if before May 10, those under 30 accounted for 7% of the total, they are now 25%. This is the case until the age of 49, but from there the trend reverses. Of the total infected, 7.1% and 12.9% are aged between 70 and 79 and over 80. These ranges previously reached percentages of 13.5% in the first case and 23.8% In a second.
The ISCIII also provides the proportion of hospitalizations, ICU admissions and deaths that occur now. All three variables have decreased. Of the total number of notifications collected by the agency until mid-May, 38.4% were hospitalized, but now they are 9.1%. On the other hand, 3.9% required intensive care compared to 0.7% from May 10 to July 15 and 8.2% died compared to the current 0.9% of deaths.
As before, hospitalization increases with age, since the virus is more dangerous for older men and those with previous pathologies, but there are changes in the level of income in the lower age ranges. An example: those under 30 years accounted for 2.2% of those hospitalized in the first months and now they are 10.8%. On the other hand, from 50 to 79, the proportion of income is lower than before May, but in those over 80 it remains practically the same and even rises a little. On the other hand, there were no significant changes in deaths.
The factors of these changes can be diverse. Fernando Simón, director of the Center for Health Alerts and Emergencies, has been referring to this decrease in age for days and blaming it both on the situation of seasonal workers and the risky conditions in which they live and work, and on the attitude of “young people and not so young “and the relaxation of protection measures. According to some experts, younger people they would be trying to squeeze time and the feeling of freedom In the face of the risk of future confinements, and in fact, we are seeing outbreaks in leisure areas, discotheques, bars … facing greater protection for the elderly and a situation of relief in residences, hit hard by the epidemic.
But there is also another explanation: “At the beginning there was only the capacity to diagnose the most serious cases, which were the oldest, that is, it was the age profile that we observed. Before we saw only a small part of the iceberg, but now we see much more and low age, “says Pedro Gullón, from the Spanish Society of Epidemiology (SEE). In other words, if more PCR are performed and younger cases are detected, this percentage will increase and that of the elderly will decrease: “If we had ten weekly cases of people over 80, but the total was 100, it was 10 %, but if we enlarge the image and see 200, instead of 10% they will become 5% “, exemplifies the expert.
In March and April, those infected with mild symptoms were not tested in order to avoid further pressure on the healthcare system, in many places on the verge of collapse. But now, after the early detection strategy came into effect in mid-May, any suspects must be PCR-tested and a search is made of their close contacts who must also be tested. If they test positive, they go on to increase the statistics.
Where do infections come from
In line with the above, the ISCIII data also reveal that case fatality has decreased in all age ranges, reaching 21.8% to 4.7% in those over 80 years of age. Gullón believes that “if before we were only able to identify the most serious cases, the number of those diagnosed was very close to that of the deceased, which is how lethality is obtained, whereas now, when we see a much larger image, it is not So”. The expert also points out, as a possible reason for more hospitalizations at younger ages, that with health systems at the limit, the priority in admissions was the most acute, but now it is possible that there are young people hospitalized with clinical symptoms. that at that time were reduced to home care.
This increased detection capacity of the system is also carried over to the time it takes to detect a case. In March and April, the days between a person starting symptoms until they underwent a PCR was between three and eleven, but now it has been reduced to between one and five, with differences between autonomous communities. The maximum time is, in general, four or five days in all the autonomous communities except Castilla-La Mancha, Castilla y León or Madrid, which reaches six, and Murcia, which can reach seven days. On the other side, Galicia, the Canary Islands, Navarra and the Basque Country are the ones that diagnose the fastest, with a maximum of four days of waiting.
If we analyze where the cases have come from since the start of the de-escalation, they are mainly distributed among five territories. By far, Catalonia is the community that has increased its positives the most, going from 22% in the first two months to 41.7% of the total. It is followed by Madrid (19.8%), but where they have dropped, and Aragon, which, as in the Catalan case, is registering strong outbreaks that have triggered the infections and they already represent 7.1% of the 23,000 analyzed by the ISCIII. Castilla-La Mancha and Castilla y León are the fourth and fifth communities that report the most cases.
Asymptomatic and contagious at home
Also according to the increase in tests associated with the outbreaks that are taking place, many of the new cases do not report symptoms, as Fernando Simón has already reported, so, as the ISCIII confirms, the increase in those infected does not translate into excessive pressure in hospitals. In fact, according to the body itself, the evolution of cases and hospitalizations showed a “downward trend” until mid-June, but there began to increase the positives that, in fact, reached their weekly ceiling this Thursday by the outbreaks of Catalonia and Aragon. However, overall, and despite the rise in positives, hospitalizations, ICU admissions and deaths “maintain a trend towards stability”.
Their figures show that more than half of the cases (56%) are asymptomatic or presymptomatic, that is, they are diagnosed as positive before developing them. The director of the Center for Health Alerts and Emergencies has spoken these days of even 60% or 70%, but it must be borne in mind that the report of the Carlos III Health Institute covers two months in which PCRs have been progressively increasing. However, experts call for vigilance even though most are asymptomatic because if the percentage “does not stop growing, a transmission chain always ends up reaching risk groups. And that can lead to a complication of the situation,” he says in this interview Pere Godoy, president of the Spanish Society of Epidemiology (SEE) and the epidemiologist responsible for the Lleida area.
Finally, of the 23,000 cases studied, one in four was infected from May 10 at home, 14.3% in a social health center, mostly nursing homes, and 11% in the workplace. However, in recent weeks, mainly family outbreaks have been found, among workers in the fruit and vegetable industry or associated with leisure areas, so the proportion may be different today. In most cases, specifically 36.9%, the possible scope of exposure to the virus is unknown.