With the “new normal” has come the revival of social and economic life and, with it, the outbreaks of coronavirus. Whether or not the decisions that the health authorities make from now on will be controlled and that is precisely where the tension will be until an effective vaccine arrives. We are already seeing it with the cases of Catalonia, A Mariña (Lugo) or Aragón, with worrying outbreaks that have reached a certain degree of community transmission. In this scenario, measures such as confinements of entire buildings, perimeter closures or phase regressions arise. What difference is there between them? What do they depend on? Based on what criteria are taken?
What is isolation, quarantine, and confinement?
Isolation, quarantine, confinement … These terms that we use so much now, sometimes interchangeably, have their differences. As explained by Joan Ramón Villalbí, spokesperson for the Spanish Society of Public Health and Health Administration (Sespas), isolation refers to sick or infected people, who must be separated from the rest, even within their own home, to avoid infection. We usually use quarantine for close contacts of confirmed cases. That is, when the tracking systems identify and find a person who has been less than two meters and more than 15 minutes with a positive, they must quarantine and only leave in case of extreme need.
And the confinement? “It is actually a bit the same, but it has different social meanings. We use it to describe when a population is confined within limits, that is, in a more massive way because we understand that all that group is, in some way, exposed to the virus, “says Pedro Gullón, member of the Spanish Society of Epidemiology (SEE). This is what we are seeing these weeks as a measure to stop some outbreaks, although on a different scale; a “spectrum of options” that “is modulated according to the observed transmission”.
On what do one or the other measures depend?
The most selective and localized or more generalized action depends on the degree and the form of transmission that the virus adopts in a territory. “When there is a lot of contagion that you are not able to establish the source of, that is, you cannot keep track of the infections, there you have to adopt more drastic measures that affect more people. When we understand the origin of the cases, we can act in a surgical way, “says Villalbí. This is what happens in Catalonia and Aragon, where there is community transmission and the positives cannot be associated with specific outbreaks. Along the same lines, Gullón explains: “It is not just a matter of the number of cases, but of whether you are capable of controlling them, that is, of identifying and isolating the chain of transmission.” When “there are cases that you are not able to connect to any other known point and trace the chain, it is not associated with an outbreak. The increase is worrying.”
Can a building be confined?
Yes. This is an example of micro confinement. So far it has already happened twice. The first in Santander, where at the end of June it was decided to isolate an entire apartment block for ten days after detecting an outbreak with 13 positives among the neighbors. All of them underwent PCR. Days later, the same happened in Albacete, which has confined another residential building on Calle Baños after detecting two intra-family outbreaks on two floors. This is a way of acting in a surgical and localized way with the aim of cutting at the root, something that can be done when the transmission chain is identified, that is, when the health authorities are able to identify the positives and their contacts. The meaning, says Villalbí, is that “if there are several cases on the same farm and it is very concentrated, it is tried not to expand, for example, through the elevator, the switches …”.
What is a perimeter closure?
Another of the formulas that we are seeing are the so-called perimeter closures, a type of confinement that basically consists of population isolation. This is what has happened in the regions of A Mariña (Lugo) and Segrià, in Catalonia. They are not home confinements, but the entrances and exits of an area are restricted with some justified exceptions such as work issues.
After a feint by the Generalitat de Catalunya to prevent citizens from leaving their homes and after justice opposed the measure, it has finally been ruled out, according to the order approved this week, and what is done is to limit the exits from the area affected by the outbreak and which encompasses the municipalities of Lleida, Alcarràs, Aitona, Granja d’Escarp, Seròs, Soses and Torres de Segre.
“Basically it is to assume that in a specific area there is a high degree of transmission of the virus and try not to spread it outside. The idea is to protect outsiders from those inside. At that point it is very likely if people start having attitudes of total quasi-confinement “, describes Gullón. According to the plan developed by Health To stop the outbreaks, it is a high risk scenario and when the incidence of COVID-19 begins to increase exponentially and community transmission is detected, that is, when several cases are detected that do not have a known source or origin and do not they are associated with the identified outbreaks.
And the confinement in the houses?
Restricting mobility more severely, that is, preventing people from leaving their homes, as happened at the beginning of the confinement, is currently one of the measures that it is not clear that the autonomous communities can carry out. Following the intention expressed by the Government of Catalonia, a legal-political debate was opened that has not ended. Precisely, the Lleida guard judge denied it, considering that the law that in principle could protect him (Organic Law on Special Measures in Public Health Matters of 1986) is too “ambiguous”. In other words, there is “legal insecurity” and legal gaps, according to various experts, which make this severe confinement viable or not, depending on the interpretation made by the judges, who must endorse all these measures.
Another thing is the recommendations to stay at home, which have already been issued by the Catalan governments in the case of Barcelona and its metropolitan area, and Aragonese for Zaragoza. The authorities have asked the neighbors not to leave their homes except for what is essential due to the increase in cases.
Can there be restrictions such as de-escalation?
Yes. Right from the start of the de-escalation Health and experts repeatedly warned that the process could involve steps back. The most paradigmatic example right now is that of Aragon, where the health authorities, due to the rate of increase in positives, have decided declare a phase 2 “relaxed” in the cities of Zaragoza and Huesca. In these cases, stricter restrictions on seating in shops, bars or terraces, a ban on visits to residential centers or limitations on the number of people per meeting are re-approved. They are not geographical restrictions, like those of A Mariña or Lleida.
These types of measures are also being taken in other places in a localized way and also complement the confinements in A Mariña and Segrià. In Barcelona and its metropolitan area The opening to the public of theaters and cinemas, the activity of gyms and nightlife establishments, such as nightclubs and nightclubs, as well as indoor sports events have been suspended. In bars and restaurants the capacity inside the establishments is limited to 50%. Also in Gipuzkoa several localities have decided to impose restrictive measures in the capacity of bars and restaurants and nightlife venues due to the outbreaks identified in this type of meeting.
Is a new alarm state possible?
It is the last resort. According to the Health plan, it would be applied ultimately if there is a scenario of “uncontrolled community transmission” or “sustained with increasing pressure”. It could be done in specific territories and also, if the situation so requires, throughout the country, as has already happened since March 15.