The 67 active outbreaks shoot the number of infections and the concern of Health


Two and a half weeks after the 'new normal' began, in Spain there are already 67 active outbreaks of COVID-19. Every day the number increases: on June 23 there were 12. Minister Salvador Illa told it this Wednesday in an interview in Catalunya Ràdio. He has admitted that he follows them with "concern", but also that they knew and know that "there will be outbreaks, there have been in all countries." Those that concern him most are those in Segrià (Lleida) and A Mariña (Lugo), regions where more restrictive measures have been required.

Cases are also rising after the de-escalation. This Wednesday there have been 257 notifications, double that of Tuesday, when 124 were notified. Aragon, where there is also a major outbreak - in several regions of Huesca - and Catalonia are at the forefront. The heads of Public Health and Health Alerts and Health Emergencies of the Ministry, Pilar Aparicio and Fernando Simón, have met this Wednesday with the representatives of those two communities and also Madrid, another of the communities that leads the incidence but which for now has only reported an outbreak of 5 people. Dialogue with all the territories is "very fluid," Illa also declared, admitting that there are also outbreaks that are closely watched in the Basque Country, Cantabria and Andalusia.

Evolution of new daily cases by date of onset of symptoms

Rhythm of new daily cases by symptom onset date. The blue line shows the weekly average of new daily cases

Source: Ministry of Health

According to the Ministry's protocol, a chain transmission of COVID-19 between 3 people is considered an outbreak, except when it is intra-family –this number is more lax and it is not necessary to notify it– and when it is in a residence –a single diagnosis is enough to that the alert be activated due to the high vulnerability of the users of those centers. Simón has spent several days explaining in press conferences that around 60% of the new people detected are asymptomatic, and that is good news: although the figures rise, the profile of the patients is not the same as in April, when only I did a PCR test on serious people who came to hospitals. Now, more than half of the cases are resolved with home isolation and without hospital treatment. The average age has also dropped by about 10 years in these weeks, as reported by Health: it is 47 years for confirmed men and 50 for women.

"The epidemiological curve is altered with respect to what we have seen in previous months, among other things because transmission chains occur among young people. But, when they get out of control, they can still create serious problems: it is being seen in Lleida, where There is a rise in income in the ICU, "notes Ildefonso Hernández, spokesperson for the Spanish Society of Epidemiology, on all these variations.

He also views the figures with "concern." "We have been insisting all the time that it is not a joke, it is necessary to forcefully reinforce public health for this stage." "People have a perception that risk decreases and relaxes, in social life and in the workplace. Especially in islands and communities where there have been no cases for weeks. But it must be remembered that the population is dynamic and travels, and there will be infections again in all places, "adds Hernández. However, he also points out that "looking at the curves of many countries, this has happened in several: first they achieve an incidence close to 0, of 2 or 3 cases per 100,000 inhabitants, and then there is a rebound due to this relaxation. But, in general They have managed to keep it there. In Germany, for example, they have had problems but it has not gone so far up. I hope that also happens to us. But these are warnings that the system must be reinforced, that there have been failures of coordination in the follow-up of contacts, that some cases have been late ... and that should not happen. It is necessary that the system is supremely prepared so that it is not serious. "

Benito Almirante, spokesman for the Spanish Society for Microbiology and head of Infectious Diseases in Vall d'Hebrón, also looks at the rest of Europe to compare and subtract alarm: "It must be divided by 47 million people, it is a relatively small number." If each outbreak can be 3 people, 67 outbreaks "is part of the possibilities in Spain and worldwide. I'm not sure if in Germany, France, Italy, Austria and Switzerland - in the UK I know they don't - same information that we give in Spain, where so many times it is difficult to assimilate ". His idea is that "everyone is going through the same thing as in Spain".

Asymptomatic patients are associated with contact tracking

That the proportion of asymptomatic patients has grown so much in a few weeks has a simple reasoning, which Simón has also highlighted: many of the new cases are not known because they come to the Primary Care center on their own, but rather through the tracking systems. "We are looking for cases very intensively if at least half [entre el 60 y el 70% del que habla Simón] they are asymptomatic people, diagnosed contacts. We did not do this in the most important phase of the pandemic, "recalls Almirante. Pedro Gullón, doctor, researcher and member of the Spanish Society of Epidemiology (SEE), adds to this explanation:" It is normal that there has been an increase in outbreaks because, with tracking, it is easy for each case to get two or three new infections, and that is already an outbreak. But it also implies more asymptomatic. That is positive. "

An increase in cases such as what we see "is worrisome," Gullón agrees with the minister and Hernández, but in their fair measure: "To be truly alarming, this increase must be due to cases not associated with outbreaks. If they are within of outbreaks, it is not so much. It seems that for now they remain like this, as happens in Aragon ". It gives it a hierarchy: "The worst thing is that people come to the hospital on the loose, not associated with an outbreak - although if we pulled a lot of the thread we would always end up finding some relationship. Later, people come loose but they can easily demonstrate a relationship. It is less bad when cases are detected because Public Health is directly looking for them. Which of these three types of infections are we talking about is what we have to be very vigilant these days ".

The one in Lleida is proving more dangerous, Gullón acknowledges, "because the Generalitat has indeed detected an increase in transmission", and we will have to wait for the restrictive measures to take effect or not, to implement others. You also have to look at Madrid, "it really is a bit strange that for now only one outbreak has been declared, I would like to know if it is because there are no or because they are not detected. Although we must also take into account that Madrid is part of a highest community transmission status. " Benito Almirante, to finish, also relativizes separating between bad and less bad situations: "Better that there were no cases, but compared to the situation two months ago ... if we had had this situation it would not have been news."

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