October 26, 2020

The largest perimeter closure since the de-escalation begins in Madrid with 4.8 million affected


Friday, 10:00 p.m. Madrid and nine other cities in the autonomous community begin the widest perimeter closure that has occurred in Spain since the end of the state of alarm. In total, there are almost 4.8 million inhabitants of Fuenlabrada, Parla, Alcobendas, Torrejón de Ardoz, Madrid capital, Getafe, Alcorcón, Leganés, Móstoles and Alcalá de Henares. All these cities have more than 100,000 inhabitants; a 14-day cumulative incidence of COVID-19 cases that exceeds 500 cases (ordered from highest to lowest incidence); and they present a test positivity rate of more than 10% of the total. Furthermore, the community ICU beds are at more than 35% of their capacity (specifically 42.12%). Therefore, they meet the three criteria established by the Ministry of Health, and approved by a majority of the autonomous communities, to initiate a perimeter confinement.

X-ray of the virus in the Community of Madrid: from 9 cases per 100,000 in July to more than 700 in September

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What does this new situation mean? For most of the affected areas it implies a greater limitation of movements: it is not possible to enter or leave the affected municipalities except for reasons such as work, studies, going to the doctor, having a legal or judicial motivation, caring for dependent people and ” other duly accredited causes of force majeure or situation of need “. These conditions are of fulfillment for those who want to get to Madrid from Parla or from Berlin through Barajas airport, according to the order of the Ministry of Health, despite the tweet with which the president of the Community, Isabel Díaz Ayuso, wanted to express her disagreement with the measures imposed, and that she is not unrelated to the insistence with which the regional government has blamed the airport infrastructure of state jurisdiction of the escalation of the virus in the community, although the number of cases imported by this route detected has been “ridiculous“.

Precisely some citizens of Parla are among those who with the new regulations now see their movements somewhat less restricted. This is so because of the 45 basic health zones in which the regional executive had applied measures, it was not possible to leave even to go to another part of the municipality where they are located (as always, with exceptions regarding work, health, education, etc). This was the situation in which the residents of San Blas and Isabel II were, who, like the rest of those ‘confined’ by Ayuso, have an incidence rate of more than 1,000 cases per 100,000, that is, twice as much as which has now marked Health as a threshold and four times what the WHO indicates as dangerous. Another of the differences that will live from this Saturday, like the rest of the affected areas so far except three, is that they will find parks and open green areas, including a children’s play area.

One of the places of concern for the transmission of the virus are the parks due to the concentrations of people (bottles). But on the other hand, experts insist that these types of spaces must remain open because they are safe and beneficial places for health, since the virus is transmitted much less outdoors than indoors.

The exceptions

There are three territorial exceptions with an incidence of more than 1,000 cases, and they are the towns of Humanes, Villa del Prado and the area of ​​Reyes Católicos (San Sebastián de los Reyes). These places do not fall under the umbrella of the Health Order because they have less than 100,000 inhabitants. The Ayuso Executive has decided to maintain in these areas the restrictions that it began to introduce two weeks ago. Among them the closure of parks and the limitation of hospitality hours until 10pm (in Madrid and the rest will be 11pm).

In reality, there was expectation to know if these specific measures of the Community of Madrid would be maintained in the 45 most stressed areas, since Health makes it clear in their order that theirs are minimum restrictions. But the government of the Autonomous Community has preferred to unify criteria in all the larger municipalities and leave only the orders of the central government in force. What is striking is that it maintains that they do it out of obligation and attack Salvador Illa for allegedly forcing them to apply more lax measures.

In any case, epidemiologists pointed out that the measures by zones were not effective, because the rest of the districts were also very affected and the threshold of 1,000 was too high. Only with 250, the World Health Organization (WHO) already considers it a serious scenario. In addition, the population density and mobility throughout the community make the region a place that must be watched closely due to the risk of it becoming an explosive source, they warned.

How did we get here?

Waiting for the resolution of the appeal presented by the Community of Madrid before the National Court to paralyze the measures approved in the moved Interterritorial Health Council last Wednesday (they voted against the PP communities except Castilla y León, which was unmarked), in the coming weeks it will be possible to see if they are really taking effect. At the moment since Spain entered the new normal after the general confinement, the Community of Madrid has been becoming, week by week, the focus and main center of the re-outbreak of the COVID-19 pandemic throughout Europe. In two months it has gone from a cumulative incidence in 14 days of 9 cases per 100,000 inhabitants on July 15 to 647.91 on October 2. It is true that there is a slight decrease in this indicator in recent days from the 782 cases on September 29.

Hospital pressure in each CCAA

Comparison of the daily hospital occupancy at the end of August and today, by autonomous communities

Source: Ministry of Health

What has not stopped growing is the hospital pressure due to the admission of COVID patients. In the Community, 42% of ICU beds are already dedicated to the most serious cases of the disease. Regarding hospital occupancy, it has gone from 9.5% of the beds occupied on August 20 to 18% on September 10 and 22.9% on October 2. This has a derivative on the care of patients with other types of ailments, whose controls and surgeries are already suffering: “the second hospital nightmare is already here”, they alert Madrilenian doctors and nurses.

The outlook in Primary Care, essential for the early detection of COVID and the rest of the diseases, is by no means more rosy. Although it has called off The strike that they planned to start in Madrid last week after reaching an agreement with Ayuso to improve their remuneration and organizational conditions, the professionals declared themselves overwhelmed. According to these doctors, 90% of their agendas are dedicated to the pandemic, both in the detection and in the tracing of contacts, follow-up and cure of the ailments. The Ayuso government failed to comply with the disease control plan necessary to start the de-escalation of the confinement and maintain the new normal: it was not able to hire the committed trackers.

“87% of the patients of the first wave of COVID did not have to go to the hospital. If we stop treating them because physically we cannot, they will go to the emergency room and saturation will come,” warns Dr. José María Molero, spokesman for the Spanish Society of Family and Community Medicine. A saturation that, according to their colleagues in the hospitals, has already spread again in the Madrid health centers, which normally at this time prepare for the flu campaign, more feared this year than ever.

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