The government of the Community of Madrid has begun this Monday to apply restrictions mainly on leisure in 37 health zones in the region, the majority in the capital. The criterion for deciding where to make them effective has been, with exceptions, that the incidence was above 1,000 cases detected per 100,000 inhabitants in the last 14 days. The community average is 682 cases per 100,000 inhabitants, an incidence that is twice that of the total in Spain and five times that of France, according to reports from the European Center for the Control and Prevention of Infectious Diseases.
Because the rest of the Community of Madrid is not much better than the confined neighborhoods. In the region there are a total of 286 ‘health zones’, and 110 have an incidence of between 500 and 1000. The bulk is between 400 and 600. Only 3 areas are below 200. The spokesman for the Ministry of Health, Fernando Simón, indicated this Monday that all the incidence in Madrid is “relatively high” and although “the measures have to begin to be applied in some place”, “it will have to be valued day by day” if the range is expanded. President Isabel Díaz Ayuso, after the meeting with Pedro Sánchez, said that she did not rule out “if we see that the measures work” and “we have a worrying projection in other areas of Madrid”, extending them to other territories.
There is some consensus among specialists on the situation in Madrid. The first is that the restrictions will be of little use if they are not accompanied by a reinforcement of Primary Care and a correct follow-up of cases and contacts: although this Monday Díaz Ayuso has promised “that the tracking capacity in Madrid will reach 1,500 trackers “, in Friday’s package of measures massive antigen tests were announced, but no more professionals. The second is that there is no standard from which to ‘confine or not’. The Community has chosen to put it at 1,000, but “an incidence of 500 is already a lot. All the thresholds are being done by trial and error, experience and comparing with surrounding countries. But we are already knowing that with incidence rates of 200 per 100,000, the health system begins to weaken “, points out Pere Godoy, president of the Spanish Epidemiology Society (SEE). Pedro Gullón, specialist in Preventive Medicine and author of the book EpidemiocracyHe adds: “It is not round, there is no criterion that says that 1000 is less serious than 900. They are all very high incidences.”
To illustrate, Gullón exemplifies that, with the current data, maybe we are no longer so far from the March figures: “An incidence of 1,000 implies that every 14 days 1% of the population is infected. And according to the seroprevalence study, between March and May 11% of the population of Madrid was infected”. So at the current rate, that figure would be reached in just over 3 months. This is counting on the fact that we now really see the entire ‘iceberg’: “We see much more of it than when we only saw the tip, in March, but with the delays in diagnoses, perhaps a case still escapes.”
Should the entire population of Madrid be confined?
In the areas of the community that have not been included in the regulation recently approved by the Ayuso Government, the same measures apply as since the beginning of September, when the Executive gave the green light to a package which included the reduction of capacity at weddings, wakes and shows. This Friday the meetings of the entire region were limited to six people. That with already the worst incidence in all of Spain, while other communities They were taking measures similar to those that are in force since Monday in part of the Community of Madrid.
If in Madrid there are only three sanitary zones below –although very close– the rate of 200 that Godoy set as the first limit, the moment the system begins to fail, should the measures have been applied throughout Madrid? How was chosen throughout the urban area of Barcelona in summer and taking into account the high mobility within the region? Godoy, that as Head of Epidemiological Surveillance in Lleida He has managed the situation there since the contagions soared in July, he does not want to judge decisions that are “very complex and have many risks. They have decided to prioritize the most extreme situation. Madrid and Barcelona are also experiencing very difficult months, with the reactivation of the activity and the grassroots incidence they had. It is possible that confining all of Madrid would have been possible, and perhaps effective. But even if it is possible, I do not know if it is feasible. It has a very large economic and social impact, also on health. ”
This Sunday, in an interview in The country, Margarita del Val recalled that, among other failures, the measures leave out “75% of infections, which occurs in the rest of the Community.” That’s right: there are 10,424 infections in the 37 confined areas and 30,137 in the rest. Del Val, virologist and director of the Global Health platform at the CSIC, clarifies in conversation with elDiario.es that, in reality, she believes that the main problem is that “what they have to implement once and for all and very seriously is the tracking thing. This confinement so Light it is not worth much, not even in the entire community. “Del Val is very critical, specifically, with the closure of parks that has been stipulated:” Moderate exercise favors the immune system, which is the only defense we have against the infection. You have to open the parks during the day, controlling crowds. ”
Daniel López-Acuña, former director of Health Action in Crisis Situations at the WHO, raises an idea to which almost all specialists join: this “creates a false sense of security in neighborhoods where these measures have not been imposed because people can come to think that they are not so bad “. He believes that limiting decisions to areas where the situation is “particularly serious” “has no epidemiological logic” and may be “sterile” because “in Madrid there is already a very generalized transmission.” There is “an error of approach”, he maintains, which is “to be treating the situation as if there were only problems in certain areas.” Miguel Ángel Royo Bardonada, president of the Madrid Public Health Association, points to the same in this article in The Conversation: Transmission “is out of control” throughout the region, so selective lockdowns may not be helpful.
Pedro Gullón believes that, given the seriousness of the situation, taking “more uniform” measures “would have been a better strategy for everyone. The restriction of capacity could have been calmly taken throughout Madrid. Perhaps by adopting more appropriate measures in the areas of higher incidence, but many in everything “. Precisely, the epidemiologist recovers, “one of the things that we learned, or that we should have learned, with the state of alarm throughout the country at the same time in March, was that there were areas that managed to stop the contagion in time by being confined when not yet they had the data fired. ”
Lack: no tracking reinforcement
Experts view the purchase of antigen tests as positive, although with caution because they have not yet been tested in large populations. And all point out that problem that the restrictions do not go hand in hand with measures to reinforce Primary Care and tracking. In the areas with more incidents and in those with less.
Margarita del Val repeats that the follow-up of contacts has to work, “it is necessary to confine selectively, which is not by neighborhoods”, 14 days for contacts of positive have negative or positive PCR, and 10 days for suspects or 3 days until ending the symptoms. López-Acuña says that the plan “is lame” if it continues without health and social measures, also “social programs to support those most vulnerable neighborhoods”, more effective than “sealing specific areas as if they were ghettos,” summarizes the expert. Pere Godoy agrees that this is the only way to control, “you have to make very quick diagnoses, quarantine contacts and process the necessary sick leave automatically. Ensuring that you will gain a lot, it is very important.” The president of the SEE also warns that it is necessary to “mentalize” that Madrid, at the earliest, will not be solved for another 5 or 6 weeks, “they have a lot of work and very hard ahead of them.”