The situation of the pandemic in Spain moves between two scenarios: contagions are on the rise —248 cases per 100,000 inhabitants in 14 days — but the pressure on care continues to be contained in much of the country. This means that some communities still have the epidemic situation under relative control, but in others the scenario is beginning to get complicated. According to the new covid traffic light, the document with the updated risk indicators to assess the evolution of the epidemic, as of December 1There are seven communities – Catalonia, Navarra, Aragon, the Valencian Community, the Basque Country, Madrid and Castilla y León – that are at a medium alert level. In other words, more than half of Spaniards (26.2 million people) find themselves in an environment with widespread and sustained community transmission and increasing pressure on the health system. The rest of Spain remains at a low alert level, where transmission still does not impact the healthcare environment.
The epidemic situation is not at all promising. The contagion curve has skyrocketed and, although the levels of European neighbors are not being reached – 14-day incidences exceed 2,000 cases per 100,000 inhabitants in the Czech Republic, Austria and Belgium, for example – the rate of new infections is slowing. keeps on the rise and the healthcare pressure increases: in one week, the incidence has grown in Spain by 45% and the admissions, by 26% (there are more than 4,200 hospitalized). In the short term, the proximity of the Constitution Bridge and the Christmas holidays – situations where mobility and social encounters are increased – or the arrival of the new omicron variant, suspected of being more transmissible and of the one that have already been detected cases in Madrid, Catalonia and the Balearic Islands. With this context on the table, the epidemic map of Spain threatens to turn redder.
The new scale to measure the evolution of the pandemic, approved last Tuesday by the Ministry of Health, reduces the weight of incidence and reinforces the importance of healthcare pressure to assess the risk posed by the disease. With almost 80% of the Spanish population vaccinated and protected against the serious forms of covid-19, the level of contagion is not so essential to measure the impact of the pandemic. Thus, updating the traffic lights raises one of the indicators of low risk of transmission from 50 to 100 cases per 100,000 inhabitants to 14 days, but adds the occupation rates in ward and intensive care (ICU) as two new indicators to take into account to assess the situation of the pandemic in a territory.
The alert level of an area – it can be the autonomous community, the province or the city council, among others – arises from the combination of the different indicators in the block that evaluates the level of transmission (positivity of the tests and weekly incidence , at 14 days and in those over 65 years of age) and those that measure the use of healthcare services (occupation in the ward and ICU). Two parameters from the first block and one from the second, at least, must be at the same risk level (or higher) to calculate the alert level. Other variables are also taken into account, such as the speed of transmission of the virus (the Rt, which measures how many people a positive infects) and “aspects related to equity in health and social vulnerability, taking into account the particularities of each territory ”, Reads the Health report.
According to the latest analysis of the transmission parameters and healthcare pressure, seven autonomies are at medium risk. The incidence at 14 days, for example, was then – on December 1 – between 100 and 300 cases per 100,000 inhabitants (medium risk of transmission) in the vast majority of communities, except Aragón (435), Navarra (676) or Euskadi. (552), which were triggered at a high or very high risk threshold. And with the incidence at seven days, the map remains at three intensity colors: at a medium level, between 50 and 150 cases per 100,000, the bulk of territories was located, although Aragon, Asturias, Navarra, Castilla y León, Catalonia and Euskadi were in high parameters (between 150 and 250 cases per 100,000 inhabitants) or very high (more than 250). To all this is added an occupation in ICUs above 10% of the places available in six communities, which also places them at an average level in this scale.
In the rest of Spain, on the other hand, although the incidences are high and the vast majority of the communities have all the contagion rate parameters at a medium or high risk level, they maintain a more contained care pressure, with occupation levels in the low range of the table. Only Melilla, with the indicators of the first block dancing between medium and very high risk and the rate of admission to the ICU at high risk, is at a high alert level.
No associated restrictions
However, the level of alert stipulated by the traffic lights it works just as a guide. Being at one level or another does not imply specific measures. Previous updates of the Coordinated Actions document they contemplated measures associated with these alert levels, recommendations of restrictions that the autonomous governments could follow to contain the epidemic, although they were not mandatory. But the approval of the new traffic lights She came alone, without measures coupled with alert levels.
Communities are betting in recent weeks to expand the uses of the covid passport – to access restaurants or nightclubs, for example – but the disparity of criteria of the courts to endorse the certificate makes it difficult and delayed its extension. The autonomies also trust the control of the pandemic to vaccination, encouraging the pricks of third doses and reinforcing the message of the bonanzas of the vaccines to the furthest behind. Spain also plans to start vaccinating children under 12 years of age this month, the only group that has not yet been vaccinated and with the highest incidence levels currently (412 cases per 100,000 inhabitants at 14 days, 50% more than a week ago).
For Álex Soriano, head of Infectious Diseases at the Hospital Clínic de Barcelona, “everything that is done to promote vaccination is favorable”. Including the covid certificate. “Forecasts and logic say that we are going to increase the incidence progressively, at least until Christmas. And even with the best scenario being fulfilled, the situation in hospitals and primary care is of high stress because ordinary activity had recovered ”, points out the infectologist. In some hospitals, such as Sant Pau in Barcelona, Trueta in Girona or Mateu Orfila in Menorca, some non-urgent surgical activity has already been postponed. In the Marina Baixa, south of Alicante, 30% of scheduled surgeries have been postponed. “Let’s hope that people understand that we have to comply with protection measures: keep masks in closed areas, not accumulate in poorly ventilated interiors … We must appeal to individual responsibility,” insists Soriano.
Some epidemiologists, however, see the covid passport of little use to curb infections and urge more forceful measures. Alberto Infante, emeritus professor of International Health at the National School of Health of the Carlos III Health Institute, recalls that the traffic lights and its associated measures “have not been followed until now”: “It has not had a value beyond being indicative. Each autonomous community makes its decisions and debate on the traffic lights is to divert focus. The attention has to be that we have had Black Friday and we have the Constitution Bridge and Christmas there. As we do not do something soon to stop the situation, we will find ourselves in a very bad situation in January ”. Infante calls for “self-protection” and “making use of schedule and capacity limitations” to begin to contain the transmission.
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