The Ministry of Health is already working with the autonomous communities on a panel of indicators that clarifies what restrictive measures to take based on the risk posed by the covid-19 epidemic in each territory, although it leaves the mandatory confinement at the discretion of the authorities depending on of the context of each place.
The draft, advanced this morning by the SER chain and to which EL PAÍS has had access, establishes a system that assesses various metrics to assign four risk levels to municipalities with more than 5,000 inhabitants: low, medium, high and extreme. If these scales are taken and applied to the latest statistics of the autonomous communities published this Wednesday, at least five of them would be in the highest step: Navarra Aragón, Castilla y León, Madrid and La Rioja, in addition to Ceuta.
According to the calculations of this newspaper (see graph), at the next level (high risk) are Castilla-La Mancha, Catalonia, Melilla, Murcia and the Basque Country. In the middle are Andalusia, Asturias, the Balearic Islands, the Canary Islands, the Valencian Community, Cantabria and Extremadura, while only Galicia would have low risk. There are none out of the woods or in the “new normal,” as the draft puts it.
To calculate risk, the document establishes two blocks of parameters. The first tries to measure the level of transmission of the virus through six statistics: the cumulative incidence per 100,000 inhabitants in 14 days and in seven; both measures, but referring to the population over 65 years of age; the percentage of positivity of the diagnostic tests and the percentage of cases with traceability. In the second block, healthcare capacity is measured through the occupation of beds in the ward and in the ICU.
Each of these metrics is assigned a value. For example, the extreme risk threshold is above 250 cases at 14 days; 125 to one week (figures that go down to 150 and 75 in the case of those over 65); more than 15% positivity in tests and less than 10% traceability, that is, only 10 out of 100 positives, or less, are known to contact. In the assistance block, the maximum risk is reached when 20% of beds occupied by covid patients on the ward are exceeded and 25% are in intensive care. When a territory has two or more indicators from the first block above these levels and at least one from the second, it is considered to be at extreme risk.
This means that a territory like Aragón, with an accumulated incidence of 434 cases per 100,000 inhabitants, is at extreme risk (since it also has its healthcare capacity at that level) and Melilla is one notch below (with 526), since still has margin in the occupation of beds.
The Health draft, which has yet to be outlined and discussed with the autonomous communities, establishes concrete measures in municipalities with more than 5,000 inhabitants that exceed each level (in minors, specific studies should be carried out based on the context of each place) .
The document does not establish mandatory confinement measures at any of the levels. But in the maximum it assures that it will suppose the taking of “exceptional measures”, after a “specific evaluation of the situation that could include the limitation of the mobility of the people, perimeter closures or other restrictions of the movement”. In addition, it includes all the limitations of level three, which are similar to those already being adopted by the communities with more cases: study limitation of mobility, social gatherings with a maximum of six people; closure of interiors of bars and restaurants and limitation of capacity to 50% on terraces, with a separation between tables of at least two meters; limitation of public transport to 30% of its capacity; recommendation of teleworking whenever possible; restrictions on wakes and ceremonies; preferred hours of physical activity for those over 70; closure of bingo halls, casinos, recreational and gaming halls and specific betting establishments, among other measures.
The rules become more lax as the level of risk is lowered. On the second level, the restriction of six people for social gatherings is maintained, but the interior of the bars and restaurants can be opened to 50%. Other measures are also more flexible, such as that bingo halls and casinos can be opened at 50% capacity and there are no limitations on public transport. When the risk is “low”, the meetings are extended to 10 people, the catering capacity to 75% and measures similar to those of phase 3 of the de-escalation are established.
In any case, the scales that are studied are not designed to apply measures automatically. “The decision on what measures and when to apply them will be taken by the autonomous communities and will be made known to the Ministry of Health through the channel that is established,” says the document. “The final decision of what level of alert will be assigned to the evaluated territory will not only be based on the level of risk resulting from the indicators, but must be modulated with the upward trend of the indicator and its rate of change, as well as with a qualitative evaluation that includes the response capacity, the socio-economic, demographic and mobility characteristics of the evaluated territory ”, adds the draft.
In the opinion of Ildefonso Hernández, spokesperson for the Spanish Public Health Society (Sespas), it is “good news” that there are homogeneous public indicators for all of Spain. “They cannot be used as a throwing weapon because I am sure there will be consensus in the Interterritorial Council of the National Health System [que es el órgano que lo estudia el borrador y que tendrá que aprobarlo]”. Hernández believes that it is reasonable to consider extreme risk above 250 cases per 100,000 inhabitants, half the limit that Health established maximum to establish perimeter confinements (along with other indicators). The map that the European Union has recently established to recommend or advising against travel is still much stricter: it sets the bar at 150, which, together with very rigid criteria in the positivity of the tests, have since Thursday all of Spain in red, the highest level.
Among the indicators that are being studied, Hernández is missing two: one that measures the capacity of primary care and the rate of people who are in isolation, which he considers very useful to know how the epidemic is being fought.
Fernando Simón, director of the Center for the Coordination of Health Alerts and Emergencies, has preferred in his press conference this Thursday not to enter to assess the document, since, he said, “it is still being worked on.” He has planned that it can be ready at the beginning of next week with the contributions made by the autonomous communities. The idea of Health is that the document that is being worked on is approved unanimously by the Interterritorial Council so that there are no legal discrepancies when applying it. Simón has defended that the indicators are designed for municipalities and mark minimum levels that will have to be qualified with other parameters (such as incidence is increasing or on the contrary decreasing). “There is a lot of room for interpretation by the communities when applying them,” he said.
This newspaper has asked the communities that are at extreme risk if they share the measures contemplated for their situation, but so far it has not obtained a response from any of them.
Information about the coronavirus
– Here you can follow the last hour on the evolution of the pandemic
– This is how the coronavirus curve evolves in Spain and in each autonomy
– Download the tracking application for Spain
– Search engine: The new normal by municipalities
– Guide to action against the disease