The Ministry of Health has resisted since the beginning of the coronavirus crisis to publish epidemiological thresholds on which to make decisions.
It has only established the margin of 500 positives per 100,000 inhabitants in 14 days (along with others) to stop what it considers an “extreme” situation, such as that of Madrid.
But both the ministry and the communities, in their internal reports, have been working since July with figures to point out alerts from which there is cause for alert.
In the case of incidence, all of Spain many weeks ago exceeded the maximum, which is set at 60 cases per 100,000 inhabitants, according to the scale to which EL PAÍS has had access.
Health has used a traffic light system in its working documents since July 13, when it published the
Early Response Plan in a pandemic control scenario for covid-19
.
It works with 13 indicators to evaluate how the situation is in each province of Spain, something that it analyzes together with the autonomous communities every week in the Public Health presentation of the Interterritorial Council of the National Health System.
It assigns each one a color: green (good), yellow (intermediate) and red (alert), but does not link measures to them, it is a panel that serves, together, to study the epidemic in each territory.
These 13 indicators are public and are included in the plan.
But not so the thresholds.
In the case of incidence, Health considered in July that a good situation was 10 or fewer cases per 100,000 inhabitants in the last seven days;
intermediate between 10 and 20;
and bad above 30 (or, what is the same, 60 in 14 days).
These figures were soon exceeded by the evolution of the second wave of the epidemic in Spain.
There was no smooth transition from green to red that allowed for limitations to be applied.
The jump is automatic for many communities.
None went yellow for even two consecutive weeks.
By August 17, all the autonomous regions, except Asturias, Extremadura and Ceuta had already exceeded the maximum alarm.
The reaction of the regional governments was mixed, but no community began to take forceful measures when the traffic light of the incidence changed to red.
In general, they all waited for the rate to be well above 60 cases per 100,000 inhabitants.
On August 14, when Spain began to turn red, the ministry brought together all the communities to agree on a package of restrictions throughout the territory, such as the closure of nightlife or the ban on smoking without a distance of two meters.
In any case, incidence is only one of the 13 indicators, which are intended to be jointly evaluated.
One of them is the delay in notification: no matter how low the incidence is in seven days, if the data takes more than a week to report, this section indicates very little.
In addition to the aforementioned criteria, it takes into account the incidence of cases with symptoms, the increase in diagnoses over the previous weeks, the increase in symptoms, the percentage of transmission of known chains, the rates of PCR performed in primary care, that of suspects treated in health centers, the proportion of hospitalized patients over the total of positives, the delay in taking isolation measures, the delay in diagnosis, the percentage of contact studies, the number of contacts that are located in each patient.
Although Health assigns numerical thresholds in its internal reports to determine in each of these indicators if the situation is good, intermediate or alert, a ministry spokesperson explains that they are not decision-making figures, but to study to see the situation in the one found in each community in the context of Spain.
“They are dynamic thresholds to develop situation maps so they constantly change.
Right now, Spain has an incidence of more than 100, so the threshold of 60 cases per 100,000 inhabitants in 14 days is out of date and has to be updated, "he says.
Many experts have criticized the lack of clear indicators for decision making.
Epidemiologists defend that it should not be based on just one, but that there must be several that are made public.
Ildefonso Hernández, spokesperson for the Spanish Society of Public Health (Sespas), believes it is normal for the threshold to be established in 60 cases from which to worry.
“The discussion between 1,000 and 500 seems idle to me;
I am worried from 50.
There are levels that allow you to negotiate with the virus or coexist in a calm way, you know that you can control any event and return to normality, but when it begins to go above 100 cases per 100,000 inhabitants you have to make quite strong efforts, having take into account the number of asymptomatic patients and supercontagators ”, he points out.
He gives the example of Andalusia: with 60 cases per 100,000 inhabitants we are talking about 4,800 cases, with their respective contacts.
You have to do surveys and isolate a crowd, "he adds.
Those 500 cases that Hernández talks about is a minimum rate published in the BOE from which to confine territories on the perimeter and reduce capacity and hours in commercial and hospitality premises.
Health is now working on a traffic light system that, yes, will be public and will order the communities to take certain measures when they exceed certain thresholds.
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