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Spain has twice as many trackers as in July, but they are late

2020-10-27T02:12:26.711Z


Primary care, overwhelmed by the avalanche of cases, cannot follow up on contacts. High incidence and delay in diagnoses make screening less effective


Army trackers, at one point during their work at the Marine base (Valencia) .M TORNICA TORRES

Spain arrived in the middle of July with 3,500 trackers, less than half of what international organizations recommend.

The country had missed more than four months of a state of alarm and de-escalation phase and had not done its homework to reinforce the public health staff of the communities to locate the close contacts of the positives and to start the diagnostic tests and the necessary isolations.

Little by little, and with the help of soldiers trained by the Army, the number of trackers is, three months later, more than double: almost 8,500.

The problem is that it is late, experts say.

"Tracking is not going to get us out of this", says Àlex Arenas, researcher at the Rovira i Virgili University of Tarragona.

The incidence is already so high that it is very difficult to follow up on contacts in order to cut the chains of infections.

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Arenas calculated in July that the ideal number of trackers in Spain would be one for every 5,500 inhabitants, precisely what we have now (about 8,500), for which he applied a tool designed by the United States Health Services and Resources Administration (HRSA ).

In mid-July, Spain had an accumulated incidence of around 20 cases per 100,000 inhabitants.

Now it has 362. "You need all the tracking power but that is efficient when the incidence is still low," explains Arenas.

And give an example.

Let us suppose that each tracker is capable of discovering at least six contacts - although the median in Spain has been falling and is now around three.

"Can I follow those contacts?

If the answer is no, tracking is useless.

If you are not able to perform all the necessary tests on all close contacts and have a diagnosis in less than 48 hours, the system does not work ”, he concludes.

That's the limit: the number of PCR samples that primary care can take, the ability of laboratories to give a quick response, and follow-up of contacts.

"We know that more than 45% of people do not do isolation," recalls the researcher.

Even less if they take five days to give them the result.

The avalanche of cases has overwhelmed primary care despite the many warnings that experts and professionals of this level of care have been making since the beginning of the summer.

In some communities, tracking was decisive to control outbreaks, such as in Catalonia (the

Segrià case

clusters

) or in Aragón.

"Now we are in a new phase, and the limiting factor is primary care," Arenas emphasizes.

Even if the number of trackers were multiplied now, the problem would not be solved.

First, the incidence of cases must be reduced.

That is why communities focus on measures that reduce contacts between people in social and family settings.

Tracing when incidence was low could have prevented the current situation.

Anna Llupià, an epidemiologist at the Hospital Clínic de Barcelona, ​​believes that the key is not so much in the cases per 100,000 inhabitants as in the positives that remain untraced, that is, those for whom no epidemiological link is found.

In Spain, since March, there is thus approximately 35% of all positives.

This means that in these last weeks there are almost 4,000 daily cases of which it is not known where they were infected.

“An early scan should have prevented this.

The countries that have done well are those that have not left cases untraced and those that have taken action when this happened ”, he assures.

He gives the example of Auckland, New Zealand's largest city, which was confined when they had barely half a dozen cases with no known links.

Or Aberdeen, in Scotland, which closed the restaurant after 5 pm with fifty.

“You have to determine what your traceability is and from how much not all cases can be traced to take action.

In Spain, when we pass 10 cases per 100,000 inhabitants, we have started to have problems ”, he assures.

A sample of this is that little more than one in ten cases are framed in outbreaks (groups of three or more linked positives that are not in the same address).

Health published a few days ago a complete report on the places where citizens were infected, but it only included cases associated with outbreaks, which are approximately 12% of the total.

The work showed that most of them were infected in meetings with friends and family.

But we still do not have information on where the remaining 88% are infected.

Pedro Gullón, from the Spanish Society of Epidemiology, points out that not all the outbreaks are being identified well and that this may indicate that traceability is not good, but also that data collection works at half gas.

The systematization of this collection, he assures, can be greatly improved with figures such as new infections or deaths, which accumulate delay in notification, and is even more problematic with outbreaks.

The numbers of trackers continue to be very heterogeneous between the different autonomous communities.

Asturias and Murcia have multiplied by five the number of staff they dedicate to these tasks, according to the information provided by them.

Valencia already had more than 1,000 trackers in July and has increased them to 1,400.

Only Andalusia is well above 5,500 inhabitants per tracker.

It has 30% more troops, from 450 to 580, which leaves the ratio at one tracker for every 14,500 inhabitants.

However, this community ensures that the tracking tasks are done in a mixed way, that is, between the Epidemiological Surveillance service and primary care, where especially the nursing staff (4,315 people) help in the process even if they do not dedicate the 100% of your day.

Comparison between communities is complicated, in any case.

It is not the same when they have large urban centers as when their population is mostly rural and dispersed, nor do they all organize tracking in the same way.

Neither Galicia nor Canarias answered the questions of this newspaper (neither did they in July, when EL PAÍS made the first calculation).

Madrid, with 846 trackers (30 of them military) according to its data, also exceeds the ratio recommended by its population.

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 the world

- Download the tracking application for Spain

- Search engine: The new normal by municipalities

- Guide to action against the disease

Source: elparis

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