The threat of home confinement gains momentum

Several people loaded with bags during the beginning of the winter sales on a street in SevilleMaría José López / Europa Press

More than 38,000 infections reported on Wednesday;

35,800 on Thursday;

40,200, on Friday.

The coronavirus is rampant in Spain and the margin of maneuver to stop it is running out.

After the relaxation of the measures - and their compliance - during Christmas, the autonomies tighten again with tougher restrictions to contain this third wave.

The drums of a home confinement are loud, but no one dares to take the step: it is the most effective measure against the spread of the virus, but the occupational, social and mental damages of applying it are very high.

Several regional leaders have asked the Government and even Citizens have offered their support to modify the state of alarm decree and activate a total closure.

Among the experts, the debate is open, although the majority of the epidemiologists consulted endorse a harsh and short confinement.

The government, however, insists that, for now, "it is not necessary."

• Several communities ask to go out only for essential activities in the face of the severity of the third wave

• These are the new restrictions in Spain by autonomous communities

Spain already exceeds 575 cases per 100,000 inhabitants and the care pressure in hospitals is beginning to strain the intensive care units.

“We are already taking time to put a strict confinement.

Continuing with the current restrictions will contain the virus, but we will take longer.

And that will affect the economy and will cost more income and deaths ”, assesses Jesús Molina Cabrillana, epidemiologist at the Spanish Society of Preventive Medicine, Public Health and Hygiene (Sempsph).

The main reason for applying home confinement has always been the risk of collapse of the health system.

Spain is not in that scenario, but many hospitals are beginning to feel saturated.

Since Christmas, people hospitalized due to covid have increased by 83% (there are more than 19,600) and the occupation in ICUs has grown by 55% (about 3,000 critically ill patients).

Communities are now rushing to tighten the restrictions that they lowered weeks ago to "save Christmas."

But they don't have all of them with them.

Some fear that advancing curfews or applying perimeter closures is not enough to slow the spread of an already rampant virus and advocate going one step further.

Andalusia, Castilla y León, Murcia and Asturias, for example, have asked the Government to consider the possibility of home confinement.

For their part, the presidents of Galicia, Castilla y León, Andalusia and La Rioja have recommended that the population self-define.

With the current decree of the state of alarm (in force until May) there is no margin for home confinement.

If this measure wants to be applied, the Government would have to approve a new decree that would have to be validated by Congress.

But, for now, there is no consensus for it.

Citizens have been favorable and the PP leaves the door open, but the PSOE is not for the work and prefers to wait to see if the current measures take effect.

The Government insists that the current legal framework provides "many tools" to combat the virus, although the autonomies are beginning to question it.

The most intense struggle was experienced yesterday between the central Executive and Castilla y León when the regional government approved to advance the curfew at 8:00 p.m., something that, according to Health, is not allowed by the decree of a state of alarm, which sets the start of the cessation of activity between 22:00 and 24:00.

The Board argues, however, that the norm allows the curfew to be "modulated, made more flexible and suspended" according to the epidemiological situation, and it seizes on this "modular" to toughen it.

Health rejects this interpretation and points out that the possibility of regulating the measure was always thought of softening it in the face of the Christmas holidays, although in the literality of the text that nuance is not appreciated.

Andalusia also asked the Government of Spain yesterday in writing to allow it to advance the curfew at eight in the afternoon and to decree home confinement in some municipalities.

"With the figures we have, we must take measures similar to those of extreme confinement or apply a radical total closure for a short period," insists Julián Domínguez, head of Preventive Medicine at Ceuta Hospital and a member of the Sempsph.

During the second wave, Health and the communities agreed on a semaphore of epidemic risk based on which to decide the restrictive measures, but with the current figures, everything has fallen short.

The toughest restrictions, such as perimeter confinements or the total closure of shops and hotels, were reserved for high-risk levels.

These were measured from the combination of several factors, such as having more than 250 cases per 100,000 inhabitants in 14 days, ICUs above 25% or the positive rate of diagnostic tests above 15%, among other indicators.

All communities, except the Canary Islands, far exceed 250 cases per 100,000 inhabitants.

Seven autonomies are above the extreme risk level in the three main parameters.

The director of the Health Alerts and Emergencies Control Center (CCAES), Fernando Simón, admitted on Thursday that the curve will continue to rise for at least a few more days and the ICUs will "suffer" saturation for some time.

But he insisted that the rise of the epidemic curve can be contained with the current restrictions and "it is not necessary" a home confinement.

“The second wave, which in its most critical phase had a transmission level similar to that of now, was controlled with measures that did not involve complete confinement.

The option of confinement is there, but with the level of transmission that we have and the specific characteristics of this third wave, it does not seem necessary now, ”he argued.

Among the experts, the debate on the advisability of a house confinement is open.

This week, the former Director of Emergencies of the World Health Organization, Daniel López-Acuña, urged an immediate total closure.

"We are light years from the health traffic light.

We have passed it all.

We have a situation that deserves decisions without hesitation: a drastic temporary confinement ”, he claimed.

A position also shared by Alberto Infante, from the National School of Health of the Carlos III Health Institute: "If we don't do more than what we are doing, we will continue to trail behind the virus."

The social costs of home confinement, however, are not minor.

And some experts are reluctant.

“I am not in favor of a closure like the one in March.

Confinement without respite measures creates many social, mental health, gender-based violence problems… ”, third Salvador Peiró, epidemiologist at the Foundation for the Promotion of Health and Biomedical Research of the Valencian Community.

A study by the Catalan Public Health Agency revealed that during confinement the symptoms of depression, anxiety and emotional distress tripled.

Another investigation by the Hospital del Mar also found that 60% of people with previous cognitive impairment worsened during the confinement.

Peiró is committed to exhausting all options and restricting some activities much more before reaching the total closure.

“What we are interested in is reducing social interaction, so that people have nowhere to go.

It is striking to me that some do not take the measures they can, but ask the Government to close everything, ”says the epidemiologist.

Andalusia, for example, has asked for confinement, but they still keep the restaurant open (although with reduced hours).

A 'pseudo-confinement'

In fact, Peiro's suggestion is,

de facto

, to go into

pseudo-confinement

without having to lock people up at home.

Something to which, in practice, many communities are already advancing, such as Catalonia, which only opens restaurants for breakfast and lunch and has ordered the closure of all non-essential activities on weekends, when more mobility of a social nature occurs.

Or Murcia, which prohibits meetings between non-partners.

In Mallorca and Ibiza, the restaurant is closed (only for home collection and delivery) and social gatherings are prohibited (except cohabitants).

Furthermore, during the curfew, "the situation is already similar to that of a confinement at that night," says Ildefonso Hernández, from the Spanish Society of Public Health and Health Administration (Sespas).

This scientific society has expressly ruled out that it is necessary to return to the March measurements.

Surrounding countries, such as Germany, have also chosen the middle way: schools and non-essential activities are prohibited, but social encounters are allowed, although they may only include a person who does not live at home.

France has a curfew from eight in the afternoon and restaurants, cinemas and theaters remain closed.

The hardest and most restrictive confinement is that of the United Kingdom, which in addition to closing bars, restaurants, pubs, cinemas, theaters and also schools, only allows outings for essentials and social encounters outside (indoors it is prohibited with no cohabitants) can be a maximum of two people to do sports.

Toni Trilla, head of Preventive Medicine at the Hospital Clínic de Barcelona, ​​also considers that there is room for maneuver before applying a home confinement.

"All measures have to be exhausted before taking such a drastic one, although this is easier to explain and easier to comply with," he says.

If the contagion curve slows down in seven or 10 days, he adds, "a complete closure is not necessary."

“Hospitals are going to have a very bad time, I already take that for granted.

We are full, but there is still capacity to do something, even if it is at the expense of paralyzing part of the surgical activity, ”he says.

Many Spanish hospitals have already begun to suspend operations to meet the demand for patients with covid-19 who require admission.

What the experts do agree on is that, in the event of a possible home confinement, schools would be exempt.

The school activity would continue to function because the schools have not shown great amplifiers of the virus.

"Scientific evidence tells us that the school serves as an element of control of the measures by the families and, except for a few cases, there have been no outbreaks," says Domínguez.

However, as long as there is no strict home confinement, Peiró qualifies the most repeated recommendations and slogans: “The measure is not to stay at home, as they are saying, because the collateral effect of moving social gatherings to homes can occur and we earn less What if we have them walking down the street.

The measure is to avoid contact with non-partners ”.

The epidemiologist also fears that a confinement of only 15 days will move the infections to the intra-family environment and to essential workers, so that, if applied, this measure would have to last longer.

The unknown of the British variant

Any prediction of epidemiologists remains in borage water if the variant of the virus detected in the United Kingdom, much more contagious, comes into play.

The authorities insist that it is not responsible for the rise of the epidemic curve and that it does not play a major role in the increase in infections.

Although they admit their concern if this variant becomes imposed.

"If the British strain starts to play and it is as they say, things will become very complicated," warns Peiró.

Contagions could multiply exponentially, leaving the already highly stressed healthcare system at the feet of the horses.

Some experts argue, in fact, that it may be more widespread than is known.

“All the communities are getting worse.

The British variant has to be circulating more than we think.

The Christmas thing has been chaos because there has not been a single plan and there has been too much joke with the restrictions.

But to attribute all this increase to individual behavior can not be.

The British variant has to influence ”, values ​​Molina Cabrillana.

Information about the coronavirus

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- Restrictions search engine: What can I do in my municipality?

- This is how the coronavirus curve evolves in the world

- Download the tracking application for Spain

- Guide to action against the disease