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Spain faces the worst of the third wave threatened by the British strain

2021-01-24T00:34:29.323Z

At the peak of the contagion wave, the hardest days remain in hospitals, which in some autonomous communities will be the same or worse than in spring



Complicated.

Horrible.

Disastrous.

Bleak.

Terrifying.

The analysis of the Spanish epidemiological situation of a dozen public health experts consulted by this newspaper moves on this scale of qualifications.

The country is at the top of the third wave, if the second ever ended.

The peak of cases was probably reached on Thursday (44,357 new).

If the curve was not bent then, the specialists estimate that it will do so next week.

But this, they add, is almost anecdotal.

With a runaway incidence (828 cases per 100,000 inhabitants in 14 days), the question is at what rate it decreases even if it enters a plateau.

And the proliferation of the more infectious British variant of the coronavirus increases uncertainty.

Even in an optimistic scenario, with a rapid decline in transmission, Spanish hospitals are guaranteed tough weeks.

The one that ends this Sunday was already worse than in the first wave for some communities and income and occupation will still continue to grow after the cases begin to subside.

As the second wave took shape and the diagnostic data resembled that of the first, experts insisted that it was not comparable.

In the spring, people who were seriously ill enough to go to the hospital were hardly tested, while in the fall a good number of asymptomatic patients were even being located.

But in this third wave, the situation is already comparable to the worst moments of the epidemic in Spain.

The most accurate data to measure the severity of the epidemic is hospitalizations.

It is difficult to compare, because the Ministry of Health only reports the occupation data since August.

With them it is verified that the third wave in hospitals is already being much worse than the second in almost all the autonomous communities.

And it will continue to grow between a week and 10 days after the peak of cases is reached.

But what about the first?

The best approximation that can be made is by measuring daily income, data provided by the Carlos III Health Institute since December, after reviewing the case records in hospitals.

That is, they are retrospective.

According to these, in the worst week of the spring there were 27,000 admissions.

In the fall, 7,000.

In the week that this Sunday ends, without counting the data from Saturday and Sunday (the last updated are from Friday), they now add up to 14,000.

And, in all probability, the one that enters will be worse than this.

That, despite the fact that in the first wave the rise was explosive;

in this it is more gradual and, probably, prolonged, since the measures to contain it are less drastic than the strict house confinement that began on March 14.

These data are in tune with the number of daily positives reported by the ministry, which, although it has limitations in measuring the actual transmission - since it presents notification delays that cause it to fluctuate according to holidays, weekends or specific overloads - is the thermometer that citizens come every day to check the temperature of the epidemic.

In the first wave the maximum was 9,222.

Thanks to the seroprevalence study carried out by Health, it is estimated that only one in 10 infections was detected then.

That is, in the worst of spring they would probably be around 100,000 infections in one day.

In this third wave we have exceeded 44,000 officially reported in a single day.

Today around a third of cases are detected.

Or, what is the same, the figure will actually approach 70,000 infections.

Territorial distribution

The panorama varies greatly between autonomous communities.

While it is unlikely that Madrid, where the situation of the first wave was dire, will see worse figures than then, in others that suffered less, such as the Valencian Community, Murcia, the Balearic Islands and Andalusia, this week there are already more hospital admissions than anyone March or April.

"We see again a saturation problem that will be mainly with non-covid pathology.

Interventions, non-personalized attention and non-essential surgery are already being canceled, ”says Ana María García, professor of epidemiology at the University of Valencia.

“The enormous effort of spring 2020 has been wasted.

The basic lessons have not been learned.

Spain has the highest incidence of the large Western countries, the highest ICU occupancy and probably the highest excess of deaths per capita.

All indicators continue to worsen, but the measures taken are softer than in countries with lower incidence and that are vaccinating faster (for example, the United Kingdom).

It's incomprehensible.

There is still the possibility that there is luck and the situation is only extremely serious instead of catastrophic, but it would be better to have a plan, "sums up Miguel Hernán, professor of epidemiology at Harvard University.

There are several factors that will help, predictably, not to reach a mortality rate like that of the first wave, which touched a thousand deaths in a single day.

The hospital burden is much more distributed throughout the territory, so the collapse of hospitals seen in Madrid, Barcelona or some cities in Castilla y León and Castilla-La Mancha is more unlikely (although not impossible).

Since then medicine has learned a lot about how to treat the most serious patients, and survival rates in the ICU are getting better and better.

There are more personal protective equipment, more mechanical ventilators to enable extra intensive care beds, the distribution of the disease by stripes is more homogeneous (there are more young people infected), the residences are more protected, in addition to vaccination.

This is the summation of elements that gives public health experts some optimism regarding this third wave.

"Surely there will not be a rationing of critical care, as happened a year ago, but it will be very complicated," says Fernando Rodríguez Artalejo, professor of Public Health at the Autonomous University of Madrid.

But now a factor is also added that can ruin all expectations: the British variant.

José Martínez Olmos, professor at the Andalusian School of Public Health, recalls that in mid-December, British Prime Minister Boris Johnson warned that the epidemic was “out of control” due to this mutation.

"He said this and the next day he took different measures than he had taken four days before."

On December 21, the European Center for Disease Control (ECDC) called for non-essential travel and social gatherings to be abolished.

In Spain nothing was done about it: all the communities, except the Valencian, remained open to welcome family members and friends at Christmas.

All the experts then warned that this would bring with it a difficult third wave, even without taking into account the British variant.

And here we have it.

Anna Llupià, specialist in preventive medicine and public health at the Hospital Clínic de Barcelona, ​​like other colleagues consulted, believes that little importance is being given to this mutation.

“It probably has more of an aerosol [airborne] component.

At the international level, there is talk of a pandemic within the pandemic and surely the measures that we have now imposed are not enough, ”he says.

Germany has taken this possibility seriously and with an incidence rate of less than half that of Spain (319 cases per 100,000 inhabitants) is taking firmer measures.

The Germans have practically closed public life for two and a half months, and last Tuesday they extended it two weeks more than expected, until February 14.

Faced with the new variant, the Chancellor, Angela Merkel, assured that it was necessary to act now, without further delay.

To the measures they already had, they have added requiring "medical" masks in shops and public transport, where you will no longer be able to enter with cloth face masks.

One of the problems pointed out by most of the epidemiologists consulted is that Spain is being reactive.

He never anticipates contagions;

it is always behind.

"We are on the way to it as in the United Kingdom [where records of daily deaths are being broken] because we have not heeded recommendations that were obvious", says Rafael M. Ortí Lucas, president of the Spanish Society of Preventive Medicine, Public Health and Hygiene (Sempsph).

He and other colleagues had recommended a strict and short confinement at the beginning of December to cut the transmission and that the scenario was not the one we have before us.

"I don't understand who benefits from these months of agony and intermittent restrictions instead of shorter and more strict periods," adds Llupià.

They both look with envy at this model, which is working in places like China, Taiwan, Australia or New Zealand.

And now that?

There is considerable unanimity on what has been done wrong.

What should be done now?

Those consulted agree that something different from what was done in the second wave.

“The triumphalism of a couple of months ago was surprising.

While the areas with the highest incidence continued to spread viruses to the rest of the country, and increasing the risk of new mutations due to the great circulation of viruses, the incidence never fell enough to empty hospitals to safe levels.

We played with fire by maintaining a high UCI occupancy throughout the fall and have burned ourselves.

Now the outlook is terrible for anyone who needs critical care, be it due to covid, heart attack or traffic accident, ”says Hernán.

A pandemic wave was concluded when there was still an incidence that in most of the communities was "high", according to the traffic light itself designed by the Ministry of Health with the autonomies.

There was talk of the success of Madrid without closing the hotel business when the virus really circulated freely in the community.

Experts call not to repeat the mistake.

“One thing we do know is that the virus responds to the measures we take;

if they are harsh, the incidence and transmission decreases.

We are going to do what we know and assume that Christmas we are wrong, ”argues epidemiologist Javier del Águila.

In the opinion of Pere Godoy, president of the Spanish Epidemiology Society, we have a new opportunity to do things well.

“We must give priority to detecting the new variant of the virus.

If it is not done, the control afterwards will be much more complicated.

It is an opportunity to establish an effective surveillance system in which these new variants are truly monitored.

And we must not settle for reducing transmission to the levels of the second wave, because if not we can reach a fourth even worse ”.

Four out of ten people do not know where they were infected

One of the great difficulties in taking adequate measures to tackle the epidemic in Spain is that much remains to be known about where the infections occur.

According to the latest reports from the Carlos III Health Institute, no epidemiological link was found in four out of 10 positives.

It is true, as some politicians repeat, that the family sphere is an important focus, but that partly happens because it is the easiest to locate.

It is overrepresented because it is very easy to trace that type of infection, but it is almost impossible when it happens on public transport, in a supermarket or in a bar with strangers.

In these circumstances a mobile tracking application would be useful, but the one in Spain has failed.

Since it opened in early September, 36,735 positives have been reported, less than 2% of those that have been officially produced. Fernando Rodríguez Artalejo, Professor of Public Health at the Autonomous University of Madrid, insists that the studies are key that show the reality of the contagion to take effective measures minimizing the economic and social impact.

"Samples should be taken and very thorough studies carried out, but upwards, to find where they were infected, not so much downwards (who they infected) and this is not being done to me," he says.

“If there are no good epidemiological studies that allow us to know the situation in detail, it is difficult to take action.

What has shown effectiveness are confinement and the study and isolation of contacts.

All the others are partial, they can be right, but a bit by chance ”, adds Rafael M. Ortí Lucas, president of the Spanish Society of Preventive Medicine, Public Health and Hygiene.

Information about the coronavirus

- Here you can follow the last hour on the evolution of the pandemic

- 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

Source: elparis

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