Restrictions beyond the alarm state

Customers on a terrace in Madrid at the end of March.JAVIER BARBANCHO / Reuters

The countdown begins to close the legal umbrella that has protected, during the last six months, some of the toughest restrictions against covid: the state of alarm falls on May 9 and with it, measures as severe as the curfew or perimeter confinements, which limited fundamental rights.

But the end of this legal instrument does not imply that the restrictions are terminated.

In fact, the experts consulted deny the greatest.

With the epidemic curve on the rise - the incidence has grown by 20% in one week and stands at 182 cases per 100,000 inhabitants in 14 days - epidemiologists assume that Spain will need to continue with more or less severe social limitations to keep the disease at bay. pandemic.

• Spain faces the end of the pandemic: 85 million vaccines in six months

• The end of the state of alarm in May confronts the Government and autonomies

No expert dares to draw the epidemic scenario that will be experienced on May 9.

The rate of vaccination and the evolution of the variants will largely depend on the epidemiological situation at that time, they insist.

But in the midst of the rise of the fourth wave and with the unknown still open as to what the real impact of the Holy Week interactions will be, even the most optimistic point to a complex scenario.

“I want to believe that the epidemiological situation will be better than now.

We will spend the days of this week and the one that is growing.

The first week of May, it will subside, but, in any case, community transmission will continue and containment measures will be needed ”, explains Alberto Infante, emeritus professor of International Health at the National School of Health of the Carlos III Health Institute.

When the decree of state of alarm was approved, Spain was submerged in the second wave, and the figures were much worse than the current ones: the incidence was 307 cases per 100,000 and there were about 2,800 people in intensive care because of the covid (They occupied 28% of the available beds).

The current incidence is half and ICU occupancy is 20%.

But the situation is difficult to compare because the behavior of the virus is often unpredictable and many factors influence: then there were no vaccinated people - it started on December 27 and now there are three million immunized - but neither did the British variant predominate. of the virus that has prevailed this year, much more contagious and currently responsible for between 70% and 90% of cases in Spain.

"In May, we may not have the intensity of the third wave, but there will be high incidents and measures will be required," agrees Daniel López-Acuña, former Director of Emergencies at the World Health Organization.

The Ministry of Health has recommended, for example, that communities with a cumulative incidence greater than 150 cases per 100,000 in 14 days keep the interior of the bars closed, although the final decision is made by the autonomies.

But controlling the incidence and pressure of care is not an easy task.

With the restrictions to stop the third wave, Spain came to reduce its incidence to 14 days from 900 cases per 100,000 inhabitants in February to 127 in March, but it remained far from the 25 recommended by health authorities to keep the pandemic at bay. .

Some communities, such as Madrid, which maintain a more lax policy of restrictions, have not managed to lower the incidence of 200 cases per 100,000 inhabitants since last August.

The President of the Government, Pedro Sánchez, who announced a few days ago that the Government works with the objective that “it is not necessary” to extend the state of alarm, assured that by the first week of May, 10% of the Spanish population will be vaccinated (five million).

But even if the immunization of one of the most vulnerable groups ends - those over 80 years of age, of which only half have completed the vaccination schedule - experts warn that there are other high-risk age groups that are lagging far behind: only 3% of people between 70 and 79 years and 5% between 60 and 69 are fully vaccinated.

"If there is a push from the campaign, we will be better.

But until we achieve herd immunity, we must protect the most vulnerable.

If we get to May 9 with important protection, of more than 80%, of the vulnerable, the clinical situation will be better ”, says Infante.

The Government has assured that in the coming weeks the rate of dose arrivals will intensify, but some epidemiologists are suspicious.

“We will not see such a dramatic effect from vaccination in May.

You can have less collapse in the health system, but the reality is that the authorities are trusting too much that immunization can stop the waves, ”says López-Acuña.

The epidemiologist recommends maintaining the same intensity of the current measures until the end of summer and the mask, interpersonal distance and coexistence bubbles, at least until the end of the year.

New variants of the virus may also play a role.

Epidemiologists do not expect surprises with the British variant, which is already installed and responds to vaccines, but it remains to be seen how the Brazilian and South African variants will evolve and whether the drugs are equally effective against them.

“It seems that these two are not expanding much, but it will have to be reassessed then.

If they don't scare us, we can do more then, but there will still have to be indoor restrictions and nightlife should be kept very cautious, ”Infante tertiary.

Legal limbo

Without a state of alarm, experts fear returning to a legal limbo, especially when communities want to apply measures that limit fundamental rights, such as freedom of movement or assembly.

To do so, they will need judicial endorsement.

“Without a state of alarm, you leave the communities that have to apply these measures to the discretion of the judges, you unprotect them.

The doctrine in this regard would have to be unified ”, Infante points out, regarding the different kinds of judicial decisions in the face of similar requests during the pandemic.

López-Acuña agrees: “We will lose a lot of time in comings and goings of regional decisions.

We will end up in a judicialization of the decisions, in a tug of war that will not allow us timely and agile measures ”.

Jesús Molina Cabrillana, epidemiologist of the Spanish Society of Preventive Medicine, Public Health and Hygiene, is in favor of extending the state of alarm "until there is group immunity" to also avoid "that the differences between the communities increase" when taking decisions.

But jurists appeal for caution in the event of an eventual extension of this legal umbrella.

“I am concerned that a culture is created that the limitation of fundamental rights is normal when it should be exceptional.

We have enough tools in the legal system to make decisions, what is needed is that there is institutional loyalty and that the judges be well reasoned with the measures they want to ask for ”, values ​​Federico de Montalvo, president of the Bioethics Committee of Spain.

Alberto López Basaguren, professor of Constitutional Law at the University of the Basque Country, also warns that “the normalization of the emergency is dangerous” and rejects that the ordinary courts should once again assume the responsibility of cutting fundamental rights due to of the pandemic.

López Basaguren calls for a reform of the sanitary and public health regulations to give more legal certainty to decisions: “We must better specify the measures that can be adopted by the ordinary powers.

What cannot be broken is the border between the extraordinary powers that regulate the state of alarm and the sanitary measures of the ordinary powers ”, ditch.