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The areas with the highest purchasing power in Madrid suffer a higher rate of covid infections

2021-12-31T04:34:34.343Z


The scope of vaccination, the high detection of the last week and the characteristics of the omicron variant make the correlation between cases and admissions more difficult in this wave than in the previous ones


If there is something that differentiates this moment from the rest of the moments since the winter of 2020, it is the vaccine. It is the main reason that in the face of the explosiveness of this sixth pandemic peak - which only in the last seven days has left 74,031 infections in Madrid - the number of sick and deceased have not grown, until now, in the way they did for months behind, although they increase steadily and with increasing speed. Always with uncertainty as the only certainty, experts believe that the Community could reach the peak of this wave next week, although they allude to the fact that we must take into account the imbalances that holidays can cause: both in the new infections that are They are giving rise to the rise in social interactions, as in the detection and notification of these infections.

Since the crisis began, Madrid has accumulated 1,133,448 positives, 18.9% (214,922) have occurred since November 10, when the beginning of the sixth wave was set. No other period has had the outbreak of infections than the last two weeks after the arrival of the omicron variant, which according to the latest data from the Ministry, exceeds 90% of infections. The day that was least reported in this last fortnight was December 19 (it was Sunday), with 3,042; and this Tuesday the maximum of the entire pandemic was reached with 19,932 positives notified in 24 hours.

With data from this Thursday, the cumulative incidence reaches 2,426 cases per 100,000 inhabitants in the last 14 days and the positivity - the percentage of cases that are positive with respect to the tests that are carried out - is 23.3%, three points above the national average.

Preciados street, in the center of Madrid, on November 28, 2021.Olmo Calvo

This infection curve, a vertical wall that has not yet bent downward, is not as parallel, as has happened on other occasions, to that of admission to the ward and ICU, and with a slightly more offset, to that of deaths.

“Obviously, thanks to the mass vaccination and the third booster dose of the elderly.

It is the most important factor for the morbidity to be much lower, "says epidemiologist Fernando García, spokesman for the Madrid Public Health Association (Amasap).

Although, he clarifies, "it remains to be verified whether omicron is less virulent than other variants, it must be analyzed with the unvaccinated, and, even so, there are still immunosuppressed people or older people" who are affected by the virus. more acute form.

The comparison made last Tuesday at a press conference by the Deputy Minister of Public Health, Antonio Zapatero, showed the differences between the third, fifth and sixth waves.

While in the peak of the wave last winter 7,879 were registered, of which 20% entered the plant and 2.8% in the ICU;

in summer, with 5,479 infections at that peak, it was 14% in acute and 2.31% in critical;

and at this moment, it is 2% and 0.2% respectively.

📊 The vice-counselor @ZapateroAntonio has explained that during the 6th wave there is:



📉 86% less income in the plant and 87% less income in the ICU, compared to the 3rd wave.



✅ This is due to the high degree of vaccination and less aggressiveness of the omicron variant.

pic.twitter.com/Rja0GsnG5d

- Community of Madrid (@ComunidadMadrid) December 28, 2021

This correlation, however, "is not entirely correct," says Saúl Ares, systems biologist and researcher at the CSIC, because the comparison between diagnoses and income cannot be made with any other wave. And it is not only because of the large percentage of the immunized population - there are 91.6% of Madrilenians and Madrilenians over 12 years of age with both doses - but because of "test fever." It refers to the pharmacy self-diagnostic tests that citizens can take at home.

Faced with the torrent of new infected, the system touched roof in the detection and the Ministry of Health decided to modify the strategy: since December 21, the positive results of these tests count as official positive for the Community. And two days later, the regional government activated points to test the population with symptoms outside the emergency rooms of 15 public hospitals. That volume of detection, says Ares, "has never happened before, and making the division between cases and admitted can be misleading, because the proportions are not the same."

Although the greater transmissibility of omicron has multiplied infections - it has an R0 of between 6 and 10, that is, each infected has the ability to pass the disease to between six and 10 people, according to the Deputy Minister of Public Health, Antonio Zapatero , last Tuesday—, "we must take into account the variable of diagnostic capacity," explains Ares.

Thus, he affirms, the wide margin between the ratio of infected and of people requiring income is not as much as it may seem at first glance.

Emergencies grow by around 2,500 daily visits

If we look at the absolute numbers and not the relative ones in terms of healthcare pressure, it seems “quite clear” that the numbers of “the two previous waves” are going to be exceeded, says Ares. On April 26, for example, there were 2,255 patients in acute and 576 in intensive care units, it was the peak of the fourth; Hospitals took almost a month to reach that number of patients on the ward, from a figure similar to the one recorded this Thursday, 1,583. In critics, where there are now 226, the situation was different. At that time, Madrid had practically linked the third wave with the fourth and between the two, seriously ill patients never fell below 400.

Immunization has "enormously" reduced the exacerbation of the disease.

According to the data offered by the vice-counselor a few days ago, the risk of entering the ward decreased by 73.5% and by 82.1% in the ICU in the Community of Madrid ”.

The issue still, experts insist, is that in such an immense volume of infections, the percentage of cases that end up needing assistance will be small, but in absolute numbers, "it will be many."

A health worker injects the covid vaccine to a minor, at the Infanta Sofía Hospital, on December 30, 2021, in San Sebastián de los Reyes (Madrid) Eduardo Parra (Europa Press)

Hospitals are already noticing it, operations are paralyzed and tests and consultations are delayed again;

Visits have already been prohibited in some of them, as in Getafe for at least two weeks;

and in the emergency department there has been an increase of between 2,500 and 3,000 daily visits since last December 17, when there were 9,457.

Those who enter from there, however, maintain a stable curve that, in recent days, has even decreased slightly;

although it has coincided with December 24, 25 and 26, times when emergencies skyrocket every year, but revenues from that area decrease.

The "déjà vu"

Intensive Medicine, Anesthesiology, Emergency or Internal Medicine professionals speak of “déjà vu”. This Wednesday, the Infanta Leonor anesthesia team received a message informing them that the ICU of that center was already "full"; that the intensivists were going to take care of “up to ten patients”, which implied that two of them would have to be taken by anesthesiologists in the resuscitation unit (REA). And all this meant that the operations that required that space during the shifts were paralyzed and that from that moment, the URPA (recovery unit after anesthesia) could “remain open at night with four posts”.

This situation, which due to global volume and in comparison with other moments is not yet critical, worsens in the context of 22 months of pandemic, with their respective suspensions of consultations, reviews, surgeries and tests; with a staff that drags physical and mental fatigue and that is also immersed in a complicated work situation due to the renewals of more than 11,000 contracts that are in the air, the so-called “covid reinforcement”.

That, points out Manuel Franco, epidemiologist and spokesman for the Spanish Public Health Society, also comes at a different social moment: “The public is also tired, and we have been caught with what we believed the honeymoon of vaccination. The media, the politicians, the people ... We

are still

in

shock

, we are not yet seeing the sociological consequences for the population ”. And he says that "you cannot forget" the area that reached that "state of collapse" the most and before: primary care and public health.

"There they reached saturation a long time ago, they have burst all the seams."

In a month, the health centers have multiplied by eight the patients they have under follow-up (from 1,191 to 8,561) and attend more than 300,000 daily consultations;

Two weeks ago they had to cancel everything that was not essential.

And the epidemiologists and health workers of the Community, in charge of tracking and monitoring the cases, are unable to absorb the volume of contacts that are taking place.

“In that, yes, all the waves are similar”, says Franco, “in the state, totally weak, in which the Community maintains the structure of primary and Public Health”.

The possible socioeconomic factors of the areas with the most contagions

Boadilla del Monte, Rivas-Vaciamadrid, Las Rozas and Pozuelo de Alarcón are the towns with the highest cumulative incidence (AI) in the last 14 days, all with around 2,000 cases per 100,000 inhabitants; and in Madrid capital, they are the districts of Chamberí (2,736), Salamanca (2,587) and Centro (2,425). These are data from the latest epidemiological bulletin of the General Directorate of Public Health, on Tuesday. But it is not new. Since the second wave, in each of them the municipalities and neighborhoods with the highest socioeconomic status in the Community have registered the highest transmission. There is still no study that has delved into the why of this question, and experts, at the moment, can only make hypotheses. 

Fernando García, epidemiologist and spokesperson for the Madrid Public Health Association (Amasap), recalls that "just as at the beginning it was the most depressed socioeconomic sectors that suffered the most from the effects of the pandemic, later it has been the opposite." He points out that “perhaps it has to do with the fact that infections occur more in areas of social interaction among young people”, but he wonders “if it is that these groups meet more in the Salamanca district than in other places” or “if it is that there is greater detection ”. What the data from the Ministry of Health says is that it is in those territories where there is greater community transmission. And, in terms of age groups, mostly among those aged 25 to 44 (2,758 cumulative incidence) and among those 15 to 24 (with an AI of 2,576). 

García adds several more questions, "all hypotheses," he warns, "which should be verified." One, that "it could be analyzed if there are differences in vaccination rates by socioeconomic level and age." Another, "that perhaps the discredit regarding the measures to be followed is greater in the highest socioeconomic areas." And a last one, "that precaution in social interactions is different by social strata." 

For Joan Carles March, researcher at the Carlos III Health Institute, professor at the Andalusian School of Public Health and former director of that institution, there are waves in which the reasons can “seem” more concrete and be “linked to the profile of the wave” . He gives as an example the fifth, “which began with the very young population, and in some way a population that moved on study trips, or with friends. And who can move the most? Who has better economic conditions ”. In the latter, the same “may” have happened: “Extreme mobility favors having many contacts and whoever moves the most is the one who has the most resources. It would be necessary to try to know where the virus is going and where it comes from, but in moments of transmission such as the current ones it is impossible, the systems, in the conditions in which they are, do not have the capacity to carry out this analysis ”. 

García agrees on this, stating that "the in-depth research that had to be done in the hospitality industry, nightlife, work, education ... has not been done to fine-tune everything that should be done", because "the tracking has never worked well" and therefore “there has not been a map that allowed us to have a much clearer idea.” Now, “there is no longer the capacity to find this out”. 

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Source: elparis

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