If Madrid were a home and the coronavirus was fire, the community would be on fire. In this simile by Javier del Águila, a specialist in preventive medicine and public health, the thresholds that are being agreed are “like discussing whether to act when the fire has reached the foundations or a little earlier.” “It’s late,” he says.
The limits that the Ministry of Health and the Community of Madrid have agreed to take restrictive measures – 500 cases per 100,000 inhabitants in 14 days, 10% positivity in tests and ICU occupancy above 35% for covid patients – are far above any international standard. Everyone urges you to act forcefully long before.
The Institute for Global Health at Harvard University it places the limit for severe home confinement at 350 infections per 100,000 inhabitants, something that is not even contemplated in Madrid yet with more than double the incidence. Germany has agreed to take action with 100 cases, the same number with which Belgium activates level four of restrictions, the highest. In the UK they look at R (the number of people contagious, on average, a positive), but it is establishing lockdowns with 225 cases, as has happened in the city of Bolton. In France, the toughest measures are established at 150, but reduce the threshold to 50 among the population over 65 years of age.
All the experts consulted agree, however, that looking only at incidence is insufficient. In this sense, these three factors agreed between Madrid and the Government – which will have to be ratified this Wednesday afternoon at the Interterritorial Health Council – are more complete.
But again, the supplemental thresholds are high by international standards. The World Health Organization (WHO) estimates that when more than 5% of people who undergo PCR test positive it is a sign of community transmission. The limit in Spain to establish measures will be 10%, the national average is 11.2%, according to the latest report from the Ministry of Health, while in Madrid it reaches 20.1%.
In the opinion of Daniel López Acuña, former director of emergencies at WHO, establishing thresholds is good news. He, along with other colleagues, had been claiming it since April. But three are insufficient. It proposes including the number of PCR tests carried out and the primary care capacity, something that will not be taken into account to tighten the measures. To these, Del Águila adds the ability to track.
With all these variables, López Acuña proposes a traffic light type indicator. “It may be that the red light is on what has just been defined, to which I would propose measures similar to phase 1 of the de-escalation,” she explains. These are stricter in many respects than is now being discussed. In this stadium you could go to terraces, but not to closed hotels, for example. But before this step, Acuña would also add an amber light, with about 300 cases per 100,000 inhabitants that had trends of increasing positivity and healthcare pressure, which could establish restrictions similar to phase 2. “With this solution we would have saved many problems ”, Says this expert in public health.
The problem, a dozen specialists that this newspaper has consulted in recent days coincide, is that it is too late for Madrid. The community this week has established new protocols to test PCR only in the closest environment of the positives and vulnerable people. “This is recognizing that the epidemic is out of control and that it has failed. And it has happened because they have allowed it, ”says Del Águila.
Although there is no scientifically indisputable measure from which to act with more or less strict confinements, the problem with exceeding figures such as 500 per 100,000 inhabitants is that it far exceeds the thresholds from which it is possible to keep the virus under control . “Of course, it seems that completing the contact studies effectively when that amount seems a very difficult task to ensure given the number of chains and contacts that would be found and on which we must act,” says Alberto García Basteiro, expert in public health from the ISGlobal health institute.
For this reason, in the agreement between Health and Madrid, the details of which EL PAÍS has advanced, has made an exception: even if some municipality exceeds these thresholds, it will not have to take restrictive measures if the trackers have controlled 90% of the infections, something which is far from happening in the most affected areas.
One of the big questions that open up now, if it is true that these measures are late, is: will they be enough? The figures will be reviewed every week to modulate the restrictions, but many experts have raised their voices demanding some tougher and, above all, different ones. Del Águila sums it up: “We are late to take gentle measures, such as 50% occupancy in the hospitality industry. You are allowing eating indoors, which is where there is more risk, and you prohibit playgrounds, which are much safer. Maybe it made sense a month ago, when it could be controlled, but right now we are in a situation where you have to ask or force people to stay at home ”.
With information from Rafa de Miguel, Lluís Pellicer, Ana Carbajosa Y Silvia Ayuso.
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 Spain and in each autonomy
– Download the tracking application for Spain
– Search engine: The new normal by municipalities
– Guide to action against the disease