CORONAVIRUS

Spanish government announces areas that will move to the next phase of coronavirus deescalation

The administration has rejected the Madrid region’s request to transition to Phase 1, “opting to wait until its primary care detection system is more robust”

Health Minister Salvador Illa at the news conference on Friday night.
Health Minister Salvador Illa at the news conference on Friday night.

The Spanish government on Friday announced the areas of Spain that will move to the next phase of the government’s deescalation plan on Monday. The announcement came after administration sources said earlier in the day that it was rejecting the Madrid region’s request to transition to Phase 1.

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Madrid, the national epicenter of the coronavirus pandemic in Spain, is not in a position to scale down confinement measures any further, according to these sources: “The government acknowledges Madrid’s healthcare capacity, but it is opting to wait until its primary care detection system is more robust before transitioning to another phase.”

Madrid’s situation will undergo a new review, but central authorities will wait at least one week before allowing the region to move from Phase 0 to Phase 1 of the deescalation plan.

Territories moving to Phase 1

Health Minister Salvador Illa gave a press conference at around 8.30pm on Friday after meeting with regional authorities to discuss the conditions of the deescalation, based on the idea of “co-governance” as demanded by regional leaders. Illa also called for “prudence, prudence, prudence” to consolidate gains.

Barring exceptional circumstances, areas will remain in Phase 1 for two weeks.

“During this transition to the new normality, social discipline is more necessary than ever: maintaining interpersonal distance, washing hands and maintaining hygiene in private and public spaces, and heeding the instructions of health authorities,” he said, noting that 51% of the population will enjoy fewer confinement measures on Monday.

The Health Ministry has approved Catalonia’s plan to let the healthcare areas of Terres de l’Ebre, Camp de Tarragona and Alt Pirineu i Aran transition to Phase 1 on Monday, because of their low population density and few coronavirus cases. Higher-density zones, including the city of Barcelona and the greater metropolitan area, will remain in Phase 0 for at least a few more days.

Also moving into Phase 1 on May 11 are the regions of Galicia, Asturias, Basque Country, La Rioja, Aragón, Cantabria, Murcia, Navarre, Cantabria and Extremadura, as well as the north African exclave cities of Ceuta and Melilla. The Balearic Islands have also been approved for Phase 1 starting on May 11, when they will join Formentera, the only island in the archipelago that has already been at that stage since last Monday. The whole of the Canary Islands will also move forward on Monday, joining three islands that were granted Phase 1 status on May 4.

In Andalusia, the provinces of Almería, Jaén, Córdoba, Seville, Cádiz and Huelva will be moving to Phase 1. Málaga and Granada will stay in Phase 0.

In the Valencia region, parts of the territory are moving to Phase 1 while others are remaining in Phase 0. The cities of Alicante and Elche, for instance, will be held back, while the designated “health zones” of Vinaròs (Castellón), Requena (Valencia), Xàtiva-Ontinyent (Valencia), Gandia (Valencia), Alcoy (Alicante), Dénia (Alicante), La Marina Baixa (Alicante), Elda (Alicante), Orihuela (Alicante) and Torrevieja (Alicante) are moving forward.

In the region of Castilla-La Mancha, only two provinces are moving to Phase 1 – the less-populated Cuenca and Guadalajara – while Albacete, Ciudad Real and Toledo will do so “almost for certain in a week’s time,” said a regional spokesperson, adding that “we accept the decision.”

In Castilla y León, no entire province is moving forward; instead, 26 smaller areas that coincide with designated healthcare zones have been selected to ease confinement measures. These include one in Ávila (Muñico), six in Burgos (Sedano, Valle de Losa, Quintanar de la Sierra, Espinosa de los Monteros, Pampliega and Valle de Mena), three in León (Truchas, Mantalla de Torio and Riaño), one in Palencia (Torquemada), four in Salamanca (Robleda, Lumbrales, Miranda de Castañar and Valdeadavila de la Ribera), one in Soria (San Pedro de Manrique), three in Valladolid (Alaejos, Mayorga de Campos, Esguevillas de Esgueva) and seven in Zamora (Alta Sanabria, Carbajales de Alba, Tábara, Santibañez de Vidriales, Alcañices, Corrales del Vino and Villalpando). They are all rural areas with few inhabitants, and in many cases have not seen a single case of the coronavirus.

No to Madrid

Official figures show nearly 70,000 confirmed coronavirus cases in Madrid and more than 15,000 related deaths, compared with the national tally of 221,447 infections and 26,070 fatalities.

According to the Health Ministry’s criteria, in order to move to Phase 1 Madrid should have between 24,575 and 26,568 hospital beds, and between 996 and 1,328 ICU beds based on the region’s population of 6.6 million. The region has this capacity, counting the field hospital set up at the Ifema exhibition center, which no longer has any patients but has not been dismantled. But the region does not meet the infrastructure or human resources requirements laid out in the deescalation plan.

The decision by Madrid’s regional executive to formally request a transition from Phase 0 to Phase 1, which involves greater citizen mobility, had triggered a political storm within the regional government. That petition was made despite recommendations to the contrary by the Madrid region’s director general of Public Health, Yolanda Fuentes, who resigned on Thursday night to signal her disagreement.

The head of the Madrid health department on Thursday presented national health authorities with a technical report arguing in favor of Phase 1 without backing from Fuentes, who wrote in her resignation letter that the petition “is not based on health criteria,” and that these should take precedence over political and economic issues, according to the news agency Servimedia.

The resignation underscores the division within the Madrid executive over deescalation. The regional premier, Isabel Díaz Ayuso of the Popular Party (PP), had herself on Wednesday expressed doubts as to whether Madrid was ready to scale down confinement.

“I’m not in a rush to move on to anything. Madrid has seen the worst scenes and that’s why I am being cautious and I want steps to be taken little by little,” said Díaz Ayuso as late as Thursday on the television station Cuatro.

But on Friday, she admitted that her government’s move to request Phase 1 was based on economic, rather than health criteria. “Medical criteria always fall back on the most cautious position, but in order to prevent a new spike, we’d have to stay at home forever,” she argued.

Her own deputy Ignacio Aguado, of Ciudadanos (Citizens), had been pressing to reopen the region. “We are prepared,” he recently stated, citing the need to restart the economy.

The “worst scenes” mentioned by Díaz Ayuso includes overwhelmed hospital emergency services, inexperienced nurses dealing with intubated patients in critical care units, and ice rinks turned into makeshift morgues. At the peak of the crisis, on April 2, there were as many as 1,528 intubated patients in the region’s intensive care units (ICU) as hospitals rushed to increase their ICU capacity sixfold almost overnight.

Shocked

Madrid’s decision to finally request moving on to Phase 1 shocked other regional governments with high rates of coronavirus, such as Castilla y León, which has had 31.08 cases for every 100,000 inhabitants in the last seven days. Madrid comes in second with 30.63.

“Never in my political life did I think I’d hear myself saying this, but I am amazed to have to say that Torra has been more sensible about this,” said Francisco Igea, the deputy premier of Castilla y León and a physician by trade, alluding to Catalan premier Quim Torra, who has requested a partial application of Phase 1 that leaves out Barcelona, Girona and parts of Lleida.

An epidemiological ranking based on four parameters (cases, deaths, hospital admissions and critical care unit occupation) divides Spain’s 19 territories – 17 regions and the two North Africa exclave cities of Ceuta and Melilla – into a leading group, an intermediate one, and one that is clearly lagging behind.

This list shows that the Canary Islands, Murcia, the Balearic Islands and Andalusia, as well as Ceuta and Melilla, are best prepared to move to a phase that allows gatherings of up to 10 people and the reopening of sidewalk terraces at 50% capacity.

The middle group comprises the Valencia region, Aragón, Extremadura, Asturias and Galicia, while the least prepared regions are Navarre, the Basque Country, La Rioja, Madrid, Castilla y León, Castilla-La Mancha and Catalonia.

These numbers should theoretically inform central authorities’ decisions to allow or prevent individual territories from introducing further deescalation measures. But Fernando Simón, head of the ministry’s Coordination Center for Health Alerts and Emergencies, has not said what indicators are being used in the decision-making, or who is making these choices.

Spain’s director general of Public Health, Pilar Aparicio, has said that numerous variables are at play, making it difficult to make purely quantitative decisions. “An island is not the same as a territory in Spain’s interior, and an urban area is not like a rural area. It’s not the same having a lot of cases in a controlled cluster, and having fewer cases scattered over a larger area,” she said.

English version by Susana Urra.

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