The Spanish government is planning to focus on the carriers of the coronavirus who do not have symptoms and who are working in essential services. Healthcare employees, workers in senior residences, police, delivery workers, staff from the food supply chain… They all form part of a flow of silent transmission of the coronavirus that the government wants to halt so that there are no new outbreaks once the social distancing measures are lifted.
To achieve this, there are two approaches being prepared. Firstly, mass testing of the population in order to locate all of these cases. Secondly, preparing infrastructure so that they can be isolated and that they don’t infect people close to them. The Spanish prime minister, Pedro Sánchez, on Sunday called on the premiers of Spain’s regions to send a list of public and private infrastructure that can be used to house those infected with the SARS-CoV-2 coronavirus but do not require hospitalization.
This also includes the “asymptomatic positives,” provided that the doctors support this, according to Interior Minister Fernando Grande-Marlaska, who is not ruling out making this isolation obligatory. “I suppose that a manifested will to voluntarily cooperate would be possible. If not, all of the legal options will be studied, because the fundamental principle is to maintain public health,” the minister said during a press conference on Sunday. “With the utmost respect to fundamental rights.”
The plan would be similar to the so-called Noah’s Ark hospitals, which China successfully used to isolate mild Covid-19 cases and halt the spread of the virus. As María José Sierra from the Health Ministry’s Coordination Center for Health Alerts explained, preparing this infrastructure is one of the measures included in the next phase of the crisis, in which early detection of all cases with early symptoms must involve isolation.
“Sometimes this can’t be done in the home,” she said. “All kinds of options are being put on the table and one of these is this kind of installation.”
Health Minister Salvador Illa, who also appeared at Sunday’s press conference, added that the isolation infrastructure would be available to all citizens who need it and who “want” to make use of it.
From this week, the strategy will be to carry out massive testing in essential services. This, Illa explained, will be the key to returning to normal life, “with all needed prudence,” minimizing the risk that there are new peaks in the disease.
The minister said that the government has ordered five million serological tests that will serve to carry out the first screening. These tests, which detect antibodies in the blood, have a sensitivity of 64% for someone who has the first symptoms, and of 80% after the seventh day of infection. They complement the PCR tests, which are still the “foundation of our strategy,” Illa explained. The health minister said that his department is working to increase the capacity of these tests by 50%, with 15,000 to 20,000 being carried out every day in Spain.
The government appears to have abandoned the use of rapid antigen tests, after 650,000 units had to be returned by the Spanish government after they proved ineffective. The Health Ministry already has a million serological tests, which it will be distributing from today to Spain’s regions, with another million on the way in the coming days.
In the future, Sierra explained, testing will be carried out across the population in order to determine the prevalence of people who have already had the disease, with or without symptoms. The National Statistics Institute and the Carlos III Health Institute are already working on this kind of serological survey.
While for now there is no scientific evidence as to what extent people are immunized from the coronavirus or for how long, the experts assume that there is protection against the disease for at least several months after infection. The result will be key for finding out how far Covid-19 has been present in the population and to continue taking decisions on how to reduce the confinement measures across Spain. Epidemiologist and government advisor Antoni Trilla explained to EL PAÍS that the government is even considering a kind of health passport for those who have overcome the disease and can get back to normal life.
A source from La Moncloa prime ministerial palace said that the intention is not to oblige people to isolate in these Noah’s Ark infrastructures, but to rely on common sense. “If a young person lives alone, it will doubtlessly not be necessary, but if the home is shared with an older person, it will be recommendable,” the source said.
The possibility of obligatory hospitalization already exists in Spanish law, as long as it is approved by a judge. It has been used on dozens of occasions in the last 20 years to hospitalize patients with a kind of tuberculosis that is resistant to treatment. The 1986 Special Measures in Public Health law allows for the authorities to adopt hospitalization measures when there is a “danger to the health of the population.”
English version by Simon Hunter.