Thermal imaging and e-forms: How Spain will screen for Covid-19 when the travel ban is lifted

Now that the coronavirus epidemic is considered to be under control in Spain, the next big danger will be the imported cases, warn health officials.

If everything goes according to plan, the first tourists will arrive this coming Monday as part of a pilot project in the Balearic Islands. Then, on July 1, Spain will officially lift travel restrictions at the border, including the quarantine requirement.

Despite the travel ban, a total of 33,500 people entered Spain during the month of May through air and maritime borders, thanks to exceptions made for specific workers, residents returning to their homes, and certain emergency situations.

But this number is expected to soar as soon as the country reopens, and authorities are scrambling to get health teams ready in time to detect all incoming cases.

A majority of people will no doubt say something when they feel symptoms, but as you scale up, there is a growing number of people who will not

Alberto Infante, public health expert

Until now, personnel from the Health Ministry have been in charge of conducting airport temperature checks and handing out forms that visitors must fill in with information about any symptoms they might have, and their contact address during their stay in Spain.

Since May 11, these health workers have detected 104 coronavirus cases, according to Fernando Simón, head of the ministry’s Coordination Center for Health Alerts and Emergencies. Most of the imported cases came from Latin America and the United States.

But this group of around 600 employees will not be nearly enough to screen all the new arrivals. Spain will reach deals with countries of origin to conduct checks at departure points.

Fernando Carreras, deputy director of Sanidad Exterior, the ministry department in charge of the screening, said that his team is incorporating automated processes such as computerized health declarations and thermal-imaging cameras, which can check the body temperature of several people simultaneously, an improvement from doing it one at a time with a thermometer pointed at a person’s forehead. Although these ministry health workers will assess suspicious cases, they will be backed by personnel hired by Aena, the Spanish airports operator.

The screening is planned only for people arriving by sea or air, not by land. Travelers arriving on trains or motor vehicles will not undergo any kind of health checks.

Inefficient system

In any case, temperature screening has not proven itself to be a very efficient method for detecting coronavirus infections. Asymptomatic individuals and those who are still in the incubation period and have yet to develop symptoms cannot be identified with this method. Fernando Simón, of the ministry’s health coordination center, was himself opposed to adopting the system at the beginning of the crisis, and he recently noted that “it is not a cure-all.”

The other element of the Covid-19 detection effort, the health declarations, seek to ensure that visitors can be contacted if necessary throughout their stay. For now, new arrivals have to self-quarantine for 14 days, with outings permitted only for essential purchases such as food and medicine. But the quarantine will be lifted in the Balearic Islands this coming Monday, June 15. Elsewhere in Spain, the official date for free travel without restrictions is July 1, although Brussels yesterday recommended that all EU member states lift restrictions on internal travel on Monday. As for the EU’s external borders, Brussels wants to implement a plan in a coordinated manner.

So far, workers have been randomly calling visitors to ask about their health and trying to make sure they are observing the quarantine. “We need to keep in mind that this is not a police-controlled confinement, it largely depends on each person’s sense of responsibility,” said sources in the government of the Balearic Islands. “The response has been very positive, and the calls also help travelers with any doubts they might have regarding the disease.” Calls will continue after July 1, but it will be more difficult to keep tabs on travelers.

We need to keep in mind that this is not a police-controlled confinement, it largely depends on each person’s sense of responsibility

Balearic Islands government source

Reopening borders “must be done,” but it must be done “very carefully,” said Alberto Infante, a public health expert who talked about a case in which a Peruvian couple residing in Spain “traveled to Peru because their son died of Covid-19, and a daughter was ill. By the time they boarded the plane back home they had symptoms, and also obviously upon arrival. But they were only detected two days later when they got worse and sought assistance. All the passengers and crew on the flight had to be isolated. It’s clear we have to be more proactive.”

“A majority of people will no doubt say something when they feel symptoms, but as you scale up, there is a growing number of people who will not," he added. "And it’s not the same thing keeping an outbreak with dozens of cases under control, as it is keeping hundreds or thousands of cases.”

The epidemiologist Alberto García-Basteiro said that if epidemiology surveillance systems are boosted, including faster detection and an effective implementation of contact tracing, it should compensate for the risk of new cases arriving from countries with higher coronavirus transmission than Spain.

English version by Susana Urra.