Experts warn against relaxing safety measures as coronavirus outbreaks spread in Spain

Meetings with friends, family reunions, senior residences, hospitals, agricultural companies, slaughterhouses and imported cases. The dozen or so coronavirus outbreaks active in Spain do not follow a single pattern. The virus is out there, taking advantage of any opportunity to infect others.

Medical experts say the country is not seeing anything unexpected: they knew that outbreaks would occur. What’s important, they say, is controlling them in time. But these experts are concerned about the public’s increasingly relaxed attitude towards prevention measures. This attitude, they warn, could lead the pandemic to escalate out of control.

The coronavirus outbreaks are reflected in the data. The report from the Spanish Health Ministry on Wednesday showed the highest number of new daily infections in three weeks: 196, without taking into account the figures from Castilla-La Mancha, which could not be added due to technical problems. One has to go back to June 3 to find a worse number: 219. Although Madrid recorded the highest number of new cases (50), Aragón has seen the biggest spike in infections, with 49 cases recorded in 24 hours. This is the region where an outbreak of coronavirus has forced four comarcas – administrative regions smaller than provinces – to move back to Phase 2 of the government’s deescalation plan.

It gives us the impression that we were unable to communicate the seriousness of the situation

Pedro Rascado, Semicyuc

“Outbreaks are to be expected and they can be overcome as long as they are controlled and limited, which depends on public healthcare systems,” explains Rafael Manuel Ortí Lucas, the president of the Spanish Association of Preventive Medicine, Public Health and Hygiene. “They have to be ready to track down contacts and the system we have is not perfect. While [outbreaks] are limited to a slaughterhouse, a certain neighborhood with special characteristics, a hospital where a patient could be infected, they are acceptable; this is what is happening and it is foreseeable.”

But the expert warns: “What worries us is if [the outbreak] escapes to the community via parties, outdoor drinking sessions, events, social gatherings in neighborhoods or summer festivities, and it is not detected by the public health system, which will be less well staffed in the summer.”

If this were to happen, an outbreak would turn into uncontrolled community transmission, which would lead to a second wave of the pandemic, as is currently happening in South Korea. In other countries that have seen a rise in cases, this situation does not apply because they are still in the first wave, according to the experts.

In Ortí‘s opinion, although the public has generally responded well to the coronavirus safety measures, “we are seeing a certain relaxation.”

“The risk of the disease remains and it seems like that is sometimes forgotten,” agrees Pedro Gullón, from the Spanish Epidemiology Association. Pedro Rascado, the coordinator of the Covid-19 contingency plan at the Spanish Association of Critical, Intensive and Coronary Medicine (Semicyuc), is also concerned about some people’s behavior: “It gives us the impression that we were unable to communicate the seriousness of the situation.”

Outbreak: a group of three or more cases

A protocol from the Spanish Health Ministry defines an outbreak as “any group of three or more confirmed or probable cases with an active infection in which an epidemiological link has been established.” Despite this definition, which was made on June 16, each regional authority has their own way of referring to these groupings. In Andalusia, for example, the regional government denies that it has any outbreaks – its health chief, Jesús Aguirre, instead uses the English word “clusters” even though they meet the Health Ministry’s definition of an outbreak.

Regional authorities, following their own criteria, are the ones who decide whether or not to announce an outbreak. The central Health Ministry presents the aggregated data every few days at a government press conference. At the last conference on Monday, Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts, announced that 12 of the 36 outbreaks detected in Spain since the beginning of the deescalation process remained active.

The ministry has decided not to identify the provinces where the outbreaks are active, nor how many positive cases each one has. The data “fluctuates a lot and some regions are more sensitive than others when it comes to defining them [outbreaks],” explains a ministry spokesperson. Although regional authorities report each outbreak to the ministry, this data is centralized and not made public, meaning it is up to the regions to show transparency over this public health issue.

Some outbreaks have been identified thanks to reports from workers’ unions, including a case at the chicken company Uvesa in Rafelbunyol, in Valencia. On Wednesday, a day after the complaint was filed, the Valencian government confirmed that seven coronavirus cases had been detected at the company.

No clear pattern

Using the data provided by the regions and press reports, it is possible to trace the outbreaks that are currently active or have been in the past few days. EL PAÍS has identified 18 outbreaks that account for more than 330 cases. An analysis of these situations highlights that unlike a month ago, when almost all outbreaks originated in parties or family reunions, now there is no clear pattern. There are outbreaks in hospitals, like the two in the Basurto and Txagorritxu hospital in the Basque Country, which authorities consider “controlled,” and the one in Río Hortega hospital in Valladolid, where 21 infections have been detected. There are also outbreaks that are believed to be linked to family or social gatherings: one in Pamplona with 21 confirmed coronavirus cases, another one in Granada, with 10 cases, and a third in Orio in the Basque Country.

The workplace has also been the site of many outbreaks. The largest of them is among fruit pickers in Huesca province in Aragón. Regional authorities on Wednesday reported 17 new cases in the comarcas of Bajo Cinca, Cinca Medio and La Litera, and 15 in Bajo Aragón-Caspe. These areas have been forced to return to Phase 2 of the coronavirus deescalation plan and regional authorities have asked residents to limit travel to and from the affected areas. Simón warned on Monday that there is a risk that the outbreak could spread to the neighboring province of Lleida in Catalonia “because there is a lot of exchange and contact.” Authorities are currently investigating whether a contagion among 24 fruit pickers in La Juneda, near Lleida, is connected with the cases in Huesca. In Lleida, seven fruit pickers have also been placed in quarantine in a hotel after testing positive for Covid-19.

In these type of outbreaks, like those that occurred in April and May in meatpacking factories, the working and living conditions of the workers, most of whom are migrants, play a large role. “We have not been able to prevent [new outbreaks] with enough forcefulness, it appears that adequate security measures do not exist,” says Gullón. “Companies must invest in prevention, in transportation systems in which workers are not crowded in together,” adds Ildefonso Hernández, from the Spanish Public Health Association (Sespas).

In Málaga, an outbreak was detected in the Red Cross shelter, with 15 cases as of Wednesday, the regional government reported. In Algeciras, 17 people have contracted the virus in an outbreak linked to two boarding houses in the city.

Imported cases

Several outbreaks are linked to imported cases, like a migrant boat that arrived in Fuerteventura in Spain’s Canary Islands with 11 infected people aboard. In Murcia, another outbreak with 17 infections was caused by a case that arrived from Bolivia. In Navalmoral de la Mata in Cáceres, an outbreak of 17 infections originated in “another region,” according to the Extremadura regional government. And in Galicia, authorities are investigating if the only known outbreak in the region – where at least seven people have tested positive in the municipalities of Ribeira and A Pobra in A Coruña – is connected to a person who arrived from Brazil.

There are also cases in senior residences. In Lleida, the private senior home Castillón began to detect positive cases on June 14, after visits were allowed again. Now 18 people have been infected. In Extremadura, the residents of two homes in Plasencia and Casa de Cáceres have been isolated after testing positive. These, however, are not considered active outbreaks as they are “old cases” that were detected before the deescalation process but continue to test positive, explained a spokesperson.

Although these outbreaks have not been directly linked with young people, epidemiologists are concerned about the images of large parties and outdoor drinking sessions where basic safety measures are not being respected. As Simón warned on Monday: “It may be that they [young people] do not suffer [from coronavirus] but they could turn into spreaders.”

According to Simón, the average age of coronavirus patients has fallen from 60 to 50 in a month. This could be due to several reasons, including the fact that tests are now being done on everyone who has coronavirus symptoms. During the peak of the crisis, tests were only done on the most serious cases who needed hospital assistance, and who tended to be older people.

Several regions have launched information campaigns aimed at young people. “It’s important to address them specifically because perhaps traditional mediums don’t reach them,” says Antoni Trilla, an epidemiologist in the central government’s team of experts. “A high percentage of people under 35 live with their families. If there is transmission among young people, it is easy for it to reach seniors and perhaps even easier for [young people] to relax [safety measures] because they are not at such high personal risk,” adds Hernández.

English version by Melissa Kitson.