After falling for months, the number of coronavirus cases has begun to rise on a national level in Spain. At the end of May, the number of new infections confirmed by PCR testing fell below 500 and in June, they were less than 250. Now however, Spain is again recording more than 1,000 cases a day.
According to the Carlos III Health Institute, the R reproduction number – which measures how quickly a virus can spread – is now around 1.3, meaning that one infected person will pass the coronavirus on to an average of 1.3 people. This figure, based on the date that symptoms begin, has been above one for two weeks. This means that contagion is on the rise and could once again become exponential.
The spike in cases is already being felt by some hospitals. Doctors in several regions have confirmed this, and it is also evident in the official statistics: the number of hospital admissions in Spain has been increasing for 10 days. In the last week, between 30 and 40 people were hospitalized a day – figures that have not been seen since May. This, however, is still far below the 2,000 daily admissions the country recorded during the peak of the pandemic in April. Hospital admissions began to rise between July 10 and 12, a week after Spain saw an increase in Covid-19 cases, as has been typical in the pandemic.
There are coronavirus outbreaks in all of Spain’s 17 regions – not just in the provinces of Huesca and Lleida, where there is already talk of community transmission – but across the country. According to data from the Spanish Health Ministry, the virus is spreading in at least 10 regions.
It is not a coincidence that the outbreaks are happening now. “I attribute them to the end of the deescalation plan,” explains Ignacio Rosell, a specialist in public health and a member of the expert committee of the regional government of Castilla y León. “With the new normality, there is more risk. People are becoming increasingly confident and this adds to summer-specific circumstances, like seasonal workers, social contacts and family reunions.”
Helena Legido-Quigley, an associate professor of the London School of Hygiene and Tropical Medicine, agrees that people have begun to let their guard down, and also points to the shortcomings of contact tracing programs. “We can see that some people have relaxed [their attitude towards the virus] and that most of the regions did not properly prepare their programs to track cases and their contacts. These factors combined mean that we are seeing a large number of outbreaks, some of which are very worrying.”
This expert is particularly critical of the response by regional authorities. “Most have not hired or prepared their system with the necessary staff. The idea of being confined was also to give them time, but they haven’t done their homework and this is going to have very serious consequences for public health and the economy.” Legido-Quigley also believes the central government acted too quickly: “We shouldn’t have moved to a different phase [of the coronavirus deescalation plan] before these systems were ready. Officials at all levels of government assured us that we were prepared when we were not,” she says, in reference to the government’s four-stage plan to roll back the strict confinement measures that had been in place since the declaration of the state of alarm on March 14.
The coronavirus continues to spread and has an especially high incidence (more than 10 cases per million inhabitants) in the Spanish regions of Aragón, Navarre, Catalonia, Basque Country, Extremadura and La Rioja. It is also on the rise in regions with a lower incidence, like Murcia, Andalusia, Valencia and the Canary Islands. Some of the outbreaks are small and can be quickly controlled. But what is concerning is the overall pattern and the experience in March, which showed how quickly transmission can snowball.
The most positive news is that the number of deaths has not increased. If there were to be a spike, it would happen two to three weeks after contagion, given the normal process of the disease. But it is also possible that the virus is becoming (or simply appears to be) less lethal, because more cases are being detected among young people. The average age of new coronavirus cases is 48, compared to 60 in April. This is partly due to the fact that previously only the most serious cases were being diagnosed, which tended to be among elderly patients. But it may also be that fewer seniors are contracting the disease now because they are taking greater precaution and have less contact with others – a situation that could also apply to other at-risk groups.
It is important not to compare the absolute figures from March and April, given that detection is much better today and a greater percentage of cases are being identified. “In March, for every case confirmed by PCR tests there could have been 10 (if not more) who were not diagnosed. Now we are sure that the number is much lower,” explains Rossell. “But if [the outbreaks] get out of control, if they enter senior residences and spread to vulnerable people, of course we will see an increase in serious cases.”
Overview of outbreaks
Barcelona and Lleida, which have both been placed under new lockdown restrictions, are not the only areas where there is now community transmission. Coronavirus cases are rising in all of the provinces of Catalonia and Aragón. In Tarragona, the Catalan province least affected by Covid-19 so far, the number of new infections jumped to more than 10 cases per million inhabitants for the first time since May. In Zaragoza, the province is on the way to more than 100 cases per million inhabitants and infections are rising at the same pace as in March.
A research group in computational biology and complex systems at the Polytechnic University of Catalonia (UPC) has been following the data for months with a traffic light system. “We get red – very likely community transmission – in the provinces of Lleida, Huesca and Zaragoza,” explains Clara Prats, a researcher from the team. “Barcelona comes up orange, probably because the part in central Catalonia compensates for the situation in the metropolitan area (clearly in red),” she adds.
In the Basque Country, there have been at least seven official outbreaks since June, two of them located in hospitals. These outbreaks have led to nearly 280 infections. And in Navarre, nine outbreaks have been reported, with 240 associated cases.
The southern region of Andalusia has been one of the least affected by the coronavirus crisis, despite having the largest population in Spain. While the situation is stable in most of its provinces, Málaga, Granada and Almería have seen a clear spike in cases. According to the regional government, since the beginning of the deescalation process, there have been 35 outbreaks, leading to at least 600 infections, most of which were reported in these three provinces.
English version by Melissa Kitson.