CORONAVIRUS

More than seven million people in Spain now facing perimetral lockdowns

Experts say the restrictions on movement, many of which are already in place, will not be enough to stop the spread of the coronavirus without measures aimed at reducing capacity and social activity

People walk down a street in Burgos, which will be placed under a perimetral lockdown on Friday.
People walk down a street in Burgos, which will be placed under a perimetral lockdown on Friday.©Tomas Alonso / Europa Press

More than 7.2 million people in Spain live in municipalities or regions that are currently, or soon to be, subject to a perimetral lockdown, meaning residents cannot leave or enter the area unless it is for essential reasons, such as for work, to access care services or in the case of an emergency.

This restriction – aimed at curbing the spread of the coronavirus – is already in place in 50 municipalities of greatly different sizes, from Madrid, with its 3.2 million inhabitants to Jerte in Extremadura, which is home to 1,266 residents. Over the past weeks and months, a series of measures has been introduced in the affected areas in a bid to slow contagion rates. But they have not worked.

This has prompted the government in La Rioja to confine the entire region from Friday, and in the northwestern region of Aragón, three provincial capitals will also be placed under a perimetral lockdown tomorrow. With the exception of Madrid, all of Spain’s 17 regions have been applying more or less strict measures in response to the rising incidence rate of the virus. A perimetral lockdown is one of the toughest measures, because it involves restrictions on movement. But experts who spoke to EL PAÍS agree that after a certain point it is only effective if it is accompanied by other measures.

To stop contagions from rising a perimetral lockdown that seals off an area is not enough. For it to be effective, you have to apply sufficient measures to restrict activity
Daniel López Acuña, former official at the World Health Organization

Daniel López Acuña, a former official at the World Health Organization (WHO), has been warning for weeks that several regions in Spain need to return to the restrictions of Phase 1 of the national deescalation plan to prevent a spike in new coronavirus cases. Under this stage, sidewalk cafés can open at 50% capacity but indoor restaurants and bars must remain closed. Limits are also placed on places of worship, cultural events and funeral services. Now, as Spain faces a surge in infection, he warns: “To stop contagions from rising a perimetral lockdown that seals off an area is not enough. For it to be effective, you have to apply sufficient measures to restrict activity within [the confined area].”

Alberto Infante, professor of the National Health School at the Carlos III Health Institute, agrees, explaining that restricting entry to and from a municipality only serves to stop the flow of people so that transmission does not spread to areas with a lower incidence of the virus. Nothing more.

Fernando Rodríguez Artalejo, a professor of public health at Madrid’s Autonomous University, compares the use of perimetral lockdowns in Spain in response to high transmission rates to that in countries like New Zealand that “cordon themselves off because they have eradicated the virus.” “This way, they prevent people from abroad from entering and starting new internal transmission chains,” he explains, adding that this is why countries like China, South Korea, Australia and China have closed their airports and introduced strict quarantine measures for arrivals. In other words, he says: “The cordon is established for exactly the opposite reasons that it is in Spain.”

“There is something that has not been understood,” adds Acuña. “The goal at this time, faced with this community transmission, is to limit interaction between people and that involves applying restrictions on capacity, reducing opening hours, closing indoor spaces, less movement.” He recommends that affected regions – in addition to applying a perimetral lockdown – either return to the restrictions of Phase 1 or Phase 2 of the deescalation plan, or introduce a nighttime curfew.

According to Infante, authorities must also strengthen contact tracing and the primary healthcare system. “In Spain, many political authorities find it easier and simpler to understand a perimetral lockdown and send police to control who comes in and out than to organize resources and provide more human and material tools, which is what is really needed,” he says.

After the national state of alarm came to an end on June 21, regional governments were put in charge of containing coronavirus outbreaks and so far, they have been introducing measures in a silo, based on their epidemiological data and the pressure on hospitals. But Spain’s Inter-territorial Health Committee – which brings together the country’s regional healthcare chiefs – will meet on Thursday to discuss a four-level coronavirus alert system aimed at clarifying the measures that should be taken to contain the epidemic, depending on the risk level in each territory.

Acuña believes that if the plan is approved by the regions, the measures should be legally binding – not just recommendations. This, he says, would prevent regions such as Madrid from ignoring the guidelines. A few weeks ago, the committee approved by a majority a similar document that ordered perimetral lockdowns and restrictions on social gatherings for cities that exceeded specific thresholds. The Madrid administration applied the rules, but immediately appealed them, and the regional High Court struck down the confinement measures for lacking a valid legal framework. When the Madrid government failed to propose new restrictions, the Spanish government declared a state of alarm to restrict movement, a situation that will come to an end on Saturday.

In Spain, many political authorities find it easier to understand a perimetral lockdown than to organize resources, which is what is really needed
Alberto Infante, professor of the National Health School at the Carlos III Health Institute

“It would be good if this were not another tug of war over legal terms, that it be clear what is needed to do what has to be done,” says Acuña, adding that if another state of alarm is declared it would be to provide a legal framework for new restrictions – not to introduce a complete lockdown like the one seen during the first wave of the pandemic, when residents were confined to their homes. “Be it a return to Phase 1 or Phase 2 [of the deescalation plan] or a curfew, it has to be done now,” he says.

Acuña is also against Madrid’s proposal to return to perimetral lockdowns based on healthcare areas, which are smaller than a city district and can include several primary healthcare centers. Although the state of alarm is set to end on Saturday, the Madrid regional government has still not clarified what measures it will introduce once it expires.

Other regions, meanwhile, have decided to introduce perimetral lockdowns due to the increasing pressure the pandemic is placing on the healthcare system. “They see the high occupancy of [coronavirus patients] in hospital and intensive care (ICU) beds and are getting scared,” says Acuña, who adds the impact is also being felt on primary healthcare services.

Under the Health Ministry’s rules, a municipality must be confined if its 14-day cumulative number of coronavirus cases per 100,000 inhabitants exceeds 500, if more than 35% of intensive care beds are occupied by coronavirus patients and if the positivity rate – the percentage of PCR tests that come back positive out of the total – is more than 10%. Many regions have chosen to take action before their figures exceeded these thresholds. These are the Spanish regions that have imposed or announced perimetral lockdowns.

La Rioja. The government of La Rioja announced on Wednesday that the entire region will be placed under a perimetral lockdown from Friday until November 7. In addition to the restrictions on movement, all commercial establishments will have to close by 9pm, with the exception of pharmacies, supermarkets and restaurants that offer home delivery. Capacity at bars and restaurants will be cut to 50% in indoor spaces and 60% outdoors, while consumption at bar counters will be prohibited. Social gatherings will also be restricted to six people. In La Rioja, the cumulative number of coronavirus cases per 100,000 inhabitants is at 549, the positivity rate is 15.2%, while nearly 14% of hospital beds are occupied by coronavirus patients.

Aragón. From Thursday, Aragón’s three provincial capitals – Zaragoza, Huesca and Teruel – will be placed under a perimetral lockdown for a minimum of 30 days. “We have had a terrible summer and we have always said that we would not hesitate when the time arrived to introduce measures,” said Aragón premier Javier Lambán on Wednesday. The cumulative number of coronavirus cases per 100,000 is at 586 (in Teruel, the figure is 1,418), the positivity rate is 20% and 40% of the region’s ICU beds are occupied by coronavirus patients. The regional government also introduced other restrictions, such as ordering the hostelry sector to close by 10pm, banning indoor consumption and reducing capacity of sidewalk cafés to 50%. Like in La Rioja, social gatherings are limited to six people.

Navarre. This is the first region to confine itself from the rest of Spain. As of Thursday, residents cannot leave or enter the region unless for essential business. The incidence rate in Navarre is three times higher than the Spanish average. Navarre is also the region that carries out the highest number of tests with respect to its population, nearly double the national average. “It’s about stopping all non-essential activity,” María Chivite, the premier of Navarre, said on Tuesday. In addition to the perimetral lockdown, all bars and restaurants have been ordered to close, with the exception of home delivery services, and commercial stores must shut by 9pm. Capacity on public transportation has also been reduced to 50%.

Madrid. Madrid is the region with the largest number of residents affected by perimetral lockdowns. Nine cities – Madrid, Getafe, Fuenlabrada, Alcobendas, Parla, Alcorcón, Torrejón de Ardoz, Leganés and Móstoles – have been confined since the Spanish government declared a state of alarm in the region on October 9. The restrictions affect a total of nearly 4.6 million people. Several healthcare areas in municipalities such as Coslada and Collado Villalba have also been confined by the Madrid regional government.

Castilla y León. The regional government has declared a perimetral lockdown in the city of Ponferrada, which will come into effect on Friday. But it is not the only city in the region facing this restriction. Burgos, which is home to 180,000 residents, has been confined since Wednesday, and Salamanca has been under a perimetral lockdown since October 17. León, Palencia, Miranda de Ebro, Aranda de Duero and San Andrés del Rabanedo are also currently in the same situation. The town of Medina del Campo was confined until October 15. Smaller areas, such as Carpio and San Pedro de Latrace, which are both in Valladolid province, are also confined.

Galicia. The regional government of Galicia decided to place the city of Ourense and the neighboring municipality of Barbadás (120,000 residents) under a perimetral lockdown on October 8. Since October 15, another three municipalities in Ourense province have been confined: O Carballiño, O Irixo and Boborás. These areas are also subject to the same restrictions applied under Phase 2 of the deescalation plan.

Extremadura. This week the regional government of Extremadura ordered the perimetral lockdown of Almendralejo in Badajoz province. The town, which has more than 30,000 residents, also faces Phase 1 restrictions. Other smaller municipalities also remain confined, with limits on social activity.

Andalusia. The 40,000 residents of Écija in Seville have been confined since October 15. At one point, this area recorded more than 900 cases per 100,000 inhabitants.

English version by Melissa Kitson.

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