Is Spain heading toward a repeat of March’s total lockdown?

Spain, like most of Western Europe, has been introducing increasingly tough restrictions in a bid to contain the second wave of the coronavirus pandemic. But the Spanish government has stopped short of ordering all residents to remain at home, as it did when it introduced a total lockdown during the first wave in March.

As cases continue to rise and hospitals come under growing pressure, authorities instead are considering a range of solutions – from the recently declared national curfew to weekend home confinement, which has been proposed by the Catalan government. These are intermediate measures that reduce mobility without stopping it completely, and it is not clear how effective they are nor when they will start to reduce contagions. This has prompted a debate in Europe over whether short but total lockdowns are more effective than long-term and staggered restrictions.

It is only possible to flatten the curve of contagions with a new strict confinement order for 14 days

Florentino Pérez Raya, president of the General Nursing Council

In Spain, it is still too soon to see whether many of the recently introduced measures have had an impact on the number of new coronavirus cases. According to Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts (CCAES), this will not be reflected in the data for another 10 days. But enough time has passed since Catalonia ordered the closure of all bars and restaurants (October 15), Navarre closed off its borders (October 19) and social gatherings in the Galician city of Ourense were restricted to household groups (October 3) for them to have affected the figures. This, however, has not been in the case. In the last 15 days, the number of new coronavirus cases has risen 23%. This week’s figures have been worse than the last in all Spanish regions and territories, with the exception of Madrid, Basque Country and La Rioja, where the rising rate has stabilized.

“Confinement is the only measure that is scientifically proven,” says Tomás Cobo, the vice president of the Collegiate Medical Organization. “With the rest [of the measures], it’s just trial and error.”

Florentino Pérez Raya, the president of the General Nursing Council, is more emphatic: “It is only possible to flatten the curve of contagions with a new strict confinement order for 14 days,” he says.

José Martínez Olmos, the former general secretary of the Health Ministry and a professor at the Andalusian School of Public Health, agrees: “It will be difficult to avoid confinement with the figures in the regions.” Last week, Spain passed the symbolic milestone of one million confirmed coronavirus cases, and on Tuesday, the Health Ministry reported the highest number of Covid-19 related fatalities since May.

Although home confinement is considered a last resort, some countries have already introduced it. On Wednesday, the French government announced a total lockdown, with people only allowed to leave home for essential work or medical reasons. On October 20, the Irish government also ordered a six-week lockdown of the country, with residents asked to stay at home and remain within a five-kilometer radius. Although it is too soon to see how this measure has impacted the contagion rate, last week the number of new cases in Ireland rose by 9%, while in Spain they rose by 12%.

Israel also reimposed confinement orders in early September. Meanwhile in Italy, the head of the Medical Association, Filippo Anelli, said on Monday the recently introduced restrictions – the closure of cinemas and theaters, and the 6pm closing time for bars and restaurants – “were the government’s last resort before an inevitable total confinement,” which will happen if the situation does not improve within 15 days’ time.

With new coronavirus cases rising across Europe, the European Center for Disease Prevention and Control (ECDC) has warned that the measures introduced in the region “have not been fully successful in controlling transmission, and the epidemiological situation is now rapidly deteriorating.” The organization has called for stricter restrictions “which proved to be effective in controlling the epidemic” in spring, arguing that this is the “only available strategy.”

The leader of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, has also called for tougher measures: “No one wants more so-called lockdowns. But if we want to avoid them, we all have to play our part.”

“We need to better direct our measures and do it as soon as possible to avoid tougher restrictions,” explains a spokesperson from the WHO’s European office. “It is very likely that the level of response will have to rise, but confinements are such a stark, imperfect and costly proposal,” they add. The ECDC agrees that stay-at-home orders should be a last resort.

Stronger health system needed

Patricia Guillem, a professor of epidemiology at the European University of Valencia, says home confinement is a “drastic measure that was able to significantly reduce figures [during the first wave], but also caused a lot of damage to the economy,” arguing it was only justified by the high mortality rate.

“In March, home confinement was proved to work against the virus, but before we reach this situation, we must strengthen the national health system,” says Guadalupe Fontán, a public health specialist from the General Nursing Council.

Silvia Soler, from the platform Covid Persistente, agrees: “Confinements without an adequate health policy to control the virus, correct contact tracking, more resources and better primary healthcare planning are not the solution.”

Carlos Arenas, the vice president of the Economy and Health Foundation, points out that “many intensive care units are already in a difficult situation.” But he says: “We are still a long way off from the first wave.” According to the Health Ministry’s report on Tuesday, one-fourth of all intensive care (ICU) beds are now occupied by coronavirus patients. “Health centers are going to be under strain, and that’s going to lead us to take more restrictive measures,” explains Arenas, adding that “the government may not dare introduce confinement on a national level, but would perhaps do so on a local level.”

“If we arrive at a total confinement it would be a total failure for everyone,” says Joan Caylà, from the Spanish Epidemiology Society, who adds that the measures already introduced, such as the curfew between 11pm and 6am, need to be more strongly enforced. “The curfew in Italy starts at 6pm, in France at 9pm. They could have made it earlier here,” she adds.

For now, regional health departments are not considering home confinement. Sources from the Catalan health department say that the proposal to confine residents over the weekend is just one of many measures under consideration, while those from Extremadura say it is not yet an option. But they warn: “We’re taking things as they come. We are going to see what the results are in the next seven days.”

English version by Melissa Kitson.