CORONAVIRUS

Two weeks after end of state of alarm in Spain, fall in coronavirus incidence continues but at a slightly slower pace

The lifting of restrictions has not brought an explosion of new cases, as epidemiologists had feared. But the improvement in the data is stabilizing after a month of a clear downward trend

Citizens wait in line in at the Estadio Olímpico in Seville for the vaccination process.
Citizens wait in line in at the Estadio Olímpico in Seville for the vaccination process.PACO PUENTES

The end of the state of alarm in Spain just over two weeks ago has not caused the uptick in coronavirus infections that many epidemiologists were fearing. Not, at least, in a swift and clear way. The emergency situation, which had been in place for six months, gave the country’s regions the legal powers they needed to impose measures such as curfews and perimetral lockdowns. But despite it being lifted, the incidence in Spain of the virus continues to fall – albeit at a slightly slower pace after a month of a clear downward trajectory. According to Monday’s report from the central Health Ministry, the 14-day cumulative number of coronavirus cases per 100,000 inhabitants now stands at 129.4. But in some regions, the data point is no longer falling, and in others, it is slowly starting to rise.

Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts (CCAES), admitted on Monday at a press conference to present the report that the fall in cases was ever slower. “We suspected that the speed of the fall that we observed the week before was going to slow down,” he said. The circulation of the virus in Spain is now “largely” among the under-50s. “As soon as the measures are relaxed more cases are observed in these groups, although a fall would be more desirable,” he added.

Between last Monday and a week before, the cumulative incidence (CI) fell 19.6%. Between yesterday and the previous Monday, the reduction was 14.5%. In terms of the seven-day cumulative incidence, which gives a more recent snapshot (albeit a less accurate one due to reporting delays), the contrast is even greater: 18.7% last week compared to 9.2% this week. This data point has been practically flat for the last few days, falling by less than one case a day since last Tuesday.

Spain is currently experiencing a brand new situation in the more than 14 months of the pandemic so far. This is the fourth clear descent of a wave, but the first where a significant percentage of the population is protected: more than a third of citizens (16.7 million) has received at least one dose of a Covid-19 vaccine, 17% (8.1 million people) have the full protection offered by the shots, while around nine million people are estimated to have been infected (3.6 million of these were officially diagnosed via testing). “We are learning,” explained Óscar Zurriaga, the vice president of the Spanish Epidemiology Society (SEE). “This is the first time that we have coverage from vaccines.”

“We are coming off the back of a sharp fall, which always tends to stabilize,” said Rafael Manuel Ortí Lucas, the president of the Spanish Society of Preventive Medicine. “There are now forces that are pulling the curve upward, such as the lifting of measures, which can cause outbreaks, and others pulling it down, such as gaining control of the situation, thus making it easier to identify chains of infection, and the vaccination, which means that there are fewer people who are susceptible to infection.”

Despite the measures being lifted, the falling trend was very strong and has continued until now
Epidemiologist Javier del Águila

In the coming weeks, this expert forecasts a plateau in the figures or a slow fall, which will not accelerate until “the end of June,” by which point most of the population should be vaccinated. A similar trend was seen in the United States as the vaccination campaign in the country progressed. Between mid-February and mid-April, the fall in the incidence halted and the curve plateaued. A month passed with no major rises or falls was seen until it started to descend once more and continues to do so.

It is difficult, however, to establish parallels – movements in the curve of a pandemic are influenced by many factors and they vary from country to country. At the time, US epidemiologists voiced a theory that could explain the plateau: the vaccines were acting as a ceiling that stopped it from rising beyond a certain point, while the virus continued to circulate among young people who were yet to be protected. When the plateau began, less of the population of the United States had at least one dose than in Spain today, but it is a similar explanation to that offered by some experts as to what is happening in the latter country right now.

According to the epidemiologist Javier del Águila, more time is needed to determine whether the end of the state of alarm – which has also seen an end to mobility restrictions across the whole country – will lead to a spike in cases. “Despite the measures being lifted, the falling trend was very strong and has continued until now,” he explained. “However, life has returned and that will mean a high probability of a spike in cases, because the virus is still there and contact between people is rising. What’s more, we will have to see how these cases appear according to age, and in hospitals – that will be the acid test. If we see an increase in diagnosed cases, of any intensity, and that is not accompanied by a worse hospital situation, that will be a good sign.”

Hundreds of people partying in Madrid’s Puerta del Sol square following the end of the state of alarm.
Hundreds of people partying in Madrid’s Puerta del Sol square following the end of the state of alarm.Luis de Vega

A change in trend in hospitals will take longer to be registered, however – a rise in infections takes between seven and 10 days before it is seen in the statistics. At least two or three weeks need to go by before this then translates into a rise in hospital admissions and then another week for a spike in deaths. Spain’s intensive care units are currently registering the lowest number of patients with Covid-19 since October.

According to Pedro Gullón of the Spanish Epidemiology Society (SEE), it is “normal” to see are small ups and downs in the curve during the deescalation process. What is clear to Saúl Ares, a researcher from the National Biotechnology Center, is that the end of the state of alarm on May 9, which was celebrated by Spaniards the night before in a spontaneous outburst of partying on the streets across the country, has not brought with it an explosion in cases. “It’s difficult to say if these falls in the rhythm of the improving situation, or even the small rises in cases, are due principally to the effect of the end of the state of alarm or to the natural dynamic of the epidemic. What is for sure is that the images seen on May 9 have ended up being an anecdote, and the underlying effect, if there was one, has not been seen.”

English version by Simon Hunter.

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