Spain’s regions move to reintroduce coronavirus measures as infections continue to spike

The coronavirus epidemiological curve is still rising fast among young people in Spain, and the country’s regions are accelerating the implementation of new measures to contain the infections among adolescents and the 20-30 group. The 14-day cumulative number of coronavirus cases per 100,000 inhabitants is currently at 225, according to the latest Health Ministry report, up 20 points on the day before. But among young people, the data point rose 77 points in a day, to reach 717 per 100,000 inhabitants.

The overall trend, experts warn, is still rising. Given this scenario and the threat of the more-infectious delta variant spreading further, the regions are taking action. Catalonia announced on Tuesday that it would be closing nightlife venues once more, a measure that Cantabria took last week in a number of municipalities. Other regions, such as Asturias, Navarre and the Balearics, are pushing for mass testing among young people. Castilla y León, meanwhile, has opted to slow down its deescalation of coronavirus measures.

The Health Ministry should seriously consider the use of masks again outdoors, because physical distancing is not going to be respected

Daniel López-Acuña, a former director of emergencies at the World Health Organization

Last night’s ministry report included 14,137 new infections, and added 18 deaths to the overall death toll. The incidence rose in all regions, but not in the North African cities of Ceuta and Melilla. Hospital occupation is still low, meanwhile, with 2.37% of beds occupied by Covid-19 patients, and 6.74% in the country’s intensive care units (ICUs).

The National Health System’s Alert Panel, which is made up of specialists from the Health Ministry and the regions, has prepared draft proposals with measures that include closing nightlife venues and even returning to a curfew system, sources from this body have confirmed to EL PAÍS, Pablo Linde reports. This is a working document, however, which will have to be revised and evaluated in the upper levels of the Public Health Commission and by the Inter-Territorial Council of the National Health System (CISNS), which brings together the central Health Ministry and the regions.

On Tuesday, the Health Ministry sent out a statement making clear that it has not proposed any measures so far related to the closure of nightlife venues nor a reintroduction of the curfew. In the Public Health Commission, the healthcare chiefs have only interchanged information about the epidemiological situation and the measures that are being taken, the statement read. For now, there has been no joint decision on common restrictions to be implemented, but the regions – which are in charge of implementing their own measures to control the spread of the virus – are taking action to reintroduce restrictions.

The spike in infections had already prompted a number of nightclubs in Catalonia to close of their own accord given the impossibility of ensuring safety measures were respected, according to the sector’s association, Fecasarm. The sector was calling for antigen tests for people wanting to enter bars or nightclubs, and initially, the regional health chief appeared to be open to the proposal.

However, after the unstoppable rise in cases over the last week – Catalonia has the highest cumulative incidence in Spain, with 493 cases per 100,000 inhabitants – the regional government has instead opted for the more severe approach of closing all nightlife from this weekend onward. Only those night spots with outdoor areas will be able to open, while music festivals will be permitted provided that attendees at any such event with more than 500 people can supply a negative test or proof of vaccination.

Experts agree that the social dynamics that are seen in nightlife venues, where control measures are relaxed and it’s easier for crowds to form without proper protection, are key to explaining the spike in infections in Spain in the last two weeks.

“We have to prohibit mass events,” argues Jesús Molina Cabrillana, spokesperson for the Spanish Society for Preventive Medicine, Public Health and Hygiene. “We have already seen that capacity limits are not respected, nor distancing nor the use of masks. We must take selective measures. I’m not talking about a lockdown, but rather the maximum control of nightlife.”

Daniel López-Acuña, a former director of emergencies at the World Health Organization (WHO), supports the mass testing of youngsters that is being carried out by regions such as Navarre, Asturias and the Balearic Islands. He is calling for “public health measures to be strengthened with more early testing and more contact tracing.” He also wants to see a step backward in terms of the use of masks, which have not been obligatory outside when social distancing can be maintained since June 26. “The Health Ministry should seriously consider the use of masks again outdoors, because physical distancing is not going to be respected,” he argues. The Catalan government is in agreement with this proposal. “We believe that masks should be obligatory again in Catalonia, but it’s the Spanish government that can modify their use,” said Catalan government spokesperson, Patricia Plaja.

Whatever is done now, the curve is not going to be reduced by much. We’re going to have a complicated summer

Jesús Molina Cabrillana, spokesperson for the Spanish Society for Preventive Medicine, Public Health and Hygiene

The experts agree that while some regions have already accelerated their measures, the pandemic is way ahead. “The infections have already taken place and now we are just seeing what is coming to light,” complains Molina Cabrillana. “Whatever is done now, the curve is not going to be reduced by much. We’re going to have a complicated summer. This should have been done much before.” López-Acuña agrees. “The Inter-Territorial Council should suggest recommendations of what to do. The worst thing is to be in paralysis waiting for the curve to stabilize by itself.”

The experts also agree that the pandemic has changed, as has the way by which its virulence is measured. In accordance with the traffic light alert system created by the Health Ministry and the regions – which takes into account incidence and positivity of testing – none of the regions is on high alert according to the last report with data up to June 30. This is because other indicators used for this system, such as pressure on hospitals, are currently low – with most vulnerable groups vaccinated, the immense majority of Covid-19 cases are now mild. This traffic light system does not, meanwhile, measure the pressure on the primary healthcare system, which is where these new infections among mostly younger people are having the greatest effect.

“The indicators from the traffic light system have ended up outdated because the dynamic of the pandemic has changed,” López-Acuña explains. “We need to establish indicators that measure how overwhelmed the primary healthcare system is and indicators for risk groups.” In Catalonia, for example, the regional government has announced it will no longer carry out diagnostic tests on vaccinated close contacts given the pressure on primary healthcare.

Ángela Domínguez, coordinator of the vaccination working group at the Spanish Epidemiological Society, argues that some indicators are still valid, such as the incidence, but that others need to be refined. “It’s true that the parameters being used by the health services are not useful at the moment, and that more indicators are needed for other age groups,” she explains, in reference to there only being incidence data for the over-65s currently. “But with the other indicators that there are, you can evaluate the risk in the regions.”

In fact, the Coordinated Response Action document states that as well as using key indicators, such as the incidence of the virus or pressure on hospitals, it is also necessary to measure their trend and carry out a qualitative analysis of “the response capacity, socioeconomic and demographic characteristics, and the mobility of the territory being evaluated.” In the case of parameters on different levels, the document adds, “the most restrictive level will be applied” when it comes to establishing the alert level.

With reporting by Lucía Bohórquez, Mikel Ormazábal, Bernat Coll, María Fabra and Juan Navarro.

English version by Simon Hunter.