More than half of Spain at medium risk for coronavirus

Coronavirus cases in Spain continue to rise, but this spike is not affecting all regions equally. According to the latest Health Ministry report, released Friday evening, the cumulative incidence of infections over the previous 14 days now stands at 248 cases per 100,000 inhabitants, up from 234 on Thursday.

In some regions, which are responsible for their own healthcare systems, the Covid-19 vaccination drive and coronavirus restrictions, this rise has not led to any significant increase in pressure on hospitals. But in others, the situation is starting to become more complicated.

Under the new traffic light system, which assesses the risk level of the pandemic, seven of Spain’s 17 regions are at medium risk. They are Catalonia, Navarre, Aragón, the Valencia region, the Basque Country, Madrid and Castilla y León. In other words, more than half of the Spanish population – 26.2 million people – are living in a region where community transmission is widespread and the healthcare system is under constant and rising pressure. The rest of Spain is at low risk, meaning the spread of the virus is not affecting hospitals.

But the epidemiological situation in Spain is far from promising. The curve of infections has shot up and, although it has not reached the levels being seen in other European countries, such as the Czech Republic, Austria and Belgium, where the 14-day cumulative incidence rate is more than 2,000 cases per 100,000, the rate of new cases is on an upward trend. In one week, the incidence rate in Spain jumped 45%, while hospital admissions rose by 26%. The situation is unlikely to improve given the upcoming Christmas festive season, when there is more travel and social gatherings, and the appearance of the new omicron variant, which is suspected of being more contagious. Cases of this new strain have so far been detected in Madrid, Catalonia and the Balearic Islands.

“Forecasts and logic say that the incidence rate is going to increase progressively until, at least Christmas,” said Álex Soriano, the head of infectious diseases at Cínic Hospital in Barcelona. “Even in the best scenarios, the situation in hospitals and primary healthcare centers is one of high stress because normal activity has returned.”

Given this context, the epidemiological map in Spain threatens to become covered in red.

The new traffic light system, which was approved last Tuesday by the Health Ministry, gives more weight to the pressure on hospitals and less importance to the incidence rate. These changes were made on the basis that contagion levels were no longer as relevant, given nearly 80% of the population in Spain is fully vaccinated and protected against the most serious forms of Covid-19.

Establishing the risk posed by Covid-19 in a specific area – such as a region, province and city – involves crossing incidence data with patient pressure on hospitals. The new traffic light system, however, unlike previous versions, does not recommend what restrictions or measures should be in place at each risk level.

Debate over measures

In a bid to contain the spread, several regions have opted to introduce the European Union’s Digital COVID Certificate. This so-called Covid passport can be accessed in Spain via each region’s healthcare system, and certifies whether the bearer has been vaccinated against Covid-19, has recently recovered from an infection, or has been tested for the virus.

In Catalonia, this measure has coincided with a boost in Covid-19 vaccination rates. Lines of people were seen waiting to get vaccinated at Barcelona’s Fira convention center on Sunday – in just a few hours, 1,500 doses reserved for those without appointments had run out. And in the last seven days, the number of first doses administered in Catalonia was 45% higher than the previous week.

Eight regions have begun to introduce the Covid passport, but according to experts, the measure has not been proven to reduce infections, beyond encouraging vaccination.

“We have the vaccines and face masks, which is definitely why we are faring better than nearly all other European countries,” said Ana María García, professor of public health at the University of Valencia. “People tend to think the vaccine is just a measure for individual protection and that is not the case.”

The Covid certificate has also divided the hospitality industry. Some support the measure on the basis that it is preferable to other coronavirus restrictions such as limits on opening hours and capacity. While others say it gives them more work to do and poses organizational issues.

“Many people come in at the same time and it’s very difficult to control,” explained one waiter at a bar in Barcelona. “Many people don’t know how to find the passport on their cellphone and we have to help them, while other patrons are in a rush to have a coffee and we are not serving them.”

Some experts say that remote working should be encouraged as a measure to reduce the spike in coronavirus cases. “It’s a way of avoiding social interactions indoors that we have seen can be implemented without great social costs in many businesses,” said Pedro Guillón, from the Spanish Epidemiology Society.

One measure that has been ruled out is mandatory vaccination. Neither health experts nor the government believe this step is necessary given that 90% of the target population (the over-12s) are fully vaccinated. The goal is to overcome this new wave without more limitations than the ones that have been in place since the state of alarm came to an end in May.

“We know what measures protect us,” said Spanish Health Minister Carolina Darias on Friday. “Social distance, the use of face masks, especially indoors or outdoors if there is no distance. Keeping the virus at bay depends on us.”

This month, Spain is also expected to begin vaccinating the under-12 population, which is the only age group yet to be immunized. This group currently has the highest cumulative incidence rate, with 412 cases per 100,000 inhabitants, according to Friday’s report. This is 50% more than the previous week’s figure.

Outbreak in Málaga

The health department of the southern region of Andalusia has detected a coronavirus outbreak in the Carlos Haya Regional University Hospital in Málaga. On Sunday, 22 cases among health workers were identified. By Monday, that number had risen to 68, according to sources from the hospital and the Andalusian regional government. Most of the positive cases have been detected among the staff of the hospital’s intensive care unit (ICU). Hospital sources say the source of the outbreak was a Christmas dinner, which was attended by 173 professionals from the ICU, as reported by the regional daily Sur.

All the workers who tested positive – a group that includes doctors, nurses and support staff – are in self-isolation, while tests are being carried out on their close contacts.

The mayor of Málaga, Francisco de la Torre, warned on Sunday that the city is seeing an “accelerated” rise in coronavirus cases. According to the latest data, released by the Andalusian regional government on Friday, the 14-day cumulative incidence in the city is 127 cases per 100,000 – nearly double what it was in mid-November. “If it continues this way, by the end of December, we could have more than 400 cases [per 100,000],” De La Torre said in a message on Twitter.