From lockdown to Covid passports: Experts analyze possible measures to curb Spain’s sixth wave

There are barely any restrictions in Spain as this, the sixth wave of the coronavirus pandemic, takes hold. Right now, masks are only mandatory in interiors, while some regions have put into place so-called “Covid passports” for access to public spaces such as restaurants and bars. Apart from that, there are merely recommendations to limit social meetings and slogans that appeal to individual responsibility.

But the rise in the epidemiological curve, with the 14-day incidence currently at 609 cases per 100,000 inhabitants according to the latest Health Ministry report, is seeing the possibility of stricter measures back on the table. The Spanish prime minister, Pedro Sánchez of the Socialist Party, announced on Sunday that he would be holding a meeting with the country’s regional premiers tomorrow in order to “evaluate new measures that can be put into place over the coming weeks.” So far, only Catalonia – which is being particularly hard hit by this new spike in cases – has announced it will take action, with plans to seek approval in the courts for a new curfew, the closure of the nightlife sector and a limit on social meetings of 10 people.

Healthcare staff are calling for urgent new measures, given the spread of the more-contagious omicron variant of the coronavirus, the pressure on primary healthcare and hospitals – admissions of Covid-19 patients have tripled in just a month. The experts are saying that action is needed to avoid the system becoming overwhelmed, but that it is already too late to stop this new wave, according to Alberto Infante, emeritus professor of International Health at the Carlos III Health Institute in Madrid. “We were already warning that Christmas would be bitter and January very bad,” he says. “It’s sad to be proved right. From now to the end of the year, everything we do will be mostly irrelevant.”

The effect of any measures taken will not be seen for weeks after their application, and not all of them are equally viable, easy to implement or will have the same effect in the current epidemiological context.

In fact, it is difficult to evaluate the impact of each measure, firstly because several restrictions are usually in place at once, and they are also influenced by the epidemiological situation at the time, the vaccine coverage and the level of adherence to the measures.

A study in the magazine Nature modeled the impact of around 20 restrictions in Europe after the second wave, and pointed to the closures of bars and cafés as having a major effect on transmission. The closure of places such as zoos, museums and theaters, meanwhile, had a smaller effect, the report concluded.

The Health Ministry’s traffic light system, which sets out the levels of risk according to data points, currently places more than half of Spain at high alert. But the system does not include restrictions associated with this situation – it is up to each region to decide what to do.

What follows is an analysis of the proposals that have been put into place at some time during the pandemic.

Strict lockdown. The closure of all non-essential activity works: it limits mobility and social interaction, and infections fall. But the price is very high, according to the epidemiologists consulted. It will also be difficult for the government to implement. The first and only national lockdown in Spain, implemented in March 2020, has since been found to be unconstitutional by the Constitutional Court, which concluded that a “state of exception” rather than the “state of alarm” emergency situation must be used to legally confine people to their homes. This will make such a measure more complicated should the central government want to use it once more.

According to Juan Antonio Sanz Salanova, the spokesperson for the Spanish Society of Preventive Medicine, Public Health and Hygiene (Sempsph), a home lockdown is “the fastest and most efficient measure to reduce infections, but it is difficult to bear in social and economic terms.” What’s more, there is widespread fatigue among the population due to the pandemic, and the Christmas season is approaching. “In this respect,” Infante adds, “we are not in a situation where we can consider a strict lockdown.” Mario Fontán, the spokesperson for the Spanish Epidemiology Society, agrees. “The current scenario does not require a strict lockdown.”

Curfew. This measure has once again been proposed by the Catalonia region, which will seek the approval of the courts to implement it from late this week. Curfews are effective in terms of reducing mobility, but they are difficult to implement from a legal point of view – any measure restricting fundamental rights must be approved by the regional courts before it can be implemented. Infante points out, however, that this measure “has had varied success in the courts,” and has not always received the blessing of judges. But, he adds, curfews are “efficient and easy for the state security forces to monitor in terms of their compliance.” Sanz Salanova warns, however, that during previous curfews in Spain people ignored the restrictions and simply met in private homes.

Perimetral lockdowns. Given the current incidence, which is very high in all territories and with widespread community transmission in the country, closing the borders of Spain’s regions will have a limited effect, according to the experts. “They are useless,” states Sanz Salanova. “There are too many leaks.” They are, what’s more, difficult to enforce apart from in the case of small areas with limited access roads. The only positive of such a measure, argues Infante, “is that they send a message that movement should be limited, and that takes root among people.”

Limit on social meetings. This is another one of the measures that Catalonia has this week proposed to limit infections. This restriction affects fundamental rights and also needs the approval of the courts. It has been applied in other waves, limiting meetings to 10 people or fewer.

Closure of nightlife venues. Experts consulted agree that this is a key measure that needs to be taken in order to limit infections. This has also been announced by Catalonia. Fontán explains that “if pressure on the healthcare system spikes, this is the first thing that should be considered, because it is very difficult to make this a safe environment no matter what measures you put in place.” According to Sanz Salanova, the problem lies with the fact that these are usually interior spaces where there are large crowds of people, which facilitates the spread of the virus. “The problem is not with the activity, but rather with the way people behave,” the epidemiologist argues. It’s very hard to maintain a safe distance and proper use of masks, and that increases the risk of infection. The downside is that, during the Christmas holiday season, such closures are a major economic blow to the sector, Infante admits.

Closure of indoor hospitality venues. Epidemiologists assume that not all bars and restaurants are equal nor do they have the same risk levels, but consumption at the bar, for example, should be limited, they say. The coronavirus is mainly transmitted by aerosols and badly ventilated interior spaces are the perfect breeding ground for the virus. But, Sanz Salanova argues, a happy medium needs to be sought, and the cure should not be worse than the illness. “When we have closed the bars, we’ve ended up with botellones [mass street drinking],” he explains. “We should start with non-coercive measures.”

Reduction of capacity and limits on opening hours. This is another of the key points on which the professionals consulted by EL PAÍS agree: avoiding crowds and limiting people’s access to closed spaces. This was done during other waves and Sanz Salanova points out that it’s an “easy measure to adopt, but it should be properly monitored because on other occasions there was a lack of supervision.” Infante considers these measures to be urgent, above all in areas with an incidence that’s greater than 500 cases per 100,000 inhabitants over 14 days.

Canceling major events. Experts agree that now is not the time for events with large crowds. The risk of transmission of the virus is very high and dangers should be minimized. “Concerts, soccer and sports events in closed spaces are potentially dangerous,” warns the Sempsph epidemiologist. Fontán agrees. “This has to be evaluated,” he says. “It’s not the same having an event outdoors as inside, but it’s not even about the activity itself, but rather the mobilization of people and the indirect activities it creates.”

Covid passport to access indoor spaces. According to the experts, this has a limited effect on bringing down the epidemiological curve. The existing vaccines are not sterilizing and someone with a certificate can be infected. “It’s an effective measure to convince those who are undecided to get vaccinated, but the vaccine does not avoid infections because immunity is being lost and there are new variants,” explains Sanz Salanova. The experts fear that this measure, already adopted by most of the country’s regions, gives a “false sense of security.”

Tracking and tracing contacts. It is always necessary to detect cases and cut chains of transmission, but the greater the community spread of the virus, the more difficult it is to track positives and their close contacts. In fact, Catalonia has announced a return to the requirement for all close contacts of a positive case to quarantine whether they are vaccinated or not. Fontán argues that “once there is a certain level of infections” the strategy makes less sense, but that contact tracing is always useful “to detect outbreaks in certain high-risk spaces, such as senior homes.”

Closing borders with other countries. Spain has already done this, limiting travel from South Africa and Brazil, countries where variants of concern such as omicron and gamma were discovered. However, experts believe this move to be “inefficient,” given that these variants – in particular omicron – are already circulating in Spain. “The only thing they do is delay the arrival of a variant by several days, but they will arrive nonetheless.”

Ramping up vaccination. This is another key measure to accelerate the protection of the population. Despite around 80% of Spaniards being vaccinated, the protection offered by the vaccines appears to be lower with the omicron variant. Spain is currently administering a booster shot of the vaccines to the over-60s, with 70% of this group already having got this extra dose. Last week, the Public Health Commission also backed boosters for the 40-59 age group.

Masks outdoors. The first to request this measure be reintroduced was the Basque Country regional premier, Íñigo Urkullu. But experts do not consider it to be the most important measure to take because the chance of infection when outside is very small. “Making this request when there are no limits on capacity to see Atletic [soccer team] play in the San Mamés stadium is a complete joke,” argues Infante. What the measure does do, according to Sanz Salanova, is to “return the responsibility to the administration, which had transferred the decision of whether to wear them or not to citizens.” Currently, the regulations in Spain state that masks must be worn outside if a safe distance cannot be observed. Fontán argues that this kind of measure has a “low political cost,” but that they are “more cosmetic than having a real epidemiological impact.”

Home antigen tests for everyone. This is a measure that has been announced by the Madrid region: a free home testing kit for each citizen, “so that in the case of social meetings, they can be held safely,” in the words of regional premier Isabel Díaz-Ayuso. But experts do not look kindly on the plan, which Infante describes as “pure demagogic populism.” A negative result, they warn, is not 100% trustworthy and they can return false results if not carried out properly. They can also create a false sense of security, Sanz Salanova adds. “This measure is a shortcoming of the healthcare system, which can’t carry out all the necessary testing with its own resources. And what’s more, you are transferring the responsibility to the population once more and the system can lose information, because it is up to each citizen to communicate the result or not.”