The spike in coronavirus cases in Spain is once again pushing the country’s contact tracing system to the breaking point. Tracers are overwhelmed and helplines are struggling to cope with the flood of calls. “When a shift comes to an end, we still have 12,000 calls to close contacts left to make,” says one contact tracer in Catalonia who preferred to remain anonymous.
This means that 12,000 people should have been given an appointment for a diagnostic test and told that they should remain in isolation and avoid contact with at-risk people. But the calls were not made because there was not enough time or resources. In the meantime, the virus is continuing to spread.
In the northwestern region of Catalonia, the primary healthcare system is so overwhelmed that the regional government has been forced to take extra measures. As of Thursday, all close contacts in the region will need to isolate for 10 days regardless of whether they are fully vaccinated. And they will not be tested unless they present coronavirus symptoms.
“When the number of cases rises so much, you have to make adjustments and ensure that the system can do what’s essential: that tracing is reaching vulnerable people in the system, such as nursing homes, pregnant women … this is what the tracing is focusing on,” said Carme Cabeza, the secretary of the Catalan public health department, on Monday. The region has also announced plans to introduce a 12-6am curfew, limits on social gatherings and restrictions on the hospitality sector in a bid to curb transmission.
In just a month, the coronavirus incidence rate in Spain has tripled. On Monday it hit 609 cases per 100,000 inhabitants, with 400,000 infections more recorded than four weeks ago. According to Spain’s Carlos III Health Institute, each positive case identifies an average of two close contacts, meaning an average of 800,000 close contacts must be monitored.
But the tracers, who – depending on the region – work in primary healthcare centers, public health offices and special call centers set up during the pandemic, are not able to keep up with the workload.
“Every day, we are left with 12,000 contacts to call, people who don’t know what to do, who are waiting for us to tell them what the protocol is,” says the Catalan tracer.
According to the Catalan regional government, there are 1,045 tracers in the public health department – a number which will rise to 1,400 – and 1,136 in primary healthcare centers, and these professionals are able to make contact with seven in 10 close contacts in less than 24 hours.
In the region of Aragón, where tracing is done by primary healthcare centers, there are 18 nurses and 19 social workers, as well as 20 military tracers working to monitor close contacts. The region is currently monitoring more than 12,000 people, nearly triple the figure from three weeks ago, but still far from the peak of 24,300 recorded a year ago.
Regional authorities in Navarre also admit the situation is “tense” due to the rise in cases. This is despite the fact that the region has an extra 140 contact tracers. According to a spokesperson from the Navarre government, the region is also considering digital tools that would allow close contacts to self-report.
In the Balearic Islands, where the number of Covid-related calls has jumped from 1,300 before the sixth wave to 2,000, regional authorities have also changed quarantine protocols. Now children who are close contacts are given an antigen test instead of a PCR test.
The main problem is that there is such a large volume of minor cases that the system cannot cope with the level of care, monitoring and bureaucracyMario Fontán, spokesperson of the Spanish Epidemiological Society
Phones are also ringing off the hook in the Canary Islands, which received 25,835 Covid-related calls in the first 15 days of December. This is more than all calls received in the entire month of November. In the Basque Country, which has 850 contact tracers, the regional government will also change its tracking protocol. Under the change, people who test positive will be asked to provide a list of close contacts and these people will receive an SMS message with an appointment to get tested – without having to wait for a call from the tracing network.
The breakdown of the contact tracing network is also having an impact on primary healthcare centers. In recent days, huge lines of people have been seen waiting outside medical centers to get tested, and the spike in demand has made it harder to get an appointment.
A resident of Moralzarzal in the Madrid region, who was given an appointment to be tested after her son tested positive, said that when she went to the primary healthcare center “there were 50 people in front of me and in the street waiting to be tested.” Another Madrid resident said she wasn’t even able to get an appointment for a test, despite being a close contact. “They put me on hold and then hung up on me. I called 15 times,” she said.
José Polo, the president of the Spanish Society of Primary Healthcare Doctors, says medical centers are simply overwhelmed. “People think that we are not picking up the phone, but it’s because we are talking on another line or seeing a patient,” he says.
To deal with the high demand for testing, Lorenzo Armenteros, a doctor at a medical center in Lugo and the president of the Spanish Society of General Practitioners, suggests setting up “specific sites to perform tests outside of healthcare centers.”
Mario Fontán, the spokesperson of the Spanish Epidemiological Society, surmises: “The main problem is that there is such a large volume of minor cases that the system cannot cope with the level of care, monitoring and bureaucracy.”