Outdoor masking in Spain: A coronavirus measure that’s ‘more cosmetic than effective’

The coronavirus is continuing to sweep across Spain but any measures to combat the spread are still up in the air. A meeting held on Wednesday between the prime minister, Pedro Sánchez, and the country’s regional premiers, was aimed at “evaluating” new restrictions to curb this, the sixth wave of the pandemic in the country. But there were few solid decisions taken: the central government is to make the use of masks outdoors mandatory once more, and will turn to military personnel to assist with the ongoing vaccination campaign and tracking and tracing of positive cases and their contacts.

Experts warn that these measures are “insufficient” if the aim is to flatten the curve of infections. Spain has this week been breaking records of new coronavirus cases, and reported 60,041 new infections on Wednesday – the highest figure seen since the pandemic began. What’s more, according to the ministry report released last night, the 14-day incidence currently stands at 784 cases per 100,000 inhabitants – 78% up on a week ago.

Experts are calling for a road map to tackle the situation: common guidelines for the whole of the country according to the level of epidemiological alert, albeit with room for the regions – which are in charge of their healthcare systems, vaccination rollout and coronavirus restrictions – to alter them as they see fit.

As for the return of masks in exterior spaces, Mario Fontán, from the Spanish Epidemiology Society, sums it up: “It’s more a cosmetic measure than an effective one for stopping the virus.”

Speaking after the meeting yesterday, Pedro Sánchez, of the Socialist Party (PSOE), explained that the use of masks would be obligatory outdoors from December 24, with the exception of when citizens are in natural spaces or when in the company of members of their family unit. They will also not be necessary if social distancing is observed.

“Experience has shown us that, together with vaccination, masks are fundamental to prevent infections,” he said. “It’s important at a time of big crowds to put into place the obligatory use of masks,” he added, in reference to the Christmas season. He stressed that the measures would be temporary and would be lifted “as soon as possible.”

The politician also announced that healthcare centers will be able to hire retirees and professionals from abroad to shore up their staffing levels, and that temporary permits would be issued so that more brands of home antigen kits could be sold, to address the recent spike in demand for the coronavirus tests with the arrival of this new wave of the pandemic – thought to be being driven by the more-contagious omicron variant.

Sánchez also explained that the government would be relying on the vaccination program to combat the pandemic. “We have not returned to March 2020,” he said, in reference to when the health crisis began and a general lockdown was put in place. “The situation is different and we’re not going to return to the measures of March 2020.”

This is a measure that can help to make people aware that we are in a pandemic, but apart from this education I can’t see any benefits

Magda Campins, head of epidemiology at the Vall d’Hebron Hospital

He stated that the vaccination campaign would be intensified, in particular the administration of booster shots, promising that 80% of the over-60s would have their third dose by the end of 2021, with 80% of the 50-59 group boosted by January 24, and 80% of the 40-49 group boosted by the first week of March.

For now, just Catalonia has announced the reintroduction of more severe measures, such as a return to a nighttime curfew, the closure of nighttime venues and limits on capacity in restaurants and cultural spaces from Friday onward. These measures will have to be approved by the regional courts before they can go into practice. The Catalan regional premier, Pere Aragonès, has called for “measures that go much further than those announced” for all of Spain.

The Basque Country regional premier, Iñigo Urkullu, also called for tougher measures, and warned that the regions lack sufficient powers to put them in place. “This conference should favor the legal framework of the measures that we can put in place,” he said of yesterday’s meeting, and called for limits to opening hours for the hospitality sector and a cap on capacity for social meetings and sporting events. But for now, no other region has taken the step of announcing more drastic measures.

Currently in Spain, face masks are obligatory in indoor public spaces and outside if there are crowds and social distancing cannot be observed. Making them mandatory in all settings outside, as they were previously during this health crisis, was a measure that a number of regions were calling for – including the Basque Country and the Canary Islands.

Sánchez is due to address the issue today at a Cabinet meeting and make them obligatory once more via a decree before Christmas Eve. “Masks and vaccination are the responses with which we can evade this wave,” the prime minister said in public statements last night after the meeting.

However, for some time now experts have warned that the true value of mask-wearing is indoors, and not outside, where the risk of contagion is much lower. The Madrid Public Health Association, for example, called for the measure to be scrapped back on April 6 of this year. Their obligatory use outdoors was eliminated on June 25 of this year.

Toni Trilla, the head of epidemiology at the Clínic Hospital in Barcelona, warns that the return of masks outdoors will not have a significant effect in containing the virus. “I don’t understand the stubbornness about introducing this measure,” he says. “It’s a superficial operation that, what’s more, loses you credibility over the effectiveness of the measure,” he complains. “If I am alone on the street or two meters away from someone else am I going to get infected? No. Can masks in the street help to reduce infections? Yes, but not at a sufficient level to justify the measure. Anyone who says that it is easier for people because that way you are always wearing it is treating citizens like they were children.”

Magda Campins, the head of epidemiology at the Vall d’Hebron Hospital, agrees. “This is a measure that can help to make people aware that we are in a pandemic, but apart from this education I can’t see any benefits,” she adds. “Right now we need drastic and robust measures.”

José Martínez Olmos, a professor at the Andalusian School of Public Health, says that bringing back masks outdoors “is not going to do anything.” He adds: “Most people already put them on when there are crowds in the street. This is not going to solve the huge increase in cases.”

With such a high incidence in Spain, primary healthcare centers are on the verge of being overwhelmed, and hospitals are also noting the increased pressure. According to the latest report, there are 7,732 Covid-19 patients right now, 1,466 of them in intensive care units (ICUs). This is a 19% rise in admissions compared to last week, albeit far from the peak seen at the end of January this year, during the third wave, when there were 30,000 coronavirus patients and some 4,800 ICU beds occupied.

The situation is different and we’re not going to return to the measures of March 2020

Spanish Prime Minister Pedro Sánchez

The Health Ministry also reported some 50 Covid-19 deaths on Wednesday, compared to 77 on Tuesday. The overall death toll since the pandemic began stands at 88,937. Experts warn that infections are likely to spike even further given the increased social mixing that will take place over the Christmas holidays, and that the only way to stop this is with tougher restrictions.

Experts also say that vaccination, while necessary, is insufficient by itself to flatten the curve of infections. In Spain, 44% of the over-40s have already received a booster shot of a Covid-19 vaccine while 18% of children aged five to 11 – the latest age group to be incorporated in the ongoing campaign – have already got their first dose of the Pfizer-BioNTech pediatric vaccine.

If no further measures are taken, the experts are predicting a “catastrophic” scenario in just a few weeks. “If we don’t take measures we could see the ICUs overwhelmed in just 10 days,” Campins warns. “The primary healthcare system is already swamped.”

The group of experts that is advising the Catalan regional government calculates that, based on the current progress of the administration of booster shots and with no other restrictions, there could soon be as many as 50,000 infections a day in the region – not far off the number reported in all of Spain on Wednesday.

“We have already had to delay non-urgent surgeries in some hospitals,” explains Campins. “If drastic measures aren’t taken, soon we will be halting more interventions and transplants and there will be a significant knock-on effect for non-Covid pathologies. We can’t allow that to happen.”