05/26/2020 11:03 – Updated: 05/26/2020 12:20
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The Ministry of Health has published, after almost a month since the de-escalation period began, the technical reports on which it had relied to agree on the progress of the measures of relief from confinement of the different provinces. With three very clear criteria as a starting point (value transmission, the severity of the situation in the area and detection and response capabilities), the department headed by Salvador Illa is now justified why he left Malaga and Granada one more week in phase 0, while recommending Catalonia to improve indicators of early diagnosis and criticized Valencia for the low rate of PCR tests performed.
From the Executive they have posted on their website all the reports in which justify progress or not of the different territories according to the parameters established by the Ministry itself. They are dated between May 3, when the islands of La Graciosa, El Hierro and La Gomera, the Canary Islands, and Formentera, in Balares, advanced to phase 1, and May 22, when the minister announced that all of Spain was already at that stage.
Andalusia, “to reevaluate in the next week”
At report on Andalusia, adopted on May 8, the general director of Public Health, Quality and Innovation of the Ministry of Health, Pilar Aparicio, recognized that the “epidemiological situation” had “improved” in recent days and marked “a favorable trend in the control of virus transmission”, but the incidence rate in Granada and Malaga was “high in the last 14 days” , and it was understood “advisable to continue monitoring and reevaluate in the next weekThus, these two provinces remained in phase zero the following week and did not accompany in the next stage the six other Andalusian provinces that did take that leap from the Monday, May 11.
Specifically, the Granada health district had an incidence rate in the last 14 days of 40.1 per 100,000 inhabitants, with 96 cases diagnosed by notification date, while that of the Granada Metropolitan in the same time period was 19.4 per 100,000 population, with 83 cases notified by notification date. For its part, the health district of Malaga had an incidence rate in the last 14 days of 15.1 per 100,000 population, with 95 cases diagnosed by notification date.
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The Ministry of Health then argued that the epidemiological situation differed between provinces, “and especially between the health districts in Malaga and Granada” for which “restrictions” had been requested and for those who don’t. Furthermore, he understood that, “since most districts are adjacent to those with a higher incidence and that mobility control between them cannot be guaranteed “, it was” necessary to apply the precautionary criteria in these two provinces and keep them under close monitoring for another week. “
Madrid, “on the edge”
At case of the Community of Madrid, which has been the most controversial process and which has ended with a complaint to the Supreme Court by Ayuso to the central Executive, the first report states that the ability to perform PCR tests was “on the edge”, it was appreciated that it did not provide data on the availability times of the information collected in its surveillance system before the covid-19, which was to be consolidated in primary care and which did not detect details of the reinforcement of the necessary personnel.
The department of Salvador Illa also pointed out that the pressure of the coronavirus in Madrid was still “moderate” And then he appreciated “some ideas” of his suspicious case surveillance system, but he did not describe his operating system or some “key” aspects, such as the circuit and responsibilities for collecting that information, the integration of private centers or how the new technological tools were integrated into it.
It was also concluded that Madrid had to expand its capacity to carry out PCR tests since the information provided at that time showed that “could be insufficient” in the event of an outbreak, with its implementation especially in Primary Care.
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However, after a second request denied, Health authorized the passage to phase 1 on Monday, considering that it already had sufficient capacity to carry out diagnostic tests of suspected coronavirus cases and after adjusting the human resources to the system of early detection of possible coronavirus cases with more than 10,100 troops, including 600 in primary care and 169 in the Department of Public Health, on which the so-called ‘trackers’ covid depend.
He also appreciated that his healthcare capacity with 72.2 beds per 10,000 inhabitants and 2.8 of ICUs over the same population proportion was “well above” what was established, to which was added the response of their hospital system during the “epidemic wave” to adapt to the healthcare demand that the population required.
Catalonia must “improve”
For Catalonia, Health recommended, in the last report of May 22, “improve and monitor the diagnostic indicators early “of coronaviruses and thus increase the proportion of suspected cases to which practice a PCR.
It was also urged to increase sensitivity to suspected cases “especially in primary care, but also at the hospital level in some regions such as Camp de Tarragona and Alt Pirineu i Aran. “In addition, it was asked to” consider the possibility of expand laboratory capacity“for PCR in four health regions.
Among other improvements, it was proposed “to advance in the approval and implementation of plans for the gradual reestablishment of habitual healthcare activity, both in primary care and in hospitals “and in the” development of the procedure for daily notificationFinally, it was advisable to “closely monitor the implementation of the traceability of contacts“, in order to find identifiers that allow monitoring the system and improving it.
“For the health regions as a whole, and in general for Catalonia as a whole, it is remarkable the high level of integration between the different institutions involved in case management “, dictates the report and adds that” in the epidemiological surveillance, human resources have been strengthened since the beginning of the crisis and there is an important reinforcement plan to hire 114 professionals“
Valencia had only performed 20.7% of PCR
Health justified its decision not to authorize the passage of the entire Valencian Community to phase 1 on May 11 by the low index PCR tests made to suspected cases, as they had been made 20.7% when requesting a minimum of 80%. The document also indicated that of these tests, A high percentage”, 35.1%, had tested positive.
Thus, he argued that if this proportion of positives was maintained, it would indicate “considerable” circulation of the virus in the community with the “risk of an increase in cases if the situation is not controlled”. Therefore, he recommended that important “effort” to test at least 80% of suspected cases within 24 to 48 hours and to track their close contacts.
Likewise, he warned that there were “intense” movement between municipalities in different provinces that “should be taken into account when relieving mobility restrictions.”
Then he raised a fragmented de-escalation and the change of areas with an adequate incidence rate was allowed (less than 1.5 / 10,000 inhabitants) and the passage of capitals and their metropolitan areas by their sociodemographic characteristics and mobility. But he advised doing “a close follow-up of the epidemiological situation to continuously assess the impact of the relief measures on the transmission of the virus” and to pay “special attention” to the areas of the province where cases were concentrated: the departments from Castellón and La Plana de Castellón, Valencia city and its metropolitan area and in the departments of with urbanization of Alicante-Elche.
Navarra with “very positive” indicators
The Autonomous Community received the approval of Health for having the capacity indicators of the system “very positive”, according to the report of May 8. It was also highlighted that at that time in Navarra “the bed availability of acute and ICU was guaranteed, as well as the possibility of increase to 37 beds of acute and 2.6 ICU beds per 100,000 inhabitants at the time that is necessary. “
Thus, it presented “a good epidemiological situation, with no case with onset of symptoms in the last 8 days”, the cumulative incidence in the last seven days was 24 cases per 100,000 inhabitants and PCR was being performed in primary care on more than 60 percent of suspected cases.
He also valued that “the capacity for rapid detection and containment of the sources of contagion is highly developed, with specific, coordinated and communicated teams, and protocols for identification, quarantine and contact monitoring “.
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