The Ministry of Health made public last night the report of May 8 with which he justified his decision to leave a large part of the Valencian Community out of phase 1 of the coronavirus de-escalation. In addition, it has also published the analysis of May 15 with which it finally allowed the 14 health departments that had not done so the previous week to leave phase 0.
In the first of the reports, that of May 8, it is confirmed that the main problem that the Valencian Community had for 14 of the 24 health areas with 70% of the population – including those of the main cities – did not advance to Phase 1 from May 11-, was the scarcity of PCR diagnostic testsas well as the difficulty in monitoring the epidemiological situation through primary care centers.
In fact, in this first analysis the general director of Public Health, Pilar Aparicio, addresses several “recommendations for improvement” for the Generalitat to be able to advance in de-escalation. For example, it asks you to “make an effort to ensure” that 80 to 100% of suspected cases perform PCR within 24 to 48 hours and to follow up on your close contacts.
Aparicio also recommends that “close monitoring” of the epidemiological situation be carried out to continuously assess the impact of the de-escalation, especially in the areas where the most cases are concentrated, which are the departments of Castelló de la Plana, València city and its metropolitan area and the Alicante-Elche conurbation.
This report of March 8 -which caught the Valencian government by surprise since it expected a generalized pass from the entire Community to phase 1-, highlights the existence of more than 1,000 cases detected in just 14 days (between April 24 and on May 8) in Alicante and Valencia and the nearly 200 in Castelló, “which are mostly hospital cases or health or essential personnel”. And it also indicates that a week before the Generalitat asked for the complete pass to phase 1 of the de-escalation from May 11, in the Community there were more than 2,000 people with symptoms who had not yet undergone PCR.
The report also shows that a week before the petition was processed, a high percentage of the still few people suspected of Covid-19 who had a PCR in primary schools (35.1%) tested positive. The director of Public Health warns that if this proportion were maintained for all the suspects detected in primary school who had not been subjected to a test, “it would be indicating that there is a considerable circulation of virus in the community with the risk of an increase in cases if this situation is not controlled. “
Another of the reasons pointed out in its day to explain the incomplete de-escalation of the Valencian Community was the mobility of the population between health departments. And this is also confirmed by the analysis published last night, which indicates that “there are intense population flows between municipalities that belong to different provinces that must be taken into account when relieving mobility restrictions.” Aparicio underlines that n the Community there are departments with incidences below the average but that are in contact with others with rates higher than 50 cases per 100,000 inhabitants in 14 days. The appropriate rate, the report indicates, should be 15 per 100,000.
Reasons why Health refused to go to phase 1 of the de-escalation to the entire Valencian Community. Photo: M. A. Montesinos –
The 10 departments that went to phase 1 on May 11 were below this rate, except the Requena area, which, despite its high incidence, left phase 0 because transmission could be easily controlled, as it was a mainly department. rural and with limited connections to metropolitan areas. Incidents were also high in the departments of Alcoi and Elda, which, however, advanced in de-escalation due to the improvement in their figures in the week prior to the analysis.
The report of May 15
A week after issuing its analysis on May 8, the General Directorate of Public Health sent another report to the ministry in which it proposed that the 14 Valencian health departments that on May 11 had remained in phase 0 this time did pass to 1. Between one report and another, the ministry notes an evident reduction in the number of cases detected, an improvement in the ability to carry out PCR and in the follow-up of cases from primary care centers, and greater control of residences.
Despite everything, the director Pilar Aparicio insisted on this analysis of May 15 in several of the recommendations she had made to the Generalitat the previous week. For example, he was again requesting an “effort” to ensure that 100% of suspected cases undergo PCR in 24-48 hours and that close contacts are followed up. It also recommends strengthening the functioning of the diagnostic circuit in primary care, as well as doing a “close follow-up” of the epidemiological situation in eight departments: those of La Plana, La Ribera, Sagunt, València-General Hospital and the four of the Alicante conurbation. -Elche.
Aparicio also asks to “pay attention” to the residences and socio-sanitary centers of the departments of La Plana, València-La Fe and Alicante-Sant Joan whose percentage of the total of residences with cases exceeds 15%, when the overall percentage of the Community is 7.8%.
Finally, the director of Public Health makes two “special observations” in this second analysis. The first is that the department of La Plana has a hospital load of patients with Covid-19 “far above” the rest of the hospitals (54% of acute hospitalization beds “and 16% of ICU beds).
The following observation has to do with the department of La Ribera. It should be remembered that the Generalitat requested social gatherings of up to 10 people in this region, having detected a significant rise in cases, and that the ministry rejected the proposal. As Aparicio asks to “pay special attention” in this area due to an increase in cases in the last week prior to the report, many of them corresponding to asymptomatic people diagnosed in the context of screenings (medical exams) for surgical admission, people who had symptoms more than 14 days and health personnel.
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