Spain has the highest number of COVID-19 cases in Western Europe, approaching a figure of 700,000 as I write on 23 September. The country is now in the grip of a second wave with the Health Ministry reporting 241 more deaths on Tuesday — the highest daily jump since May. In the last week fatalities surged by 900, bringing the death toll to 30,904. Because the second wave has been largely concentrated among under fifties, the death rate still appears low, but it could spread to the elderly, with potentially fatal results.
The spread of infection shows no sign of slowing down. The number of infections jumped by nearly 10,800 on Tuesday. In just the last two weeks, more than 135,000 people have tested positive for the infectious disease. In Madrid 36 percent of intensive care beds are occupied by Covid-19 patients, compared to the national average of 16 percent.
The worst hit area of Spain is the capital, Madrid. Out of every 100,000 people in Madrid, 772 have been infected in the last two weeks, more than 2.5 times higher than the national average. 36 percent of intensive care beds in the city are occupied by Covid-19 patients, compared to the national average of 16 percent.
Spain’s Health Minister on Tuesday asked everyone in Madrid to limit their movement and close contact as much as possible. Much of southern Madrid has been isolated, but schools, indoor bars and restaurants remain open, as well as theatres and concert halls.
The regional government, run by the right-wing Popular Party, is resisting a complete lock down. The Catalan government is calling on its citizens to avoid Madrid and is introducing testing for passengers arriving in Barcelona on flights and high-speed trains.
When this second wave began in July it started in two hot spots; in Aragón and in the Catalan city of Lleida. Initially Aragón and Catalonia had among the worst rates of infection in the country, but now these regions report some of the best numbers in data points such as hospital admissions.
Reported cases and deaths by region in 7 days until 22 September 2020
New York Times, 23 September 2020 (figures given by Spanish Ministry of Health) – numbers here
How the Catalan government succeeded in reducing its infection rate, and the contrast between measures imposed in Catalonia and in Madrid, is the point of interest here.
Catalan Response
When the second wave commenced in Catalonia measures to prevent the spread of Covid-19 were put in place, starting with the compulsory use of face masks and the closure of night clubs, with subsequent restrictions limiting smoking in public and placing restaurants under curfew.
In mid-July, fifteen municipalities in the Barcelona metropolitan area and much of the western Segrià and Noguera counties were placed under more strict measures. On August 22 additional restrictions were put in place for the city of Reus in the south of Catalonia, and from August 25, these measures were extended to three towns in the Vallès Oriental area, north of Barcelona. On September 14, health authorities extended the restrictions to Girona and Salt, in Northern Catalonia. On September 16, it was announced that restrictions in much of Noguera were to be extended again, but lifted in Segrià, including the city of Lleida.
In these areas it is recommended that people only leave the house for the following reasons: to work; for health and care reasons; to buy essential food and drink; to go to the bank; for other purchases by appointment; to do sport outdoors; to look after allotments; in genuine emergencies; as well as procedures that cannot be postponed, like exams, or renewing ID and permits.
Meetings of over 10 people in both private and public are prohibited, except for work or on public transport. Bars and restaurants can open, but with a maximum capacity of 50 percent, both indoors and outdoors on terraces. Shops are recommended to only accept clients by appointment. Places offering cultural events and shows, as well as establishments offering fun activities, sports centres, gyms and similar can only open up to 50 to 70 percent of their capacity.
The Catalan government also put in place measures prior to schools returning so that face masks are compulsory for those over twelve everywhere at school, and those younger (but over six) will also be obliged to wear them when their neighbourhood is located in a high epidemiological situation. Depending on the activity or the area within the school, pupils aged between six and twelve can also be told to use masks. Pupils’ temperatures are being taken upon their arrival.
Teachers will have to wear them when in contact with multiple groups simultaneously, and it will be recommended with “stable groups.”
Understanding Covid
Daniel López Codina, a lecturer at the Polytechnic University of Catalonia, Barcelona, and a member of its computational biology and complex systems research group, has an explanation of why the first wave hit so hard but why the second appears to have been contained. First, the country’s stringent, three-month lockdown was lifted a month too soon and should probably have remained in force until mid-July. Second, people treated the virus as a seasonal phenomenon like the flu and were eager to return to bars and beaches. And, third, the medical contact tracking systems weren’t primed. Or in plain speak: “We opened up again too soon, we were too relaxed and we didn’t have surveillance ready at a local level.”
I was lucky to attend a briefing given by Oriol Mitjà, a Catalan researcher and consultant physician in internal medicine and infectious diseases with expertise in poverty-related tropical diseases. He is working on new therapies to reduce the risk of infection with the SARS-CoV-2 coronavirus and advises the Catalan government (although he is critical of its handling of the first wave, and even more so of Spain’s reaction).
Crucially, Mitjà urged the Catalan government to buy antigen tests, the new antibody tests that show results in ten minutes. Mitjà believes these cheaper and faster tests can aid the return to school and allow children to safely visit their grandparents: if teachers are tested weekly and children are tested prior to visiting people at risk, the possibility of infection is greatly reduced. “The rule should be test, test, test,” he says.
The new antibody tests have now been used by the Catalan health department to react to coronavirus clusters within a few hours or days after a risk is pinpointed – so the target might be residents of specific streets or neighbourhoods.
The screenings usually take place on the street, inside a yellow medical marquee belonging to the Catalan emergency services. They are taking place in areas where both the number of transmissions and the index of transmission is growing, and sometimes for certain age ranges – most of the tests have been performed in the Barcelona metropolitan area.
So, when the town of La Seu d’Urgell in the Pyrenees became a hotspot, there were three days of testing. The first day for catering workers; the second for those aged 16-35 (the groups most affected by the second wave). Those showing symptoms of Covid-19 were directed to primary care clinics and hospitals.
Because the majority of infections are among younger people the symptoms may be slight or not apparent, so the three days of testing, while not covering everyone, located the true rate of infection and made clear what needed to be done.
Learning Lessons
During the first wave of COVID the Catalan government was critical of the Spanish government’s considerable delay in putting Madrid under lockdown, which meant considerable numbers with second homes left the city spreading the virus. It wanted to control its borders but the Spanish government refused this.
At the height of the first wave, it was able to use Catalan police to stop people leaving Barcelona at weekends and even to evict those who had gone to their second homes, which are often in areas with fragile health care resources.
As the Scottish, Welsh and Northern Irish government’s impose tougher measures than those of Boris Johnson’s in Westminster, there are lessons we can learn from Catalonia. Rapid lock downs and mass testing – not just of those with symptoms – using the cheaper, quicker tests seem an obvious starting point for controlling the spread. The Catalan model, in comparison with Madrid, may provide lessons. Still, as Mitjà suggests, the response of the Catalan authorities must also be criticised and, while they seem to have contained the spread of infection, Catalonia is not out of the woods yet.
