The Ministry of Health will present this afternoon to the councilors of the Autonomous Communities branch the draft that it has called Coordinated response actions to control the transmission of COVID-19 in the Interterritorial Council of the National Health System. This document recommends the measures to be adopted in each territory to stop the spread of Covid, in this second wave of the pandemic.
These measures include the recommendation of self-confinement and to avoid leaving the home except for essential procedures, the closing of bars and restaurants at 22.00, or the creation of “social bubbles” structured in groups with stable coexistence to limit social life as much as possible. But, what criteria does the department led by Salvador Illa establish to assess the risk of each territory?
The ministry has divided the indicators in this new draft – a “technical development of the indicators collected in the Early Response Plan“elaborated after the state of alarm of the first wave- intwo blocks. The first includes indicators related to transmission level, and the second, at the level of use of healthcare services.
Regarding the first block of indicators, Health will take into account the cumulative incidence (IA, that is, the number of positives per 100,000 inhabitants) both in the last 14 days and in the last seven days, and these values will also be considered more strictly for the population over 65. In other words, Health plans to assess both AI in the general population and AI among those over 65 years of age.
The stable Ministry in an incidence of the last 14 days less than 25 among the general population and under 20 among those over 65 as the lowest risk level, equivalent to being in what he called the ‘new normal‘ after the end of the de-escalation in June. He low risk level stands at an AI of between 25 and 50 cases in the last 14 days for those under 65 and between 20 and 50 for those over 65; he medium risk level, between 50 and 150 cases for the general population and between 50 and 100 among the elderly; he high level of risk, between 150 and 250 AI for those under 65 and between 100 and 150 for seniors; and the level of extreme risk, in an AI more than 250 cases for those under 65 and 150 for the elderly.
The following table shows all these indicators:
The Ministry will also take into account the percentage of positivity of diagnostic tests, and stable that less than 4% of every 100 carried out in the last seven days is equivalent to desirable transmission levels, that is, a situation equivalent to the ‘new normal’. From there, between 4 and 7%, it represents a low risk; between 7 and 10% evaluate it as medium risk; between 10 and 15% consider it a high risk; and more than 15% means that this territory is at extreme risk due to Covid transmission.
Health adds a final indicator in this first block to assess the risk of each territory: the percentage of cases diagnosed with traceability, that is, tracked. The objective is to trace at least 80% of the cases, but if this percentage is between 80 and 65%, Health considers that this territory is at low risk; between 65 and 50%, at medium risk; between 50 and 30%, at high risk; and less than 30%, at extreme risk.
Regarding the second block of indicators, the department directed by Illa will measure the number of hospital beds occupied by Covid cases and the number of beds in Intensive Care Units (ICU) occupied by people affected by coronavirus with respect to the total number of beds available “active “.
“It is important to emphasize that no single indicator is capable of giving a complete vision of the epidemiological situation. It is essential to put these indicators in context depending on the territory and the characteristics of the population that is being evaluated, as well as having detailed information on the cases that allows the interpretation of transmission dynamics “, includes the draft prepared by the Ministry, which also includes some” complementary “indicators to those indicated above to” help assess and characterize the epidemic status and management and response capabilities in more detail. “
The monitoring indicators have been selected, according to the document, “for their usefulness in capturing the most important aspects of the epidemiological situation and response capacities based on scientific evidence, international standards and the experience accumulated by the health administrations of our country”.
However the European Center for Disease Control (ECDC) has established a threshold of cumulative incidence in 14 days of 25 cases per 100,000 inhabitants to consider that the risk begins to increase, and a upper limit of 150 to consider that the risk is very high. In Spain, the Ministry explains, “we have established an additional threshold”, that is, 250 cases per 100,000 inhabitants.
Definition of alert levels
The combination of the result of the indicators from table 1 (see above) will position the evaluated territory at a risk level that corresponds to four alert levels that Health plans to establish as follows:
- Alert level 1: When at least two indicators from block I and one from block II are at a low level and the rest of the indicators are at a new normal level.
- Alert level 2: When at least two indicators from block I and one from block II are at a medium level and the rest of the indicators are at a lower level.
- Alert level 3: When at least two indicators from block I and one from block II are at a high level and the rest of the indicators are at a lower level.
- Alert level 4: When at least two indicators from block I and one from block II are at the extreme level and the rest of the indicators are at a lower level.
Read here the complete draft of the Ministry of Health