Is Spain doomed to a new confinement?

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Spain, and practically all of Western Europe, have been testing increasingly severe restrictions for a couple of weeks to try to contain the increase in cases in the second wave without having to press the button of home confinement, the most effective but most feared method. In that situation is half a continent. As hospitals fill up, the repertoire of restrictions ranges from the recent curfew to the idea of ​​a weekend lockdown, as Catalonia weighs. They are intermediate measures that affect mobility without nipping it in the bud. The problem is that it is not clear how effective they are or in what time frame they bear fruit, and time is running out in the face of a runaway virus. So the debate that runs through Europe now is whether a short-circuit strategy, of total but brief confinements, would be more effective than gradual restrictions sustained over time.

In Spain it is too early for many of the most recent measures to be noticed. Fernando Simón, director of the Center for the Coordination of Health Alerts and Emergencies (CCAES), estimates that it takes about 10 days for them to be reflected in the number of infections. But the closure of the hotel industry in Catalonia (October 15), the perimeter confinement of Navarra (October 19) or the reduction of groups in Ourense (October 3) could already be seen in the statistics. It’s not like that. In the last 15 days the number of diagnoses in Spain has risen 23%, and in all the communities and territories – except Madrid, the Basque Country and La Rioja, where the rate of increase is stabilized – the most recent week has been worse than the previous.

“Confinement is the only measure for which there is scientific evidence,” says Tomás Cobo, vice president of the Collegiate Medical Organization. “With the rest we are in trial and error, but I would leave it as a last option,” he adds. “They are new measures and we do not know their effect,” says Patricia Guillem, Professor of Epidemiology at the European University of Valencia. “Beyond the restrictions, the main thing is to raise people’s awareness: to always wear the mask and to be more than a meter and a half or two meters from other people,” adds Joan Caylà, from the Spanish Society of Epidemiology.

The situation is not unique to Spain. In France, a pioneer of the night curfew, a month ago the Nobel laureates in economics Esther Duflo and Abhijit Banerjee proposed a 20-day home closure in early December to save the Christmas campaign. Since the restrictions were implemented, France has added 380,000 new cases (in Spain there have been 150,000), and is the western European country most affected, according to the European Center for Disease Control (ECDC).

In line with Duflo, the president of the General Nursing Council, Florentino Pérez Raya, is blunt: “It is only possible to stop the contagion curve with a new strict confinement of 15 days,” he says. “It is clear that the temporary closure would serve, but it would be necessary to see other impacts and see what politician dares,” says Caylà. José Martínez Olmos, from the Andalusian School of Public Health, ditch: “It will be difficult to avoid confinement with the figures of the communities.”

Despite the rejection caused by the measure, there have already been countries that have opted for a total confinement, such as Ireland, which decreed it for six weeks on October 20. Although it is still too early to see its effect, in the last week their cases have risen 9%. In Spain, 12% have done so. Israel has also resorted to confinement since early September.

Given the lack of control of the epidemic in Europe, the ECDC and the World Health Organization (WHO) repeat their mantra of measures: isolation, detection, quarantines, masks, hand hygiene, physical distance, reduction of social activity. With all the countries in a situation of “great concern” – only Norway, Cyprus, Liechtenstein, Estonia, Greece and Finland are spared – the ECDC notes that all have taken measures such as group and contact restrictions, “but these have not been completely successful and the epidemiological situation is deteriorating rapidly ”. The agency affirms that taking stricter measures, “which were the ones that proved their effectiveness during the spring of 2020, seems the only possible strategy.”

The doubt about the usefulness of the intermediate restrictions seems to lead to home confinement, “a drastic measure that managed to greatly reduce the figures, but also caused a lot of damage to the economy. The justification for applying it in March was the high mortality, ”says Guillem.

The Director of WHO, Tedros Adhanom Ghebreyesus, spoke on Monday: “Nobody wants confinements.” “We need to better target our measures and do it sooner to avoid more restrictive interventions,” says a spokesman for the WHO European office. “It is very likely that it will be necessary to raise the level of the response, but the confinements are a proposal with a thick, imperfect and expensive line,” he adds. The ECDC also insists that the stay-at-home order is a last resort.

But delaying such a drastic measure as much as possible will depend on the evolution of the pandemic. In Italy, for example, the president of the Federation of Medical Associations, Filippo Anelli, pointed out on Monday that the latest restrictions adopted – the closure of cinemas, theaters and gyms, and the closure of bars and restaurants at 6 p.m. They represent “the last attempt by the Government before an inevitable total confinement”, which will occur if the situation does not improve in 15 days.

“In March, it was found that home confinement was working against the virus, but before reaching this situation, we must greatly strengthen the National Health System. After overcoming the first wave, we have seen how our system has failed to put a barrier to the second one ”, says Guadalupe Fontán, specialist in Public Health at the General Council of Nursing. “Confinements without an adequate health policy to control the virus, correct tracking and more resources and better planning for primary care are not the solution”, points out Silvia Soler, from the Persistent Covid Platform.

If total confinements are not decided, the selective ones (at night, weekend) “now make more sense because there is a much greater capacity to do tests,” says Cobo. The doctor admits that new measures are now being tested because before the complete closure it is necessary to seek “the balance between economy, restriction of freedoms and disease.” “We go through the funnel tube, each time towards the narrowest part,” and this leads to total confinement, says Cobo.


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