A little more than two months separate a sentence from the Spanish head of government, Pedro Sánchez – “We defeated the virus, controlled the pandemic and bent the curve” -, on the other hand, from his Minister of Health, Salvador Illa: “Hard weeks lie ahead in Madrid ”. THE new normality of Spain did not last. The restrictions that were lifted on June 21 have been reimposed here and there since July. On August 18, the whole country experienced a tightening of limitations, and little by little new measures are gaining ground in more and more areas, which already see home confinement as a very real and close possibility, when not already adopted.
It is the story of a failure. Spain only managed to move away from Europe’s worst statistics in the incidence of the covid-19 pandemic around the second half of June, to return to leading them strongly in the middle of the European summer, with a huge difference over almost any other country in the world. its surroundings. What happened in that period?
To find an answer, it is necessary to go back to the alarm state itself. De-escalation plan. Its spirit was to model, as several experts agree: an asymmetrical lifting of restrictions, which would advance in regions that had a sufficiently low incidence and that guaranteed sufficient capacity to cope with possible recrudescences. But there were two major problems: the Ministry of Health chose not to quantify what the incidence and guarantees should be: there were no clear parameters. And many regions have moved forward when they shouldn’t have. The clearest case is that of Madrid, which began the process of de-escalating the restrictions by promising an epidemiological surveillance capacity that it never complied with and that, from there, jumped to the new normality by precipitously ending the state of alarm before all the other autonomous communities ( regions of Spain are called) to follow the path outlined initially.
Miguel Hernán, professor of epidemiology at Harvard University (USA) and one of the specialists who worked to lay the foundations for the transition, summarizes it this way: “The new normality was something else. What we experienced was simply a rushed de-escalation without doing homework ”. In his opinion, to reach that moment of relaxed restrictions, which has come to be called new normality, four conditions would be necessary which, in his opinion, have not been fulfilled. The first would be the leadership of the autonomous communities to create and strengthen both capacities for care, diagnosis, screening and isolation or quarantine. The second, the leadership of the Spanish Government to define transparent and harmonized epidemiological indicators that would facilitate coordinated actions. Third, a design of concrete de-escalation measures by multidisciplinary specialists – including specialists in epidemiology and economics – to combine sustainable economic activity with available scientific knowledge about the coronavirus. Finally, an ongoing decision-making process on opening and closing based on an assessment of epidemiological data from the previous three weeks.
Miquel Porta, full professor in epidemiology, preventive medicine and public health, believes that the failure of the new normality began even before the epidemic. “The mistake was not that there were no criteria for de-escalation, but the application of these criteria”. And this happened, he says, due to the “incapacity of the State”. “It is not even a problem for politicians, but for the state apparatus”, he stresses. For the sake of a better understanding, he cites the example of the Tax Agency, in comparison to the non-existent Public Health Agency, which he and other colleagues have been claiming for years: “The Farm is an oiled mechanism, with 21st century tools. Obviously there are frauds and it could work better, but any municipal tax in any corner of Spain is registered. Our [a saúde pública e os serviços de vigilância epidemiológica] function as they did in the 19th century; it is as if there is an accountant taking notes with an abacus ”.
The most similar to this agency in Spain is the Center for the Coordination of Health Alerts and Emergencies (CCAES), a department of the Ministry of Health with less than half a dozen employees who were overwhelmed as soon as the crisis began. There was not even a system capable of compiling the data quickly and properly. And, most worrying, there is still no. At least not entirely.
Nor is there a sufficient number of trackers, and the primary care capacity, the second wave containment dyke, is far below the European average. All of this adds up to the behavior of citizens and some companies, who did not try hard enough to protect themselves or their workers, the stubbornness in not giving up nighttime leisure and, as some experts point out, a certain random component. The result was a cocktail that is leaving a tremendous hangover in the form of restrictions and new confinements.
The CCAES issued a document, defined in consensus with the autonomous communities, which tried to act early so that the new cases did not turn into community transmissions – which apparently did not work. The call Early response plan in a covid-19 pandemic control scenario it was approved on July 16, when hundreds of rural workers in the Aragon region were already becoming infected. He established three scenarios and measures in each of them. But again, without numerical limits. There were no figures from which to close nightclubs, restrict meetings or confine populations. Two months later, Madrid and the central government are discussing whether 500 cases per 100,000 inhabitants in 14 days are sufficient to adopt limitations on citizens’ mobility. Harvard set this limit at 350.
Between that document and today’s situation, there is an “excess of bias towards normality”, in the words of Rafael Bengoa, one of the most respected Spanish sanitarians. “It is justified on the part of the citizens, because after being locked up for almost four months it is natural to want to return to normality. But all governments know that this bias is dangerous in any situation. We should have had a more solid plan of deflation. All communities were prepared, but some were not. And if you add that to a very irregular behavior of the citizens, the perfect storm is created ”, he says.
“Calling it a new normality may have been a failure, because it made us confident,” reflects Saúl Ares, a scientist at the National Biotechnology Center. “As long as the virus is with us, we must be sure of three things: primary care that is reinforced to the maximum, all the time; trackers, with or without cases, as recommended. And thirdly, even if the incidence is low, the population should live with the rules of a certain distance until this passes: avoiding meetings indoors and whenever they happen to be wearing a mask, in addition to hygiene rules ”, he explains.
In the same vein, Daniel López Acuña, former director of emergencies for the World Health Organization (WHO), manifests himself. “For many people, the new normality was to return to normality, and there was a fundamental mistake: not to assume that we were returning to a moment of a curve that fell, but where the virus had not disappeared”, he points out.
Until the vaccine is reached, it is possible that it is necessary to forget that ephemeral concept of new normality. There are months of battle with the virus ahead, including a possible third wave. To surf it in the best way it is necessary to have a good evaluation. Bengoa and 19 other health workers subscribed to the magazine The Lancet a manifesto asking independent experts to study what has failed and propose measures to the Spanish Government so that it does not happen again, because, as they all predict, when this pandemic ends, others will come. “I would not seek a new normality,” says Bengoa. For him, it will not be possible to return to the political, social and inequality normality that exists in Spain. Change is needed. Together with another group of experts, he works for WHO on a far-reaching document that lays the foundations for a more planned, fair and environmentally friendly health system. Definitely, to learn from mistakes, something that has not always happened in this pandemic.
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