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Coronavirus flourishes in Spain as response splinters among regions

Coronavirus flourishes in Spain as response splinters among
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SANTANDER, Spain — Spain is fighting back a second wave of coronavirus — with no consensus on the way forward.

The spread of the virus has accelerated in Spain this summer, with 2,415 new cases diagnosed just on Tuesday. The country now has Europe’s highest incidence of COVID-19, with 173 positives per 100,000 inhabitants in the last two weeks. Regions such as Catalonia have reported more than 1,000 cases per day for four days in a row, while the number of positives is surging in Madrid and the Basque Country. 

In contrast to March, however, cases have been largely limited to young people socializing after a long lockdown. That has kept deaths low as well. 

Nevertheless, Prime Minister Pedro Sánchez conceded during a press conference on Tuesday that the evolution of the pandemic in Spain is “worrying.”

“I’d like to convey a message of alert but also serenity,” he said. “Alert, because the evolution is not good, it is worrying in some parts of the country. But also of serenity because we are far from the situation in which we were in mid-March.”

In another contrast from the spring, the Spanish government is now allowing the country’s 17 autonomous regions to respond to the local outbreaks on their own. Regional and national leaders hold regular meetings to coordinate their response, hashing out issues such as a recent ban on smoking outdoors if the 2-meter social distancing rule can’t be guaranteed, and shutting nightlife venues such as clubs and cocktail bars. 

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However, when it comes to implementing these restrictions, the regions are hitting a legal wall.

Since the national state of emergency expired in June, regional governments must obtain a judge’s approval for any measure that could curtail fundamental rights. That has led to judges in various parts of Spain overturning restrictions.

Meanwhile, the variety of voices representing different levels of the government haven’t always been on message with public communication. 

Carme Borrell, the director of Barcelona’s Public Health Agency, points to this disconnect as a major concern.

“At the state level, we have [health emergency coordinator] Fernando Simón,” she said. “But at the level of the regions we had a number of different people communicating, each one with their own view, and that hasn’t helped.”

The conservative opposition — which forced Sánchez to lift the state of emergency in June — is now demanding stronger action. The Popular Party (PP) has called for legal reform to allow regional leaders to impose the state of emergency locally without needing national approval.

Sánchez has countered that such a reform isn’t necessary because, in his view, regional presidents have that authority already. But he also admits that some regions have been more effective than others in tackling the spread of the virus.

Pending homework

Another charge from the conservatives: Sánchez is yet to fulfill his promises, including creating a national public health agency.

“The responsibility for the pandemic is with the government of Spain, independently of the powers of the devolved administrations,” said Ana Pastor, vice-secretary of social policy at PP, in an interview last week with public radio station RNE.

There are critics beyond the right as well.

Rafael Bengoa, co-director of the consultancy firm Healthcare and Strategy Institute and former health minister in the Basque Country regional government, also believes that the lack of a national agency is hurting the response. He also notes that Spain lacks a public health system that’s integrated with primary healthcare — which has led to a lack of contact tracers and discrepancies in COVID-19 data. 

“The basic infrastructure wasn’t up to the challenge,” he said. “And because we don’t have that infrastructure, we have had to constantly improvise, more than in other countries.” 

“Over the next month or month and a half, we must control the increase of cases because there is community transmission in at least a third of the country,” he added. “In those places it’s going to be very difficult to open the schools.”

Simón has been hinting at further local restrictions, pointing to high mobility among different parts of Spain as an important driver behind the surge in infections.

“In some instances, we will have to implement forceful actions to restrict mobility when there are many cases,” he said at a press conference on Monday.

Virologists, however, are warning that Spaniards are not complying with the restrictions enough, partly because of a desire to enjoy the summer and break free from the lockdown.

“Nobody wants yet another strict confinement,” said Margarita del Val, a virologist at the Severo Ochoa Cell Biology Center in Madrid. “But to avoid that, we must apply all the other restrictions with [more] rigor.”

Fernando Rodríguez Artalejo, director of the doctoral program in epidemiology and public health at the Universidad Autónoma de Madrid, agrees that the desire to socialize is a key driver.

“The young have a very important role here,” he explained. “The typical profile of infection is young and asymptomatic.”

“We know that the majority of the cases and the outbreaks come up from social settings, gatherings of family and friends that are very typical of Mediterranean life — and Spain in particular — in the summer,” he added.

Rodríguez Artalejo did note, however, that hospital capacity remains robust and deaths from the virus are low, in contrast to the spring.

Meanwhile, Sánchez has been rebuking his critics by pointing to rising testing capacity across the country and to government plans to create an independent public health agency. He has also announced that 2,000 soldiers will be at the disposal of regional leaders for contact-tracing work.

Rodríguez Artalejo, however, is skeptical that ramping up contact tracing is a silver bullet.

“It would be good to have more contract tracers, but we also know that when you have community transmission, contact tracing isn’t enough,” he said.

For example, a number of regions, such as Andalucía and the Basque Country, are reaching government targets for contact tracing, but still grappling with increases, he noted.

“What we are missing is a massive strategy aimed at increasing social responsibility,” he said. “And we experts are also a little responsible, because we made the world think that if we have enough contact tracers, that would be enough.” 

Borrell, from Barcelona’s Public Health Agency, warns that the situation could still get worse. 

“If the virus spreads more in the cold, like the flu, the situation in the autumn gets more complicated,” she said. “Whether we can open schools successfully will be the big question.”

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