We have already written a couple of entries showing the impact that early and strong confinement measures have on reducing the number of deaths from the current Covid-19 epidemic (see Covid-19: early confinement helps save lives and Confinement has saved hundreds of thousands of lives). Well, even now, confinement can still save lives.
In the post What can be the meaning of the number of detected people infected by Covid-19 at the beginning of September? we showed that the epidemic was far from being on the scale it was in March, even though the number of infected people detected was even higher. We also explained that this did not mean that the control of the epidemic was satisfactory; in fact, there was every reason for alarm since the situation had got out of control since June and showed worse (even much worse) figures than in the surrounding countries. Although it is well known, we will show below that the epidemic has worsened in the last two weeks. If we use the same methodology with data from September 22, we get the following estimates: According to the Health Department figures there were 468 deaths in the week of 16-22 September. Given the improvement in therapy over the last few months, it is possible that the average number of days between infection and death has risen from the 16 days estimated in June; we will therefore make the estimates with a range of 16-20 days.
With an average of 16 days between infection and death, we have, for the number of actual infections between 1 and 6 September (assuming a lethality of 1%, 0.75% and 0.5%, respectively):
Lethality: 1% 0.75% 0.5%
Estimated actual infections 1 to 7 September: 46,800 62,400 93,600
According to the Health Department, 49,716 people were found to be infected in the week before 7 September.
If we assume 20 days average between infection and death, we have for the number of infected between 28 August and 3 September:
Lethality: 1% 0.75% 0.5%
Estimated actual infections 28 August to 3 September: 46,800 62,400 93,600
In the week before 3 September, 46,371 people were infected.
All of which shows that it is quite possible that during September we may have missed between 10,000 and 40,000 infections per week (while that figure was in the thousands in mid-August). These several tens of thousands of actual undetected infections will not be quarantined (many of them will be asymptomatic and will not even be aware that they have the virus) and will continue to drive the epidemic forward out of control.
At this point, it is going to be difficult to get the epidemic back under control without the imposition of some form of confinement.
We have insisted from this blog, and we insist again now, that the situation of the epidemic is very heterogeneous in Spain, noting great differences not only between Autonomous Regions or between provinces within each Autonomous Region, but between villages within the same province or even between neighbourhoods within the same town; as an example, the ratio of Covid-19 deaths per 100,000 inhabitants was 2.55 in Madrid, while in Andalusia it was 0.55 (which is one fifth of the figure in Madrid); in Almeria the ratio was 1.57, while in Huelva it was 0.4 (both of them are provinces in Andalusia). This heterogeneity tells us that confinement does not have to be applied to the whole country as it was in March, but could be more surgical, and applied in much smaller areas. Since data (infected, hospitalised, deaths, etc.) are now available almost by street, it might not be necessary to go so far as to confine entire provinces and it might be sufficient to confine some villages, some town and, depending on the case, even just some neighbourhoods. But what does seem crystal clear is that it will be necessary to confine (possibly with much more energy and restrictions than the pseudo-confinement decided on last Friday for certain areas of Madrid; in the end much ado about nothing, given the enormous uproar caused and the limited amount of what has been decided to control an epidemic which is already rampant there).
If we also want to avoid having to confine the whole country, it is essential to reinforce primary healthcare (which is clearly overloaded in many of the autonomous regions) and increase and improve the efficiency of tracing.
Surely also, return to the state of alarm to ensure an efficient implementation of local confinement measures (see in this regard the column yesterday by Javier Pérez Royo in El Diario). Because any delay in confinement, even if local, will cost lives.
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