In Andalusia, public health officials drill into data for a deeper look at virus spread

by Maria Jesus Corrales

Public health officials in Andalusia have given an insight into the low number of confirmed coronavirus cases in the Campo. 

As this edition went to print, there were 182 confirmed Covid-19 cases and 20 related deaths in the Campo, as well as 990 cases in the whole of Cadiz province. 

But despite the low figures in the area, there are questions over the real impact of the virus and the uncertainties surrounding Covid-19. 

At a regional level Andalusia has now exceeded 10,000 confirmed cases, which amounts to 64 individuals per 100,000 contracting the virus, the Spanish Ministry of Health confirmed. 

But in these difficult circumstances, the numbers for the region are some of the most encouraging in comparison with the rest of Spain, where there are 172,541 confirmed cases and 18,056 deaths at national level.

There was a glimmer of hope as Saturday recorded the lowest number of deaths over a 24-hour period since March 23, with 510 deaths recorded on Saturday morning, although the totals increased again since then.

 REAL PICTURE?

 Joan Charles March, professor of public health at the Andalusian School of Public Health (EASP), and one of Europe’s leading experts in the profession, said Andalusia still has a long way to go in the fight against the pandemic. 

Although Almeria and Huelva present a smaller number of cases, the other provinces are reflecting trends seen elsewhere in Spain, Mr March said. 

“The reality is not what we see,” Mr March said, while trying to explain the low numbers in Andalusia. 

“We have not yet reached the peak of the number of cases in the region and we have not begun to lower the contagion curve.” 

“We have to continue to work towards this and this includes confinement, good hygiene and making reliable information available to the public.” 

He said it is difficult to explain why the spread of Covid-19 in Almeria, Huelva and Cadiz has not been as aggressive as other larger cities such as Seville, Malaga or Granada, but this will be analysed later. 

But a real picture of the virus will not be truly known unless “necessary tests are carried out on a good proportion of the population”, he said. 

“Those who have tested positive have done so using PCR tests [which are used to detected active infections, not antibodies], but if these are done at a faster rate, then we will be able to have a more precise number of cases,” Mr March said. 

For now, health officials cannot even give an estimate of confirmed Covid-19 cases in Spain, Andalusia, Cadiz or even the Campo. 

The PCR tests have been the most reliable in detecting Covid-19 antigens in the body, but only detect cases within a small window of active infection. 

Andalusia had 64 confirmed cases of coronavirus among 100,000 of its population, which is one of the lowest numbers in the whole of Spain. 

During the peak of the pandemic, the R0 number - which indicates how many people an infected person is expected to transmit the virus to - continued to remain over one.  Until it drops below one, the infection will continue to spread.

But at the weekend, the R0, or rate of infection, reduced to just under one in the whole of Spain (0.8), meanwhile in Andalusia this reduced to 0.65, indicating that there is light at the end of the tunnel.

The Gibraltar Chronicle prepared data visualisation of the evolution of Covid-19 cases in Andalucia between March 13, 2020, and April 14, 2020. The visualisation was prepared using data from the Junta de Andalucia.

 CORONAVIRUS-RELATED CALLS 

 Although confirmed cases in Andalusia remain relatively low, the reality is very different for those fielding calls from concerned patients who believe they may have contracted the virus. 

The Andalusian Emergency Health Service (EPES in Spanish) has received more than four million calls since the state of emergency was declared in the country. 

Maria Paz Carmona, the medical director for EPES, told the Chronicle that an average of 8,300 Andalusians contact the emergency number on a daily basis. 

At the start of the lockdown, 55,000 calls were made in a single day. 

This forced public health bodies to increase services and hire new members of staff, as well as introduce a self-diagnosis service as well as using online chatbots for basic information requests. 

More than 80% of calls to EPES were related to coronavirus or concerns about its related symptoms, Ms Carmona said. 

“We triage the calls based on the information shared by the patient over the phone,” she said. 

“We detected a significant increase in calls relating to coughs, those complaining of a fever tripled, and there was an increase from people complaining of a shortness of breath.” 

“I would say 80 to 88% of calls are in relation to these concerns.” 

The pressure on health service has decreased as the spread of the virus has evolved and people are now more informed on Covid-19 than at the start of the pandemic. 

“Over the past few days we have noted that the number of calls has reduced and now these are for mostly for medical consultations as opposed to medical assistance,” Ms Carmona said. 

Patients have also shown their appreciation towards medical staff, Ms Carmona said, adding that they have been responsible in the use of the healthcare phone line during this time. 

In the province of Cadiz, there have been 4,717 requests for coronavirus-related health care as opposed to there are less than 1,000 confirmed cases. 

DISCREPANCY IN NUMBERS

The discrepancy between confirmed cases and the reality of the pandemic was also highlighted in a study carried out by Imperial College London. 

The study focused on the spread of the Covid-19 virus across 11 European countries, including Austria, Belgium, Denmark, France, Germany, Italy, Norway, Spain, Switzerland, Sweden and the United Kingdom. 

Working with the findings of the World Health Organisation, this study led by epidemiology professor Neil Ferguson follows the evolution of the pandemic in each country and its contingency plans. 

The study is based on the assumption that contamination is a response to restrictions as opposed to broader behavioural measures. 

The numbers are assessed by observing the current number of deaths and using that to figure out the transmission of virus from a few weeks before, which leaves a lag time between infection and death. 

With regards to Spain, the study said that at the end of March, 15% of the population would have been infected with the virus, which amounts to seven million people. 

This is a much larger number than the confirmed number of cases in Spain yesterday, which was over 170,000 when this edition went to print. 

But this lack of an accurate number of cases is not just an issue for Spain. 

Scientists at Imperial College claimed that a smaller number in cases could be due to “mild or symptomless infections, as well as a limited number of resources for tests” across the 11 countries. 

While work is being done to understand the impact from the virus, health officials are also researching new medical treatments to fight the virus. 

Mr March explained that “various and diverse treatments are being used” in clinical trials, such as Remdesivir, a combination of Lopinavir-Ritonavir, and a hydroxychloroquine with azithromycin.

“We are trying out every treatment because we need to be able to evaluate what is best for the individual,” Mr March said.

“We are also looking at future vaccines, although this is a much slower process, and we are not looking at an effective vaccine for another year.” 

LOCKDOWN CONTINUES 

And while scientists are looking for answers and public health bodies debate over the effectiveness of the use of masks in public, the politicians are looking to lift the lockdown. 

Since Monday, Spain allowed people to return to their jobs in non-essential services, but under strict precautionary regulations on hygiene and security to avoid a second wave of the virus. 

This seems like the first step in a long procedure. 

Mr March said: “This de-escalation process will be progressive.” 

“On the one hand once the lockdown lifts the economy will open one step at a time, affecting those who have already had the virus and have the antibodies, to then be able to open up the other sectors.” 

But the most vulnerable in society, such as the elderly and the immune-compromised, will continue to remain in lockdown for an indefinite period of time, Mr March added. 

The way in which people work will also see a change. 

“Working from home will continue for as long as it is possible to continue,” Mr March said. 

“Every thing will eventually open up such as shows but to smaller crowds, and even bars and cafes will have to decide on the number of people.” 

“Schools and universities will not open for the rest of this academic year.” 

“Everything will be done to avoid the spread of infection and a second spike in numbers.”