Five mistakes that made Catalonia lead contagion numbers in Europe

Santa Coloma de Gramenet"This is the fifth time we were wrong and failed in de-escalation. The difference is that now we had all the elements to foresee and prevent the wave," says the head of infectious diseases at the Hospital de Sant Pau, Joaquín López-Contreras. The epidemiological situation in Catalonia is critical in terms of contagions and the pressure on care. The European Union strongly advises against both entering and leaving the country due to the brutal cumulative incidence (1,089 infections per 100,000 inhabitants) and the Catalan Minister of Health, Josep Maria Argimon, admits that the Government should have "reacted earlier". He added: "With these figures, we clearly cannot have done things right".

Anna Llupià, epidemiologist at the Barcelona Institute for Global Health (ISGlobal), recalls that "turning green" on the European map is no improvisation. "We were told that the time frame of the pandemic was 2 to 5 years. The transmission does not stop by itself", she stresses. In fact, the experts consulted advocate for rapid and severe surgical measures to minimise damage and avoid yo-yo measures", which are more harmful to the economy and the population's health. Researcher at the University of Leicester Salvador Macip also regrets that the authorities "lack the guts" to decide and carry out a prudent easing of restrictions for fear of losing tourism. He adds: "With the virus we have to act preventively and not reactively".

These are the five causes that have precipitated the fifth Catalan wave, an unprecedented outbreak in Europe.

1. A rapid de-escalation despite the advance of the delta variant

Catalonia began its de-escalation at the beginning of June and in two weeks it recovered local festivals and street parties, lifted the 10-person limit on social gatherings, allowed restaurants to serve more people per table and reopened nightlife. At the same time, the Health Department was already announcing that the delta variant, a mutation that was putting countries like the United Kingdom against the ropes, represented 20% of infections in the country. In a few weeks it changed the rules of the game: it is much more contagious than the alpha variant (originating in the UK) and is more easily transmitted by aerosols. "With previous variants we would certainly not have an explosion in cases like the current one," admits Llupià

Macip claims Catalonia was hasty and took "all the wrong decisions" against the fifth wave. He underlines that this variant is the main factor behind the renewed destabilisation of a large part of Europe, but recalls that in the United Kingdom the virulence of the delta variant had already demonstrated its potential to rage against those who have not received the jab. Thus, the British example advised caution and avoiding excessively quick de-escalation. On the other hand, if the high transmissibility of the virus is added to the reduction of containment measures and increased social interaction, you get the "perfect storm", as it detonates a new wave. Catalonia propitiated it.

"A decision was made to continue with the de-escalation plan despite the forecasts already being out of date," explains the doctor, who says that no European country had any excuse to reproduce the mistakes of the United Kingdom and while "countries like France foresaw it, others like Spain and Catalonia, didn't," he concludes. López-Contreras also believes that the threat of this variant was underestimated. "The mistake was again to see a neighbouring country having a hard time, to ignore it and go ahead with the plans. And until the cases did not break out we did not see that the speed of contagion is massive and that it does not resemble anything experienced so far," he regrets.

2. Sant Joan festivities and end-of-year trips

In Sant Joan week 450 cases were diagnosed, there were half a thousand covid patients in hospitals and 179 in intensive care units (ICU). "Six weeks ago we had one of the best trends and this, plus the good pace of vaccination, made us overconfident," says Lopez-Contreras. According to the infectologist, social fatigue also played a key role: "We did more things that week than in the previous two months and the setback has been spectacular"

The spike in infections began in Barcelona and the metropolitan area and with an acceleration in infections among young people. On the one hand, the festival of San Juan was the first festival to be celebrated with a certain degree of normality. Although some towns closed their beaches, many nightclubs reopened, both indoors and outdoors. "We knew that in summer we would have a problem with the under 30s before the end of the school year. Sant Joan should not have been held," says Macip.

The other factor was the end-of-year trips. Mixing with other groups and a lower degree of compliance with prevention measures favoured the expansion of mass outbreaks, such as the mass outbreaks in the Balearic Islands, which spread the virus like wildfire among the unvaccinated. The Minister of Health took the blame and regretted not having recommended more insistently to cancel these trips.

3. Masks off, both outdoors and indoors

Along with other regional health ministers from all over Spain, Argimon has repeatedly asked the Spanish government to modify the decree that forces people to wear masks on the street, arguing that the risk of transmission is much lower. The mask, Argimon said, was not necessary outdoors if distances were kept. Finally, the Spanish government repelled the decree and the Spanish president, Pedro Sanchez, announced in Barcelona that the rule would no longer be in force by June 26th, only ten days later.

"In a de-escalation plan there is an unwritten part: what people interpret. Taking off the mask gives the message that the pandemic is over. "If the mask was not worn on the street, you can be sure that it was not worn indoors," he points out.

Macip also believes the authorities's mistake was communication: "It was a decision that had to be explained very well. You gave the population breathing space because things were going well, but it was dangerous for people to stop wearing it where it was needed. And this is what happened: it was not well understood and people have not worn it in risky environments. Llupià also agrees: "There is always a lot of confusion with the discourse and the rules. People ask themselves: 'Can I do it?' instead of saying: 'If I protect myself, can I do it?'"

4. Backing concerts and large music festivals

Half of the outbreaks of this fifth wave took place in the social sphere, i.e. nightlife, concerts and festivals. This was expressed by the government in the documents that justify the adoption of the curfew to stop the spread of the virus. The report "proves" that in these environments non-compliance of self-protection and safety measures - e.g. lax mask use - is widespread. Argimon acknowledged that letting three large music festivals go ahead was a "mistake".

According to López-Contreras, concerts and music festivals were "a time bomb". “In clinical trials everything goes great because the conditions are never identical to reality. With the contagion there was, I think that the principle of prudence was not applied as would have been necessary," he says. In fact, the same day that Cruïlla music festival began, on July 9, the Health Department assured ARA that it was not considering cancelling it despite the epidemiological evolution. A few days later the government announced its intention to call for a curfew. "Bringing in restrictions just after allowing some festivals for young people, the most infected, takes away credibility," says Macip, who adds: "We have repeated the mistake of solving economic problems assuming health risks".

5. No planning and overconfidence in the vaccine

When the government began de-escalation only 20% of the population were fully vaccinated. Although the rate of inoculations is high and in one month it has increased to 50%, Llupià describes as "excessive faith" the authorities' confidence in vaccination. "We can become infected whether we are vaccinated or not," she says, "so changing isolation protocols for those who have received both doses and allowing vaccinated people to transmit the virus is serious," she warns. The virus circulates, there greater the risk is that it will mutate and a variant that can escape the vaccine may appear, "taking us back to square one", according to Macip. He also wonders whether there will be a "Catalan variant" after the explosion in cases. "The vaccine prevents mortality but not contagion, you cannot eliminate the containment measures overnight," he insists.

Nor will any restriction do. "We need to plan, anticipate problems and have a public grid as Ireland and New Zealand have, detailing the progression of the measures for each sector and reviewing it every 15 days to adapt to each situation, such as new variants", says Llupià. The expert believes that, before applying measures that can be "massively expensive" for their returns in terms of health, they must be evaluated. "We don't know who makes the decisions at Procicat [Catalan Civil Protection]. There are many loopholes in the management and you cannot limit fundamental rights based on intuition. This is very serious. Can we not see that an institutional crisis may be unleashed?" she wonders.