the christmas test

Three weeks ago, in these same pages, I described October as “the month in which we lost hope”, given the evolution of the pandemic around the world and, in particular, in our country. In November, things have not been better. But nevertheless, we have regained hope by the announcement of the upcoming availability of several vaccines that have shown great effectiveness in the different phases of their development.

Indeed, these vaccine announcements have counteracted the low mood due to the evolution of the pandemic in much of the world in the two-thirds of the month of November, and the data of which are summarized below. In red, the countries that have worsened, in number of new cases, the data of an already horrible month of October. In green, those that have improved and in black those that have maintained the same trend from the previous month.

In the world as a whole there have been, until the 20th, more than 11 and a half million new chaos, a figure similar to that reached in the entire previous month. The US has already 3 million this month and did not reach two million in October. The country enters the period of political transition after the November 3 elections in a third wave unleashed. India and Brazil, on the other hand, are improving, something that is also happening in Argentina and other Latin American countries.

without Russia or Turkey. Source: worldometers and own elaboration @migsebastiang

without Russia or Turkey. Source: worldometers and own elaboration @migsebastiang In the East, things are just as good in China and Vietnam. They have improved, and it is not easy, in Australia and New Zealand. And they have worsened, albeit on an enviable scale, in Japan and South Korea. Europe, excluding Turkey and Russia, has registered 5.2 million new cases. That figure already exceeds that of October as a whole, and there are still 10 days of the month of November. Within Europe, almost all states accumulate more new cases this month. France and Italy stand out, who have been the protagonists in these three weeks of November.

Some countries, such as Spain and the United Kingdom, have already reached the peak of the second wave and are in de-escalation.

This is not the case in Italy, nor in France or Germany.

It gives the impression that we have learned to bend the curve, but we are unable to avoid its escalation

The evolution of the pandemic in the latter country is noteworthy. Given as the example in which Spain should be looked at, by a senior ECB official, the truth is that Germany has overtaken Spain in the number of new cases, something that had not happened in the entire pandemic. This fact, not being “the worst of the class”, together with the very evolution of the pandemic in Spain, has improved the atmosphere of pessimism that reigned here just a month ago. Evolution of incidence

The data on the accumulated incidence in 14 days (IA-14), the number of new cases in that period per 100,000 inhabitants, has become the most popular reference to analyze the evolution of the pandemic in any nation or region. In Spain, it also serves as a threshold to activate or deactivate certain containment measures. And, more recently, it has become the official national goal to reach the end of the alarm state: an IA-14 of 25 out of 100,000 inhabitants. In the graph I present, in blue, the evolution of this variable since it began to be published on May 25. From that date to July 15, the IA-14 moved below a level of 15, with the minimum of 7.7 achieved on June 25. That is

we have already lived those records that now seem unattainable to us.

And we all know what happened next. In the second half of July an escalation begins, in the form of outbreaks in multiple places in our geography, all of them “presumably controlled”. At the beginning of August we surpassed the barrier of 50, and some, the “tired of Covid”, began to warn about the evolution of the pandemic while in Spain, except for the aforementioned outbreaks, summer was enjoyed, with some restrictions such as use of the mask, which was not mandatory throughout the country until the end of July.

At the beginning of September the IA-14 reached 200 and it was beginning to be a clamor that measures should be taken, to avoid a repeat of the dramatic first wave of March. But the truth is that the emphasis was placed on hospital admissions, the saturation of ICUs and the number of deaths, all of them variables that move with delay and that then were not so bad. And he allowed himself to return to school and work, trying to control the outbreaks, which continued to multiply. Incidence continued to rise, albeit at a somewhat slower rate, reaching a value of 290 on September 23. It was in that range for a few days and then, oh miracle, it began to decline, albeit at a gentle pace, until it reached 256 on October 8. They were moments of wine and roses, and even of merriment in some press conferences.

And in this, the bridge of October 12 arrived.

Source: Ministry of Health and own elaboration @migsebastiang

Source: Ministry of Health and own elaboration @migsebastiang It is true that Madrid, which was ahead on the curve, took some containment measures. But in the rest of Spain, the consequences of the bridge were strongly felt. The graph shows the brutal rebound, from 260 on October 12 to 530 on November 3, more than double. An escalation of more than 270 points in just 3 weeks with its dramatic consequences in terms of hospital stress and deaths.The truth is that, since then,

containment measures seem to have worked

, although we are not able to specify the effectiveness of each measure taken individually, which causes many tensions in the sectors on which the weight of the adjustment falls. It gives the impression that we have learned to bend the curve, but we are unable to avoid its escalation. It is like the beach lifeguard who is very good at reviving bathers when they have almost drowned, but who cannot prevent them from entering the sea recklessly. Or look the other way. The third wave will be avoided if a strict program of tracking and testing of the cases that are detected is followed.The question now is twofold: when could we reach the announced goal of 25? And what could we do to avoid the third wave? In general, the third wave will be avoided if a strict program of tracking and testing of the cases that are detected is followed. That is, what was not done in the summer. For this, we would have to use all the tools at our disposal, such as the

wastewater analysis and Covid Radar

, which still does not work in our territory and which, in different versions, has been key in many successful countries with the pandemic, to the point of not having a “second wave”.

The added problem is that, this time, the achievement of the goal is likely to be reached around Christmas. And this forces you to have a plan. Not so much because of the hackneyed theme of “saving Christmas”, a concept whose meaning I must confess that I do not understand, but to avoid a third wave like the one that happened to us after the October 12 bridge to which I referred earlier. Christmas Plan Indeed, in the same graph I present two scenarios for the fall of the IA-14 curve for the next few weeks. In the first, simply by following the evolution of the last ten days, in which the incidence has fallen by about 100 points, at a rate of 10 points a day, we would reach the objective in the middle of Christmas. In the second scenario, following a pattern similar to a Gaussian bell,

improving incidence becomes more difficult as it reaches a lower and lower level.

The objective, in this case, would not be reached until well into February. But that is not relevant. The important thing is that, in both scenarios, the levels of the curve on the eve of Christmas would be around 200 points. It is well known that it is different to have a value of 400 in full climb or when you are descending the curve. For example, current incidence levels of 400 are the same as at the end of October. In those dates they supposed a maximum alert level and a request for drastic measures, on the part of many, among whom I am. But a level of 400 now is almost cause for celebration. Well imagine a level of 200! If even in the escalation it was not enough to activate the alerts, what is going to happen with all the environmental, business and social pressure, so that the maximum number of restrictions is lifted when we reach 200.

Does anyone consider a 12 o’clock curfew on Christmas Eve or New Year’s Eve with an incidence of 100 or below realistic? And a perimeter confinement in municipalities or communities that prevents family reunions or the transfer to the second residence? Therefore, realistically, you have to make a plan to prevent all those Christmas contacts and mobility from becoming the germ of a third wave. In addition to controlling mass events, such as parades, which should be “televised”, or mass bells, the strategy to make Christmas as risky as possible must revolve around mass tests. PCRs are expensive, cumbersome, and slow to reveal the result. But

antigen tests are quick, can be cheap and they will be accessible if they are allowed to be made in pharmacies, with all the necessary guarantees.

An antigen test would not be valid for all the holidays, but it would help you to have peace of mind at each of the Christmas Eve-Christmas, New Year-New Year’s Eve, or the Three Kings’ meetings separately. Anyone who wants tranquility in the three celebrations should take 3 antigen tests. So,

its availability must be maximum and I can think of no other formula than pharmacies.

The cost issue can be relevant to many families. Therefore, there should be one free antigen test per person, but only one. Those who want to do more will have to pay for it out of pocket, although many families will probably opt for a single celebration, given the circumstances.The strategy to make Christmas as risky as possible should revolve around mass testing.

New Year’s Eve parties for young and old, could be allowed as long as they were outdoors , with limited capacity and after presenting a negative result in a recent test, of no more than 24 hours. They could also be required at family reunions, under threat of sanction, although individual responsibility would have to be appealed. And required to circulate through the streets at night. They would also be necessary for trips to other locations. On the way out and on the way back. In addition to a quieter Christmas, carrying out these tests would help to locate possible non-symptomatic infected bags, which are the ones that are difficult to locate. Many large companies are already doing this as a prerequisite for their face-to-face meetings. And with great success.

That is why it should be generalized to the entire population, and that they are not the privilege of a few.

But this probably requires legal modifications, preparing the pharmaceutical sector and allowing companies and families to rationally plan their Christmases. That is, a plan.

We play a lot in the coming weeks. We are playing a third wave that can be devastating, despite the proximity of the vaccine. We need to pass the “Christmas test.” For this, it is necessary to approve that they are the “Christmas of the test”.

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