Coronavirus trackers: the keys to vigilance for safe de-escalation

Author: Verónica Fuentes

Spain is in full de-escalation. In recent weeks, the downward trend in the numbers of people affected and killed by COVID – 19 it has fostered hope in society. However, we must not let our guard down.

As explained to SINC Helena Legido-Quigley, expert in health systems and professor at the National University of Singapore , “ these Positive results are due to very strict containment measures followed by the majority of the population. But the current phase is just as important, if not more, to avoid possible outbreaks like the one in South Korea . ”

Pere Godoy, president of the Spanish Society of Epidemiology (SEE), believes the same: “ The situation is good but we must continue to monitor and continue with all the recommended measures. It would be very dangerous for us to trust ourselves, we still have a very high percentage of the population susceptible to passing the disease, and if the chains of transmission were reactivated, the figures could be reversed . ”

“The positive data for Spain is due to very strict containment measures. But the current phase is just as important to avoid possible outbreaks ”, explains Helena Legido-Quigley

As part of the Plan for the Transition towards a New Normality, last week the Ministry of Health published the diagnosis strategy, surveillance and control in the transition phase . In it, it is established that epidemiological surveillance systems must provide daily information to adopt rapid reactions in case of new infections.

Hence, the study of the contacts of these possible outbreaks is so decisive, known as virus tracking. However, this will require more staff in Primary Care (AP) and professionals who can follow up on contacts, trackers.

It is a complicated job that requires many resources. The PA system and the epidemiology units in each territory are the two key institutions, but their resources will have to be increased so that they can face all the cases and their contacts , ”says Godoy.

In Scotland they propose to hire 2. 000 people in the UK are thinking of hiring 18. 000 and in the US between 100 .000 and 300. 000. According to what is being done in Singapore and the public health networks that Spain has, I estimate that at least some will be required 20. 000 people ”, adds Legido- Quigley.

For Fernando Simón , director of the Center for Coordination of Health Alerts and Emergencies (CCAES), “it is not easy to define the number of people we are going to need, since that there is a very important variability between the autonomous communities (CC AA) ”, he indicated in the press conference of the past 11 of May.

The importance of tracking

During the last two months and until now, most of Spanish society has been homebound. So even if there were a chain of transmission, there were not many opportunities for an inter-community transfer. But the situation has changed.

“With the relief of the containment measures, contacts are resumed and transmission may occur. Hence, it is essential that all cases are properly diagnosed, “says Pere Godoy

The Official State Gazette (BOE) has published this week a ministerial order to optimize the collection of epidemiological data from the AA CCs and to ensure that they perform a PCR test or other diagnostic technique appropriate to each suspicious case in the first 24 hours from the knowledge of the symptoms.

With the return to work of many people and the relief of confinement measures, contacts are resumed and transmission may occur. Hence, it is essential that all cases that occur are properly diagnosed , “says Godoy.

Each confirmed case must be properly isolated, tracing all the contacts that person may have had and to whom the disease may have been transmitted. “ These contacts must be isolated at your home for 14 days to make sure that if any of them develops the disease, it does not generate new chains of transmission ”, he continues.

But what about asymptomatic spread? According to experts, the study of contacts cannot go this far, it is only based on detecting clinical cases –which contact the health system– and their contacts.

We can only protect ourselves from asymptomatic cases if we comply with the non-pharmacological prevention measures, such as physical distancing and the accompanying measures. Fortunately, although they are very numerous, they transmit little at the community level , ”says the President of the SEE.

Technological surveillance

For all affected countries, the detection of cases and the isolation of their contacts is a priority issue to reduce transmission. According to Fernando Simón, in Spain all the Autonomous Communities try to develop computer tools that help in this task.

“Technology watch has yet to be proven to work. Singapore developed the world's first tracking app but it has only been downloaded by 20% of the population, “says Legido -Quigley

If, in addition to providing adequate resources, a technological platform is made available to enable simultaneous monitoring of all cases, the work would be greatly facilitated ”, claims Pere Godoy.

However, although technology can help, it can only be complementary. “ In fact, it has yet to be proven to work. Singapore developed the world's first bluetooth tracking app. It has only been downloaded by a 20% of the population and to function effectively it would require a 60% , ”says Legido-Quigley.

The problem is that, on the one hand, it drains the phone battery very quickly and, on the other, that older people are not installing it,” he insists. “In addition, in the Asian country the population trusts the government a lot, but I have serious doubts that an application with the same characteristics will work in Spain .”

However, the expert's recommendation is to try it. “ Singapore has provided all the technology for free, so it should not be very difficult to put it into operation in our country .”

Summer vacation, in the air

From the experience of Wuhan and the European countries, it seems that the confinement strategy has worked. “ The countries that have been most successful have been those that acted quickly, those that introduced containment measures at the right time, those that stocked up on the necessary material, carried out enough tests, and launched a contact tracking plan ”, emphasizes Legido-Quigley.

“At least until after the summer, the basic prevention measures will be maintained. The holidays this year are far and compromised “, concludes Godoy

What is no longer so clear is how long it should be maintained. “ It is very difficult to say how much time we are going to spend like this. This is what we have to see in the coming days ”, declares Godoy. “Every time you enter a new phase you have to be very careful about what impact it has on the transmission indicators .”

The epidemiologist considers that at least the basic measures will be maintained until after the summer, such as physical distance, hand washing, the use of masks when indicated, surface cleaning or avoiding large crowds. “ Clearly, in some communities the holidays this year are far away and compromised ,” he concludes.

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