The areas with the highest purchasing power in Madrid suffer the highest rate of covid infections

If there is something that differentiates this moment from the rest of the moments since the winter of 2020, it is the vaccine. It is the main reason that, given the explosiveness of this sixth pandemic peak —which in the last seven days alone has left 74,031 infections in Madrid—, the number of sick and deceased has not grown, until now, in the way in which it they did months ago, although they are increasing uninterruptedly and with increasing speed. Always with uncertainty as the only certainty, experts believe that the Community could reach the peak of this wave next week, although they allude to the fact that the imbalances that holidays can cause must be taken into account: both in the new infections that are they are giving by the growth in social interactions, as in the detection and notification of these infections.

Since the crisis began, Madrid has accumulated 1,133,448 positives, 18.9% (214,922) have occurred since November 10, when the start of the sixth wave was set. No other period has had the outbreak of infections of the last two weeks after the arrival of the omicron variant, which according to the latest data from the Ministry, exceeds 90% of infections. The day that least reported in this last fortnight was December 19 (it was a Sunday), with 3,042; and this Tuesday the maximum of the entire pandemic was reached with 19,932 positives reported in 24 hours.

With data from this Thursday, the accumulated incidence reaches 2,426 cases per 100,000 inhabitants in the last 14 days and positivity – the percentage of cases that are positive with respect to the tests that are carried out – is 23.3%, three points above the national average.

Boadilla del Monte, Rivas-Vaciamadrid, Las Rozas and Pozuelo de Alarcón are the towns with the highest cumulative incidence (AI) in the last 14 days, all with around 2,000 cases per 100,000 inhabitants; and in Madrid capital, they are the districts of Chamberí (2,736), Salamanca (2,587) and Centro (2,425). These are data from the latest epidemiological bulletin of the General Directorate of Public Health, on Tuesday. But it is not new. Since the second wave, in each of them the municipalities and neighborhoods with the highest socioeconomic level in the Community have registered the highest transmission. There is still no study that has delved into the reason for this question, and the experts, at the moment, can only make hypotheses.

Fernando García, epidemiologist and spokesperson for the Madrid Association of Public Health (Amasap), recalls that “just as at the beginning it was the most depressed socioeconomic sectors that suffered the most from the effects of the pandemic, later it has been the opposite.” He points out that “perhaps it has to do with the fact that contagions occur more in areas of social interaction between young people”, but he wonders “if these groups meet more in the Salamanca district than in other places” or “if it is that there is more detection.

What the data from the Ministry of Health say is that it is in those territories where there is greater community transmission. And, in terms of age groups, it occurs mostly between those between 25 and 44 (2,758 cumulative incidence) and between those between 15 and 24 (with an AI of 2,576).

García adds several more questions, “all hypotheses”, he warns, “that would have to be verified”. One, that "it could be analyzed if there are differences in the vaccination rates by socioeconomic levels and ages." Another, "that perhaps the discredit regarding the measures to follow is greater in the higher socioeconomic areas." And one last, "that precaution in social interactions be different by social layers."

For Joan Carles March, a researcher at the Carlos III Health Institute, professor at the Andalusian School of Public Health and former director of that institution, there are waves in which the reasons may "seem" more concrete and be linked "to the profile of the wave" . He gives the fifth as an example, “which began with the very young population, and in some way the population that moved on study trips, or with friends. And who can move more? Who has better economic conditions? In the latter, the same “may” have happened: “Extreme mobility favors having many contacts and whoever moves the most is the one who has the most resources. It would be necessary to try to know where the virus is going and where it comes from, but in times of transmission like the current ones it is impossible, the systems, in the conditions in which they are, do not have the capacity to carry out that analysis.

Garcia agrees on this, assuring that "the in-depth investigation that had to be done in hospitality, nightlife, work, the educational field... To fine-tune everything that should be done has not been done", because "the tracking has never worked well" and, therefore, "there has not been a map that would allow us to have a much clearer idea." Now, "there is no longer the capacity to find this out."

Vaccination and self-diagnosis make correlation difficult

That infection curve is a vertical wall that hasn't folded down yet; The good news of this wave is that it is not as parallel as other times to that of admissions to the ward and ICU and, with a slightly more offset, to that of deaths. “Obviously thanks to mass vaccination and the third booster dose of the elderly. It is the most important factor so that morbidity is much lower”, says the epidemiologist García.

Although, he clarifies, “it remains to be confirmed whether the omicron is less virulent than other variants, it must be analyzed with the unvaccinated, and, even so, there are still immunosuppressed people or older people” who are affected by the virus. more acute form.

Somebody was in a hurry to get the new #bccoilovers on the dodge tonight. Ill take any help that i can get! At 7yo… https://t.co/auRVEwVmx8

— EJ25Turbo Thu Jun 25 01:26:56 +0000 2020

The comparison made last Tuesday at a press conference by the Deputy Minister of Public Health, Antonio Zapatero, showed the differences between the third, fifth and sixth waves. While at the peak of last winter's wave, 7,879 were registered, of which 20% were admitted to the ward and 2.8% to the ICU; in summer, with 5,479 infections at that peak, 14% did so in acute cases and 2.31% in critical cases; and at this moment, it does 2% and 0.2%, respectively.

This correlation, however, “is not entirely correct”, says Saúl Ares, a systems biologist and researcher at the CSIC, because the comparison between diagnoses and admissions cannot be made with any other wave. And it is not only because of the large percentage of the immunized population —there is 91.6% of Madrid and Madrid over 12 years of age with both doses—, but because of “the fever of the tests”. It refers to the pharmacy self-diagnostic tests that citizens can do at home.

Faced with the torrent of new infections, the system hit a ceiling in detection and the Ministry of Health decided to modify the strategy: since December 21, the positive results of these tests count as official positives for the Community. And two days later, the regional government activated points to test the population with symptoms outside the Emergencies of 15 public hospitals. That volume of detection, says Ares, "has never happened before, and making the division between cases and admissions can be misleading, because the proportions are not the same."

Although the greater transmissibility of ómicron has multiplied infections – it has an R0 of between 6 and 10, that is, each infected person has the ability to pass the disease to between six and 10 people, according to the Deputy Minister of Public Health last Tuesday —, “we must take into account the variable of diagnostic capacity”, explains Ares. Thus, he affirms, the wide margin between the ratio of infected and people who require income is not as much as it may seem at first glance.

Emergencies grow by about 2,500 daily attentions

If the absolute numbers are observed and not the relative ones in terms of healthcare pressure, it seems “quite clear” that the numbers of “the two previous waves” are going to be exceeded, says Ares. On April 26, for example, there were 2,255 patients in acute care and 576 in intensive care units, it was the peak of the fourth; hospitals took almost a month to reach that number of patients on the floor from a figure similar to the one recorded this Thursday, 1,583. In critics, where there are now 226, the situation was different. At that time, Madrid had practically linked the third wave with the fourth and between the two, the seriously ill never fell below 400.

Immunization has “greatly” reduced the severity of the disease. According to the data offered by the deputy minister a few days ago, the risk of being admitted to the ward decreases by 73.5% and by 82.1% in the ICU in the Community of Madrid. The issue even so, experts insist, is that in such an immense volume of infections, the percentage of cases that end up needing assistance will be small, but in absolute numbers, "there will be many."

Hospitals are already noticing it, operations are paralyzed and tests and consultations are delayed again; Visits have already been prohibited in some of them, such as Getafe for at least two weeks; and in the Emergency Room there has been an increase of between 2,500 and 3,000 daily visits since last December 17, when there were 9,457. Those who enter from there, however, maintain a stable curve that, in recent days, has even been slightly reduced; although it has coincided with December 24, 25 and 26, times when emergencies are triggered every year, but admissions from that area decrease.

The 'déjà vu'

Intensive Medicine, Anesthesiology, Emergency or Internal Medicine professionals speak of “déjà vu”. This Wednesday, the Anesthesia team of Infanta Leonor received a message informing them that the ICU of that center was already "full"; that the intensivists were going to take care of “up to 10 patients”, which meant that two of them would have to be taken by anesthesiologists in the resuscitation unit (REA). And all this meant that the operations that required that space during the guards were paralyzed and that from that moment, the PACU (anesthesia recovery unit) could "stay open at night with four positions".

This situation, which by global volume and compared to other times is not yet critical, is intensifying in the context of 22 months of pandemic, with their respective suspensions of consultations, check-ups, surgeries and tests; with a staff that drags physical and mental fatigue and that is also immersed in a complicated employment situation due to the renewals of more than 11,000 contracts that are in the air, the so-called "covid reinforcement".

The fatalism of ómicron: the wave that hits when the end was already in sight

That, points out Manuel Franco, epidemiologist and spokesman for the Spanish Public Health Agency, also comes at a different social moment: “Citizens are also tired, and they have caught us with what we thought was the vaccination honeymoon. The media, the politicians, the people... We are still in shock, we are not yet seeing the sociological consequences for the population”. And he says that "you cannot forget" the area that most and before reached that "state of collapse": primary care and public health.

“They reached saturation there a long time ago, they have burst all the seams.” In one month, the health centers have multiplied by eight the patients they have under follow-up (from 1,191 to 8,561) and attend to more than 300,000 daily consultations; two weeks ago they had to cancel everything that was not essential. And the Community's epidemiologists and health specialists, in charge of tracking and monitoring cases, are unable to absorb the volume of contacts that are taking place. "In that, all the waves are similar," says Franco, "in the state, totally weak, in which the Community maintains the primary and Public Health structure."

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