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Why \de-escalation\ is much more dangerous than what we're being sold

2020-04-26 | Spain

A few moments ago, the Spanish Minister of Health appeared live on public television, reaffirming yesterday's message from the President. According to the government, the downward trend in the number of new infections would mean that "we are flattening the curve". The implication is that this change in trend would correspond to data in absolute terms being significant enough not to fear the effects of a "de-escalation" of confinement, something supposedly endorsed by the health recommendations report. Unfortunately, both of these things are false according to the data and documentation presented by the government itself in its hearings.

Daily new cases. Graph from the Spanish Ministry of Health.

The decline in the number of daily confirmed new covid infections is the main argument for deconfinement. The minister said:

on March 14th to 0.8% today

But if 35% daily change on March 14 meant 1,519 new cases, 0.8% today means that 1,729 people tested positive on PCR yesterday. If we compare it to the date of the start of the confinement, we have more new cases daily than we did back then. In a disease in which the possibility of collective immunization is increasingly questioned due to the recurrence of infections in discharged patients, to infer from this or simply to assume that the percentage drop in new infections is sufficient to enter into a "de-escalation" of social distancing measures is beyond risky.

Let us now compare with Italy, France or Germany, which will begin their "de-escalation" at the same time as Spain.

New confirmed cases every day by country, updated today.

Spain may be starting to flatten the curve... but, for a smaller population, it has a higher absolute number of new infections than the other countries. It seems to be the hastiest government in Europe, even more so than Italy's. Isn't the government being reckless once again, just as it called upon everyone to participate in the 8M demonstration?

The second idea that has been repeated is that "the experts" support the start of deconfinement. But if we read the health recommendations report we find out that the goal of the report is not to find whether it is advisable or not to relax the confinement but to find out whether a "de-escalation" could take place without producing a new overwhelming of the health system. Let us quote:

Strategies should be directed at reducing the number of cases to a level that can be assumed by the health system, avoiding the risk of being overwhelmed or suffering again the stress to which it has been subjected during the first epidemic wave. ‎...‎ This goal can be achieved with an orderly process of transition from the current situation, with extreme measures of social distancing, towards a new normality that guarantees the reduction of risks.

And in case anyone doubts that the real objective is "de-escalation" and that the "Coordination Centre for Health Alerts and Emergencies" (CCAES) is not responding to whether it would be desirable or not to actually undertake it, but exclusively to whether it is possible to do so without saturating the intensive care units:

The control of the epidemic is guaranteed by population measures that facilitate controlling the disease’s spread, but in the absence of any of these capacities, an excessive relaxation of the social distancing measures currently in force would imply a high risk of loss of control and overwhelming of the health system.

And since "de-escalation" is a presupposition behind the question received and its most evident danger lies in a resurgence of infections... among the facilities required by the report to prevent health system overwhelming, there are some such as doubling the capacity of the ICUs.

Immediate availability/access, if necessary, of twice as many ICU beds as the pre-COVID capacity and identification of spaces that allow an increase of up to three times the pre-COVID capacity.

The inevitable conclusions

The fact that there is a decrease in the number of new cases does not mean that there are fewer new cases than when confinement began or that Spain is at a level comparable to that which has served as a signal for de-escalation in other countries. In fact, compared with 14 March, there were more today, and the number of new patients is significantly higher than in France, Germany and even Italy, which have a larger population.

And the fact that "de-escalation" is possible without overwhelming the health system is not the same as saying that de-confinement will not produce more infections and deaths, nor that it is advisable from a health point of view.

To say the opposite, to insinuate it or to pretend there was a misunderstanding can only be qualified as trickery or recklessness. We must always put forward saving lives rather than saving investments and impose the shutdown of non-essential production until the epidemic has really been brought down.