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Contact tracing falters in Barcelona amid virus spike
Published in Ahram Online on 21 - 07 - 2020

When Sonia Ramirez was told by her local clinic that she had tested positive for the coronavirus, she expected to be asked about anyone she had come in close contact with recently.
Instead, like an unknown number of Spaniards in the northeast region of Catalonia, she was left on her own to warn family, friends and co-workers that they could have been exposed amid a new surge of infections.
``They didn't ask me who I had been with,'' said Ramirez, a 21-year-old cleaner in the greater Barcelona area. ``They didn't even ask if I had been to work recently, which of course I had.''
With the virus rebounding in parts of Spain, it appears Catalonia and other regions are not adequately prepared to trace the new infections in what was supposed to be an early detection system to snuff out any outbreaks and prevent a new cascade of cases.
Spain imposed a three-month lockdown earlier this year and reined in a devastating first wave of infections that left at least 28,000 dead. As conditions improved in May and June, the government in Madrid gave in to pressure by the separatist-minded leaders in Catalonia and the right-wing political opposition to return full control of the health care system to the regions.
Now, Barcelona and an agricultural area in the same Catalonia region have become the two areas hit hardest by a resurgence of the virus.
Ramirez believes she got infected from her boyfriend, who had caught the virus a few days earlier. After her positive test, the clinic she visited told her to self-isolate for two weeks, and someone has called every two days to check how she feels.
In over a week since testing positive, no health care worker has asked Ramirez or her boyfriend about their contacts in the two weeks before their symptoms started, as mandated by public health guidelines.
Catalonia leads Spain's 19 regions with 9,600 new reported cases since May 10 and its growth rate has more than doubled in the past three weeks, according to Spain's National Epidemiological Survey.
The survey found that Catalonia on average only traces up to two contacts and detects under one new infection per case, the lowest rates in the country. Experts say that on average, each infected person spreads the virus to three more people.
``We are seeing a rise in cases and community contagion that worries us,'' Dr. Jacobo Mendioroz, the epidemiologist in charge of Catalonia's virus response, told Catalonia Radio on Sunday. ``The system of contact tracers can still be improved. Now we have 300 tracers and we are going to add another 600 shortly.''
Catalonia's Health Department did not respond to repeated requests from The Associated Press for Mendioroz or another top official to comment on the contact tracing failures, which also have been reported in local media and have drawn complaints from mayors.
``This is the main problem: The virus is outpacing our control measures,`` said Dr. Joan Cayla, a retired epidemiologist who set up Barcelona's contact tracing unit in the 1980s.
According to Cayla, Catalonia should have boosted its full-time contact tracing force to 1,500 trained professionals over a month ago when the virus was still in remission.
``It would have cost a lot of money, but it would have paid off because the consequences are going to be much more costly,'' he said. ``This is a race against the clock.''
The contact tracers were supposed to be supported by 120 workers of a private call center that the Catalan government contracted for a reported 17 million euros. Faced with criticism from health professionals who said the call center workers were not properly trained, the government has scaled back their role to checking in on patients in self-isolation.
Because of the flare up in Catalonia, authorities have restored restrictions. Catalonia was the first region to make face masks mandatory regardless of the distance between people in public areas. It then closed off a rural area that is home to 210,000 people around the city of Lleida, and prohibited gatherings over 10 people in Barcelona, while also asking them to limit their outings.
Even so, Barcelona's beaches were packed Saturday, and young people appear to be fed up with social distancing guidelines.
Wary of privacy concerns over smartphone apps that warn users they could have been exposed to the virus, Spain has focused on manpower to track outbreaks.
England recruited about 25,000 contact tracers, but data shows the number of people reached and asked to self-isolate has been falling since the program began in May.
Italy has had no major complaints about its contact tracers, but it has pinned its hopes on a tracing app that few people have downloaded.
Spain's doctors and nurses, who fell sick in world-leading numbers during the spring outbreak, are once again being asked to step in and do their own contact tracing.
``We have always been ready to take our place in the front line,'' said Dr. Rocio Moreno, who coordinates several clinics in an area of greater Barcelona that has a large virus cluster.
``Our own doctors, nurses, and social workers are making the calls and searching for contacts,'' Moreno said, adding that her staff has had to drop almost all other work to concentrate on COVID-19 cases.
Nurse Raul Martin is tracing contacts from his clinic because he and his colleagues say the contact tracers are overloaded.
``I would speak with a patient to see if they had been contacted by tracers to get their contacts, and they would say nobody had called them,'' Martin said.
His biggest fear is that another onslaught of infections is coming.
``If a second wave like the first one hits, I don't believe that the system could take it,'' Martin said. ``Maybe we do have enough protection suits and better protocols now, but as human beings we could not take another period of 12-hour shifts treating COVID patients, one after the other, and seeing people die all alone.''

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