Finally, the Government of Spain closed the country yesterday and approved a package of restrictions to stop the spread of the epidemic that is unprecedented in our recent history. The message is clear: the coronavirus crisis is a terribly serious problem and fighting it will require sacrifice from everyone. What’s more, it will require them for days or weeks .
Days that will be emotionally hard because what we will see is how the numbers of infected and deceased continue to grow without the measures that have just been approved apparently taking effect. And, as draconian as general confinement can be, a total quarantine such as the one approved this weekend in Spain needs time to take effect . The question is, how much?
Is the worst of the contagion spike to come?
The key to the explanation is in this graph that Zunyou Wu and Jennifer M. McGoogan published in the Journal of the American Medical Association (JAMA). In it you can see two types of bars: the blue ones, which quantify the number of cases “from the date of the onset of symptoms” and the yellow ones, which quantify them “from the date of diagnosis”. In the daily count of new cases that occurs from the ministry we only see the yellow bars and that means that, at any given moment of the epidemic, we are diagnosing symptomatic cases with delay. Or what is the same, that before the peak of the epidemic, there are many cases that due to their early evolution are still to be diagnosed .
But if we really want to get an idea of when the numbers of new infections will begin to drop, we have to imagine a third type of bar, even earlier ones: cases by date of infection. And we must bear in mind that, on average, the first symptoms take between five and six days to appear. Therefore, given that we were in full growth of cases, it is reasonable to think that the bulk of the new infections will be in the days prior to the introduction of social distancing measures .
To give us an idea, Antonio Villareal estimated that, compared to the 4,209 infected that marked the official data on Friday the 14th, there would be about 11,000 infected in the country. Obviously, these approximate figures and, in fact, he himself acknowledges that “it is impossible to know with certainty how many undiagnosed cases are currently roaming the country.” However, it does give us an overview of the size of the outbreak (and the problem) .
This gives us an approximate, but clear, time horizon: if we add the incubation period and the period between when the first symptoms appear and when it is diagnosed, it is reasonable to think that the effects of quarantine will not be seen until at least a week and a half . It is true that possibly in work environments that require attendance, in family or other settings, new infections will continue to occur, but with measures of social distancing, the chains of contagion should slow down and the numbers begin to fall.
In this sense, the Korean case clearly shows how, although the peak of new cases stops growing, that is not noticeable in the case statistics until days later. And, in fact, if we only look at the accumulated cases, the feeling is that the epidemic is getting worse and worse . Therefore, it is important to remember that sensations are that, sensations that do not have to correspond to reality.
What impact does this have on us?
A few days ago, the United Kingdom presented its plan against COVID-19, ruling out the application of total quarantines and other measures of social distancing because, as they explained, the confinements tend to lose effectiveness as the days go by . The reason is not only in the possible feeling of ineffectiveness of the measures that can be extended during the first days.
Also in the ‘psychological stress’ caused by the sudden interruption of our daily practices. ” Sudden changes in context lead to behavioral and motivational changes ,” says Eduardo Polín , a psychologist and professor at the European University of Madrid, “what they call individual responsibility does not come out of nowhere; they train.” Therefore, it is important to face confinement proactively and looking for activities that are reinforcing for us .