The Ministry of Health will delegate to the regions the competence to decide on the flexibility, modification and even duration of the measures over territories in phase 3 of the de-escalation as of Monday, June 8th. The state of alarm continues, but the new and last extension, approved this Wednesday and which will be in force until June 21st, transfers the powers to the autonomous regions and may even reach before time what has been called the ‘new normality’. A scenario that is not yet defined but whose “prevention, containment and coordination measures” will be specified on Tuesday in a law decree, as Pedro Sánchez has explained in Congress.
Technicians from Health and other ministries are currently working on that document. The Government does not give details at the moment about the process, although, according to president Sánchez, the content of the decree will be discussed before in an Inter-territorial Council with all the autonomous councilors that will be led by Minister Salvador Illa. Fernando Simón, director of the Center for Health Alerts and Emergencies, specified this Wednesday that the text “is being discussed now and we have to review it, probably tonight”.
“The decree that will regulate the ‘new normality’, the stage of our lives that will go from the end of the state of alarm until the COVID-19 is controlled with a vaccine or a very effective treatment, this will feature not only sanitary measures but also related with transport and with commerce”, Simón stated. Regarding the strictly sanitary issues, it will have to guarantee above all “the assistance capacity, the fluidity of the data, and the supplies”. Illa has mentioned aspects that will surely be present in the daily life of the coming months, while “we learn to live with the virus”: “The interpersonal distance of two meters, the use of the mask in the stipulated conditions, and constant higiene”.
Don’t let your guard down
The ‘new normal’ will not only reach Spain but all the countries attacked by the pandemic, as they emerge from the de-escalation of confinement. But not even the World Health Organization (WHO) can define for sure what this exactly means. In any case, the criteria of the WHO and Government have not always coincided: the WHO still does not recommend masks to the entire population to reserve them for the healthcare workers, while the Spanish Executive has made them mandatory for everyone whenever the safety distance cannot be maintained. After the state of alarm, Health ministry will continue to recommend them as a minimum.
“It is very important to understand that nobody has a map of the ‘new normal’. I speak worldwide. It is an unknown and unexplored territory that is about to be built and in which we have never been”, illustrates Daniel López-Acuña, former director of Acción Health in Crisis Situations of the WHO and professor at the Andalusian School of Public Health. What is clear is that this new context will be different and will have to deal with a horizon in which we do not know how the virus will behave and if there will be a second epidemic wave in the fall that will force again to impose restrictive measures.
The ‘new normal’, wields López-Acuña, “means not to let your guard down”: neither as regards sanitary capacities nor the “responsibility of the population” when it comes to complying with hygiene and safety measures. In other words, the system should continue to count on an extra muscle of resources and epidemiological surveillance to detect transmission chains and control possible outbreaks through early detection, racking and surveillance of cases and their contacts. On the other hand, the specialist points to the need for “a common framework at the state level” because “there cannot be 17 different ‘new normalities’”, he says, referring to the 17 regions.
No crowds or mass events
Beatriz González López-Valcárcel, professor of Public Health and part of the scientific committee of the Canary Islands government, recognizes that, even without a decree, they are not clear on what the ‘new normality’ will consist of. In the debates, “what worries us most in the Canary Islands is, on the one hand, what to do with tourism, which is our way of life. How two conflicting interests are reconciled: minimizing the risks of contagion but opening up the economy. The virus came here from the outside, and we know that it will come again from the outside. Regarding education, we talked about how to do it for a long time. And, of course, how to return to normality within the health sector itself”.
Regarding social interactions, López-Acuña details some ideas and stresses that “the behavior of distancing is going to have to continue and we must encourage very cautious behavior”. López-Valcárcel agrees, who relies more on “social control, in which all of us as citizens are responsible” than in coercive measures that may be stipulated. In addition, the former director of Health Action in crisis situations at the WHO focuses on nursing homes, which have been hit hard by the pandemic and which, since they have a vulnerable population, “must be vigilant and take precautions” also in this new stage.
All the specialists consulted are clear that large agglomerations should not be part of this ‘new normal’. Ildefonso Hernández, spokesman for the Spanish Society of Public Health (SESPAS) summarizes it in that “it will be a reinforcement of the issues that we have been establishing these months”, such as not meeting too many people. “Until there is a vaccine or I think that mass events or discos can be held. The virus is still there, it does not go away with the state of alarm”, says López-Valcárcel.
Reform of the Public Health Law
Another great question is how exactly the regulation of the ‘new normal’ will be carried out. There are several ways, but having anticipated that it will be by a royal decree-law, Juan Luis Beltrán, president of the Transparency Council of Navarra and former president of the Association of Health Jurists, bets on a modification of the General Law on Public Health of 2011: “It is an ideal norm for this that can be modified and expanded, that’s what it is for. It can contemplate everything other than restrictions of fundamental rights“. So adding paragraphs would be enough to legislate on masks, crowds and health services, he explains, under penalty of administrative sanction for citizens if it is not complied with and that the communities will apply as health authorities no longer in a state of alarm.
“The law itself appeals to individual responsibility, with high penalties of thousands of euros”, continues Hernández. Although it was thought for things of less importance than the current ones, which is why everyone agrees that it would require expansion. It is a General Law so it is not valid for measures that restrict fundamental rights, as in the case that at some point it is necessary to confine territories again. For that, it would be necessary to resort, according to the criteria of Juan Luis Beltrán, to the Organic Law of Special Measures in Public Health, of 1986, which already includes the possibility of isolating people for health reasons “but not entire communities, but areas with For example, it was possible to quarantine people in a hotel in Tenerife in February, so that it can limit fundamental rights it would also have to be extended, but it would be another process: the government would have to request an urgent modification to the Congress”.