Reply to: “Integral management of COVID-19 in Madrid: Turning things around during the second wave”

The Commentary by Candel and colleagues [1] mentions that certain non-pharmacological interventions - perimeter closure of some Basic Health Areas (BHA), screening with rapid antigen tests in some BHAs, or sewage water testing in Madrid - have had a relevant impact on the control of the COVID-19 epidemic in the Community of Madrid (CM). However, the Candel's et al. Commentary does not provide specific outcomes data [1]. The CM has not increased its health care personnel, despite having fewer primary care physicians and nurses per million inhabitants than the national average (0.7 and 0.5 vs. 0.8 and 0.6, respectively) [2], which severely limits the fundamental tasks for controlling the epidemic spread: tracing, testing, and isolation.

The CM strategy, actually, translates into poor outcomes: 1) on 9 February 2021, the accumulated incidence at 14 days was 759.58 cases/100,000 inhabitants in the CM, vs. 630.00 in Spain[3]; 2) the hospital beds occupancy was 25.62% vs. 20.41%; 3) the intensive care unit beds occupancy was 50.60% vs. 42.28%; and 4) the excess mortality was 31.3% (from 10 January 2021 to 2 February 2021) vs. 21.7% (from 4 January 2021 to 2 February 2021), respectively [4]. In addition, the estimated job growth for 2021 in the CM is 1.7% vs. 1.9% in Spain, and for gross domestic product, 4.7% vs. 5.5%, respectively [5].

We believe that Candel's paper [1] does not provide valid empirical knowledge on what strategies could reduce the impact of the epidemic on the CM health and wellness.