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

A commentary by Candel et al. [1] argued that the management of the COVID-19 pandemic by the Community of Madrid (CM) was reasonably successful. We do not agree since that conclusion is not evidence-based. Fig. A shows that preventative measures were implemented while incidence rates were increasing [1]. Fig. B is an illustration of how few diagnostic tests were performed: only 7 tests per case, while in South Korea and Uruguay, countries with effective management of the pandemic, their ratio were 95 to 100 tests per case, respectively. The cumulative incidence peaked at 785, almost two-fold what Fig. D shows [2]. The early downward trend of incidence shown in Fig. D coincided with the partial replacement of PCR testing with less sensitive lateral flow tests.

Madrid was at the highest risk level in 10 of the 16 weeks between 20 August and 3 December 2020, according to three indicators [3]: cumulative incidence over 14 days >250/100 000 (15/16 weeks), acute care beds occupied by COVID patients > 15% (10/ 16 weeks) and intensive care unit beds >25% (13/16 weeks).

Since the pandemic started until 10 February 2021, 13 080 COVID-19 deaths (194 deaths per 100 000 population) occurred in the CM [4]. Among the 17 regions of Spain, Madrid has had the highest age-adjusted mortality rate in men (2.4/1000) and shared the second highest in women (1.5/1000) [5]. This high mortality and the fact that in Madrid nearly 20% of the population was already infected by November speak of the failure of its government to contain the epidemic.

Author Contributions

MV Zunzunegui wrote the first draft of the letter. F García López, MA Royo and I Cienfuegos contributed with new statements, editing and references to the final letter.

Declaration of Interest

Dr Zunzunegui, Dr García López, Dr Royo-Bordonada and Dr Cienfuegos have nothing to disclose.