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

We have read with great interest the comment written by Candel et al. [1] about how Madrid developed an integral management to overcome COVID-19 pandemic's second wave in august-october. However, this analysis requires some clarifications.

First, both Basic Health Zones (BHZ) perimeter lockdowns and antigen test introduction were implemented once COVID-19 incidence rate was already going down. By performing a joinpoint regression analysis to compare the confined BHA and those with high incidence that were not, we found that, in both cases, the change in trend occurred before the entry in force of these measures [2].

Second, the lack of additional public health measures aimed at radically cutting transmission led Madrid to a sustained levels of COVID-19 transmission defined as “high risk” [3] with over 150 cases/100000 inhabitants 14-day incidence rate since mid-August, and a continuous high hospital occupancy and Intensive Care Units occupancy rate. This placed the health services in a very weak position to face the third pandemic wave, and might have deteriorated and delayed the attention to other pathologies different from COVID-19 [4].

Finally, after eleven months of COVID-19 pandemic, Madrid continues to have an ineffective contact tracing system, being one of Spain's regions with less tracing capability (only 16•7% cases are currently being traced) [5].

The COVID-19 pandemic is leaving us many lessons. A more comprehensive public health approach is needed to tackle the impact of COVID-19 syndemic on previous and new health and social inequities. The knowledge acquired has to be used to transform public health response structures, and that in Madrid does not seem to have been done.

Declaration of Competing Interest

All the authors disclose non conflict of interest.