Around a thousand tourists who are staying at a hotel in Tenerife, in Spain’s Canary Islands, have been placed in isolation after an Italian guest tested positive for the Covid-19 coronavirus, police sources said on Tuesday. The H10 Costa Adeje Palace is located in Adeje, in the south of the island.

The patient is a tourist who hails from Lombardy, in northern Italy, which has seen a recent spike in coronavirus cases. He has been hospitalized at a medical center in the south of Tenerife, the news agency Efe reported. The man is a doctor by profession, and requested to be tested for the coronavirus after presenting symptoms such as a fever. He had spent a week in the hotel, along with his wife.

This was the third known case of the coronavirus in Spain, although the other two patients have already been discharged after being quarantined at hospitals in La Gomera (Canary Islands) and Mallorca (Balearic Islands). A fourth case was confirmed on Tuesday afternoon in Catalonia, by the regional health authorities. The patient is reported to be a 36-year-old Italian woman.

By Tuesday afternoon, a fifth case had been confirmed: the wife of the Italian man who was staying in the H10 Costa Adeje Palace. The patient has been isolated and is being treated in the Hospital de La Candelaria in Santa Cruz de Tenerife, Pedro Murillo reports.

Officers from the National Police were on Tuesday guarding the hotel, but sources from the Canarian health department were avoiding using the terms isolation or quarantine, instead focusing on the “health controls” being carried out on the guests, according to protocols.

The Spanish government has announced the creation of an Interministerial Committee on the Coronavirus, to be presided by Prime Minister Pedro Sánchez of the Socialist Party (PSOE). The first gathering will take place on Tuesday following the weekly Cabinet meeting.

A new scenario

The situation in Italy, its proximity to Spain and the numerous ties between both countries have created a new scenario for health authorities.

“This changes a lot of things, it’s the beginning of a new period,” said Pere Godoy, president of the Spanish Epidemiology Society. “Until now, the criteria for suspicion were simple: showing symptoms, and having spent time in [the Chinese province of] Hubei. It is now urgent to reformulate these criteria in a precise manner, and that’s going to be complicated because the situation in Italy is changing fast and because of the deep ties between both countries.”

The virus is very close, and there are few opportunities left to contain it Santiago Moreno, Ramón y Cajal Hospital

Experts from Spain’s major hospitals spent much of Monday trying to adapt to a situation that few had predicted would be changing so fast, so soon. “The first step now is to change the protocols and have contingency plans ready for whatever may come,” said Jesús Rodríguez Baño, head of the infectious diseases department at Virgen Macarena Hospital in Seville.

These contingency plans include elements such as “reinforcing teams, protection measures for personnel, defining the spaces reserved for suspicious cases in the ER, and having hospital rooms ready for admissions.”

Patient definition

But updating the protocols that determine who is a potential coronavirus patient is proving harder. On Monday, the advisory board of the European Center for Disease Control (ECDC) met in Stockholm in a bid to define the clinical criteria that should be followed across the EU to identify cases. But the board, made up of representatives of the public healthcare services of member states, failed to reach a consensus. “It’s still being debated and will be newly reviewed tomorrow or in the coming days,” said a source at the ECDC.

Antoni Trilla, head of preventive medicine and epidemiology at Barcelona’s Clínic Hospital, agreed that it is “urgent” to resolve this point in order to deal adequately with suspicious cases in the coming days.

The definition of what constitutes a case is the key tool Antoni Trilla, Clínic Hospital

“The definition of what constitutes a case is the key tool,” he said. “It tells us what symptoms and personal background (trips, contacts...) we should take into account to decide whether a patient is likely or not to be infected with the virus, and to adopt all appropriate measures.”

Spain’s Health Minister Salvador Illa has also mentioned “the meeting of experts” of the ECDC as a preliminary step for the central and regional governments of Spain to draft a new protocol.

In the meantime, hospitals have started to adapt their existing guidelines “case by case and prudently,” said a department head at another large hospital, speaking on condition of anonymity. “The [existing] protocol is now dated, it’s no use any more. You get patients coming from Milan, and what good is it to know whether they have been to China?”

Santiago Moreno, head of infectious diseases at Ramón y Cajal Hospital in Madrid, said that “the time has come to make firm, negotiated decisions because the virus is very close, and there are few opportunities left to contain it.”

English version by Susana Urra.