Extract - Analysis section (26-02-2021)

Analysis and prediction of COVID-19 for

European Union and other countries

Authors: Martí Català, Enric Álvarez, Sergio Alonso, Daniel López, Miquel Marchena,
Blas Echebarría, David Conesa, Pere-Joan Cardona, Clara Prats

With the collaboration of: Mª Cayetana López, Pablo Palacios, Tomás Urdiales,
Aida Perramon, Inmaculada Villanueva

A document prepared for

European Commission
Analysis: On the heavy burden carried by tourist destinations due to COVID-19. Vall
d’Aran (Catalonia, Spain) as a case study.
The epidemics evolution in touristic hot spot has been a topic of discussion during the whole epidemics. Small
countries with a high level of cross-country mobility like Luxembourg or Andorra had have periods of very
high incidence. Similarly, ski resorts and movement related to ski resorts are a key focus point of the
discussion regarding the type of measures needed to control the epidemics and its impact. For example,
France carried out border checks to stop skiers spreading COVID-19 in early December. The reason exposed
was that coronavirus clusters in Alpine resorts played key role in early spread of virus in Europe 1.
Ski resorts and, more generally, any other hot seasonal touristic spot can be a challenge in epidemiological
terms. This is specially so if we are not talking about large cities that act as hub between cities, but country-
side areas with low population that suddenly see outburst of incoming population. If general, low populated
regions and countries have a particular epidemiological dynamics, and a touristic hotspot even more so.
It is usual to use 14-day or 7-day cumulative incidences per 105 inhabitants as indicators, but these indicators
can become extremely sensitive and noisy when the reference population is low. If we consider a 10,000
inhabitants’ region, a 30-cases outbreak results on an incidence of 300 cases per 100,000 inhabitants, which
is above most risk thresholds. Besides, and more importantly, when these low-populated regions are popular
destinations, a holiday period can completely disturb its epidemiological situation.
Vall d’Aran, a low-populated county in Catalonia
Vall d’Aran is one of these low-populated regions that is a popular tourist destination in Catalonia (Spain),
both for local and foreign visitors. Vall d’Aran is located at the Pyrenees, adjacent to France (Figure 1). In
Summer, it is a mountain destination for hikers and families. In Winter, ski stations are the most important
attractions. Last Christmas holidays, ski stations were open in Catalonia. Mobility was restricted between
counties, but it was allowed if the destination was a hotel or a second residence.

Figure 1. Location of Vall d’Aran in Spain (left) and Catalonia (right)

Epidemiological evolution of the Vall d’Aran

The epidemiological situation of the Vall d’Aran county during the second and third waves is shown in the
following figures. We observe that, while Catalonia had a clear second and third wave in October and
December (black line in Fig. 2), the second wave in Vall d’Aran raised continuously over a long time, then it
dropped by late Novembre thanks to the application of measures, and then exploded again during January.

1
https://www.theguardian.com/world/2020/dec/02/france-will-carry-out-border-checks-to-stop-skiers-from-
spreading-covid

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Notice that we plot the 7-day cumulative incidence (Figure 2). Figure 3 shows the daily new cases in an
absolute values scale.

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Figure 2. 7-day cumulative incidence in Catalonia (black) and Vall d’Aran (red), from August to present.

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Figure 3. Number of cases of covid-19 smoothed by a seven-day average in the Vall d’Aran for the last six months.

Notice that the total number of daily cases is rather low. The increase until mid-November was never higher
than 6 cases per day. However, the large increase of cases in January is quite high given the characteristics
of the region. It is indeed a clear wave that, given the low population, raises faster accumulating one outbreak
after the other.
We want to compare now this evolution with the interaction of the county and ski resorts with the rest of
the country. It is key thus to analyze mobility data around the area to check if these outbreaks may have
anything to do with increases in mobility. In other words, we want to do an association analysis. Is the
increase in cases associated with higher mobility in and out of the area, or within the area? We must recall
at this point that association does not mean causality. We just want to know if Aran is just another of those
cases where an association exists. This is particularly important since after January 7th there was a municipal
lockdown. After February 22nd such confinement was relaxed, however any movement between counties
was still forbidden.
Mobility in the Vall d’Aran region
To analyze mobility, we are going to use data from Ministerio de Transporte, Movilidad y Agenda Urbana
(MITMA). They provide daily tracks of mobile phones, giving total number of trips from different “Movement

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Districts” and within ”Movement Districts” (MD). A MD is either a small city, a district in a large city, an area
with high population, or an aggregation of towns that are considered to be extremely connected. There is no
MD that corresponds exactly to Vall d’Aran county. However, two MD encompass a key area around the ski
resorts in Vall ‘Aran. They include all Vall d’Aran and the North of the Pallars Sobirà (a nearby county). They
all encompass a clear mobility unit given the structure of the roads and traffic. This area can be observed in
the map in Fig. 4. We will analyze mobility in this area.

Figure 4. Location of the county of Vall d’Aran and North

of the Pallars Sobirà (in black) in the map of Catalonia.

First, we show the difference between people staying overnight and people whose living address is in this
area (roughly 13,500).

Figure 5. Population staying in the region of Vall d’Aran and North of the Pallars Sobirà during the last year (blue) in
comparison with the people living there (in black).

Notice how during summer the population more than doubled. Surprisingly, it also almost doubled during
Christmas holiday. The other smaller increases in September and October correspond to 4-day weekends.
The relevant point is that during summer movement was allowed without restrictions but not during
Christmas, when county confinement was in place. This is, there were not allowed trips between counties
except for some very specific reasons. Given the increase in population we focus on the number of trips that
leaved or entered this MD. Given that the MD is between two counties we split those trips according to the
distance. We compute from the MITMA databases the number of trips that enter or leave the area but are
shorter than 50 km, and those longer than 50 km. Trips above 50km were clearly restricted.

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Figure 6. Evolution of the number of trips in and out the region per 10,000 inhabitants divided by short length (<50 km)
trips and large length trips (>50 km) in comparison with the evolution of the government restrictions.

It is very clear that daily county confinement was not forcefully implemented, and that mobility was very high
as if those measures did not exist. This increase in/out also produces an increase in total mobility, since the
number of trips within this area also increased significantly. In the figure below, we show both types of trips.
It is clear that an increase in the number of people in the area also increases the total activity.

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Trips In/out Area
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Figure 7. Evolution of the number of trips in and out (black line) and within (green line) the region per 10.000
inhabitants.

Relation between epidemiological situation and mobility in Vall d’Aran

We can now put two and two together and draw both total mobility and incidence to observe a clear
association between a large increase in mobility and large surge in cases that start increasing precisely one
week after mobility increases. This is precisely the expected delay time between contacts/infection and
symptoms/detection.

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 Mobility in Aran area and incedence in Aran. Second and third wave
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Figure 8. Evolution of the number of trips in the region per 10,000 inhabitants (orange line) and seven days incidence
per 10,000 inhabitants (blue line).

Conclusions
The situation of the epidemics in Vall d’Aran seemed completely controlled at the beginning of December
with zero cases for two weeks. A sudden increase in activity, associated with Christmas time and trips to
second-residences close to ski stations, coincide with a large increase in the number of cases. Public
information indicates that roughly 90% of cases appearing in the Vall d’Aran belong to the new variant
B1.1.1.7. Given the evolution of the epidemics, the most probable scenario is that this new variant entered
the region carried by tourists or visitors. This is, it is consistent with a situation with almost no cases of the
old variant, where then suddenly the new variant appears and becomes the only game in town.
Since the peak in Christmas, mobility came back to very low levels, with a worrying trend again at the
beginning of February. The largest peak has passed, but there have been secondary outbreaks. All in all, the
situation seems harder to be controlled precisely because of the high transmissibility of the new variant.
In any case, the persistence in the number of cases after Christmas can be explained by two different
hypotheses.
In the first hypothesis, the Christmas peak and the increase in mobility carried associated a level of relaxed
measures that have been sustained. So, the reason for the outbreak is not the peak in Christmas per se, but
a general relaxation of the population. The fact that the number of trips dropped dramatically after
Christmas puts in question this scenario. However, during February we are observing again an increase in
mobility, so this scenario cannot be completely ruled out.
The second hypothesis is that people from abroad not only brought the new variant but also generated a
cascade of outbreaks that started first at the local in-house level and then, through contacts, extended
through the local population in the following weeks. The double peak seen after New Year (and 6th of January,
the Three King’s day, local bank holiday in Spain) and then later in mid-late January.
We are not sure which one it is, but clearly the local contact tracing analyses can provide the answer.
In any case, Vall d’Aran is another example of an association between an increase in activity and in people
at a touristic attraction that previously presented a very low incidence of COVID-19, leaving behind an
extremely complicated situation. We think that an in-depth analysis of these cases is necessary in order to
set a clear public policy regarding highly touristic attraction.

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