Spain be­comes world’s hard­est-hit country be­hind Italy

The Washington Post - - THE CORONAVIRU­S PANDEMIC - BY PAMELA ROLFE AND LOVEDAY MOR­RIS loveday.mor­[email protected]­post.com Mor­ris re­ported from Ber­lin.

MADRID — Spain is now fac­ing the worst coro­n­avirus out­break in the world be­hind Italy, af­ter its re­ported deaths sur­passed China’s on Wed­nes­day.

Spain an­nounced 738 new deaths, tak­ing its to­tal to 3,434. That was the big­gest overnight jump any­where in the world and took Spain past the of­fi­cial tally of 3,285 deaths in China, where the global pandemic be­gan but where the rate of re­ported new in­fec­tions has ta­pered off.

Italy re­mains the world’s worsthit country, with more than 7,500 dead. Ital­ian au­thor­i­ties, though, in­di­cated Wed­nes­day that their out­break may have peaked, with the daily death toll dip­ping to 683 in the pre­vi­ous 24 hours.

In Spain, ex­perts an­tic­i­pate the sit­u­a­tion will get worse be­fore it gets bet­ter. That’s a daunt­ing prospect for the country’s over­stretched, ex­hausted health ser­vices.

“There are some hos­pi­tals which have al­ready col­lapsed,” said Oriol Mitjà, an in­fec­tious­dis­ease spe­cial­ist at Ger­mans Trias i Pu­jol Hos­pi­tal in Barcelona. “They have to make a de­ci­sion when to ad­mit a pa­tient to in­ten­sive care or not, and the cri­te­ria is mainly by age, so some el­derly peo­ple are not pri­or­i­tized.”

Mitjà said his team ex­pects the country’s in­ten­sive-care beds to be com­pletely filled by the end of the week.

Among those who have been hos­pi­tal­ized is Spain’s deputy prime min­is­ter, Car­men Calvo.

Span­ish tele­vi­sion has broad­cast im­ages of sick­ened pa­tients sleep­ing in hos­pi­tal cor­ri­dors, while staff com­plain that med­i­cal sup­plies are so low they’ve been forced to use plas­tic garbage bags as pro­tec­tion in­stead of gowns.

Madrid has been forced to turn an ice-skat­ing rink into a morgue to cope with the dead.

In one par­tic­u­larly macabre devel­op­ment, Span­ish sol­diers found the bod­ies of el­derly peo­ple aban­doned in nurs­ing homes.

The in­ten­sity of the out­break in Spain — which iden­ti­fied its first main­land coro­n­avirus case only a month ago — drives home the no­tion that Italy is no out­lier, epi­demi­ol­o­gists say. Across Europe, hun­dreds of mil­lions of peo­ple face se­vere re­stric­tions on their daily lives, as au­thor­i­ties at­tempt to bat­tle com­mu­nity trans­mis­sion. But some coun­tries, in­clud­ing Spain, have been crit­i­cized for be­ing too slow to in­ter­vene and to man­date so­cial dis­tanc­ing.

Span­ish au­thor­i­ties im­posed re­stric­tions on trips out­side the home a lit­tle un­der two weeks ago. While city streets are largely de­serted, and many com­pa­nies have asked em­ploy­ees to work from home, that is not man­dated, and com­muter trains are still run­ning, al­beit at 50 per­cent of their ser­vices.

“What has hap­pened in Europe, not just Spain, is we un­der­es­ti­mated this virus,” said Mitjà, who has pushed for a fur­ther tight­en­ing of the re­stric­tions on move­ment.

Health au­thor­i­ties have been scram­bling to add ca­pac­ity. This week, the mil­i­tary set up a pro­vi­sional hos­pi­tal with 1,300 beds at a Madrid con­ven­tion cen­ter in just 24 hours.

Spain has about 6,000 crit­i­cal­care beds, of which 3,166 are be­ing used to treat coro­n­avirus pa­tients, ac­cord­ing to Span­ish au­thor­i­ties. Hos­pi­tals have de­layed nonessen­tial surg­eries in an ef­fort to free up beds, but it is un­clear how many of those beds re­main avail­able.

Fer­nando Simón, who heads Spain’s co­or­di­nated emer­gency health re­sponse, said it is dif­fi­cult to de­ter­mine ex­actly where Spain is on the coro­n­avirus curve, but he ex­pects the peak of new cases is “very close.”

Still, he told health-care pro­fes­sion­als to brace them­selves, as there is a de­lay be­fore that peak is re­flected in the num­ber of pa­tients ar­riv­ing in hos­pi­tals. “We are in the tough week,” Si­mon said.

The Span­ish gov­ern­ment has faced par­tic­u­lar crit­i­cism for fail­ing to ban mass events as the virus took hold, es­pe­cially the de­ci­sion to press ahead with a 120,000per­son women’s march in Madrid on March 8.

“There were thou­sands” of women in at­ten­dance, said Mitjà. “That could have been the trig­ger and the rea­son why Madrid is the num­ber-one place af­fected. We did not work quick enough with con­trol strate­gies.”

Calvo, the deputy prime min­is­ter, had urged peo­ple to at­tend the march. Other high-pro­file at­ten­dees — in­clud­ing the prime min­is­ter’s wife, Be­goña Gómez, and two other fe­male min­is­ters — have since tested pos­i­tive.

Lock­down mea­sures in Spain have re­duced trans­mis­sion rates, Mitjà said, but they re­main high enough to sus­tain the virus, with each in­fected per­son pass­ing the virus on to an av­er­age of 1.7 peo­ple.

Covid-19, the dis­ease that de­vel­ops from the novel coro­n­avirus, is par­tic­u­larly dan­ger­ous for the el­derly and has swept through the country’s nurs­ing homes. The mil­i­tary took con­trol of all res­i­den­tial facilities this week, making chill­ing dis­cov­er­ies when they did so. In a tele­vi­sion in­ter­view, De­fense Min­is­ter Mar­garita Robles said sol­diers had found el­derly res­i­dents aban­doned by staff and left “dead in their beds.”

“We are go­ing to be ex­tremely firm with this kind of neg­li­gence,” she said.

But staff mem­bers have com­plained they do not have the proper pro­tec­tion to tend to the sick or move bod­ies. More than 22 peo­ple died at the Santa Horten­sia nurs­ing home in Madrid, ac­cord­ing to Span­ish me­dia re­ports.

The avail­abil­ity of such pro­tec­tive sup­plies has been a per­sis­tent com­plaint dur­ing the out­break.

“This is an over­whelmed sys­tem,” said Angela Hernán­dez Puente, deputy sec­re­tary gen­eral of the Madrid doc­tors union AMYTS. She said front-line med­i­cal work­ers had been “over­worked and overex­tended for weeks now.”

“They are an­gry,” she added. She said that two fam­ily physi­cians had died af­ter con­tract­ing the coro­n­avirus, and she ex­pected more deaths of med­i­cal work­ers to fol­low.

A group of na­tional med­i­cal as­so­ci­a­tions sent an open let­ter to Span­ish au­thor­i­ties Tues­day, de­cry­ing the lack of pro­tec­tive equip­ment.

“We health work­ers find our­selves in a sit­u­a­tion of com­plete in­se­cu­rity and lack of pro­tec­tion while con­duct­ing our du­ties of as­sis­tance and preven­tion . . . given the in­ad­e­quate and very risky health con­di­tions, and the lack of pro­tec­tive ma­te­rial and equip­ment sup­plies nec­es­sary to guar­an­tee the pre­cise safety of our­selves, as well as the pa­tients,” they wrote.

With the in­ter­na­tional med­i­cal mar­ket strug­gling to keep up with de­mand, coun­tries in Europe have turned to China for as­sis­tance. Spain’s health min­is­ter, Sal­vador Illa, an­nounced Wed­nes­day that the country had pur­chased $467 mil­lion in med­i­cal sup­plies from China, in­clud­ing 950 ven­ti­la­tors, 5.5 mil­lion test­ing kits, 11 mil­lion gloves and more than half a bil­lion pro­tec­tive face masks.

Ac­cord­ing to the Span­ish Health Min­istry, about 14 per­cent of those who have tested pos­i­tive are med­i­cal work­ers. Spa­niards gather on their bal­conies at 8 p.m. each evening to ap­plaud the country’s health and se­cu­rity ser­vices.

Hernán­dez said she was sur­prised other coun­tries were not act­ing more de­ci­sively. Pres­i­dent Trump has said he wants to see the United States “opened up” by Easter, with the churches full.

“There are coun­tries that, even when given the clear case of what’s happening in Spain, are not learn­ing the lessons,” she said.

PAU BARRENA/AGENCE FRANCE-PRESSE/GETTY IM­AGES

A sol­dier stands amid beds set up in a tem­po­rary hos­pi­tal in Barcelona. Spain over­took China in to­tal fa­tal­i­ties on Wed­nes­day as Span­ish au­thor­i­ties an­nounced 738 new deaths from the coro­n­avirus.

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