Following the declaration of the state of emergency, Spain ordered one of Europe’s strictest lockdowns. Travel is restricted to the absolute minimum, gatherings are banned and the majority of stores have been forced to close. Spaniards are allowed to leave their homes for a limited number of reasons, but as these relate only to essential purchases, to work for those unable to work from home and to pets that need to be taken out, children ended up housebound altogether. Children are, in fact, seen as risky drivers of contagion, and were forced to stay at home for a period that eventually exceeded one and a half months. The radical nature of this measure and the psychological effect it may have in the long run are the subject of considerable debate in Spain. It is no coincidence that the first easing of measures announced in mid-April relate in particular to children, who can now leave their homes for up to one hour a day.
The "best healthcare system in the world"?
Under the state of emergency, all civil and military, public and private health resources are to be made available to the Ministry of Health. Private companies in possession of medical and personal protection equipment were given 48 hours to notify national authorities of their stock. The army and its "Military Emergency Units" were immediately dispatched to disinfect places at risk, to contribute to the erection of field hospitals, or to evacuate corpses.
The mobilization of Spanish society in support of the national effort is symbolized by several emblematic actions. As of March 25, Real Madrid’s stadium has been transformed into a storage space for corporate donations to the healthcare system. The head of the Inditex Group (Zara) made nearly €62 million available for the purchase of medical equipment. As in other European countries, the textile and automobile industries are adapting their production lines to produce much-needed personal protection equipment and ventilators. To compensate for the lack of space in Madrid’s hospitals, the city’s Exhibition Center has been converted into a field hospital. In spite of this widespread mobilization, however, hospitals are utterly overwhelmed. Inresponse to the shortage of intensive care beds and ventilators, the Spanish Society of Intensive and Critical Care Medicine (SEMICYUC) published an ethical guide to help intensive care units choose which patients to treat. Medical staff in Spain are among the most affected in Europe: on April 10, a study revealed that healthcare personnel represent at least 15% of confirmed cases and that 19,000 doctors and nurses had tested positive since the beginning of the epidemic.
To make up for the dearth of equipment, the Spanish government set up an air-bridge with China at the end of March. The Spanish Ministry of Health concluded a €430 million contract with Chinese suppliers for the provision of 550 surgical, FFP1 and FFP2 masks, 5.5 million test kits and 950 artificial ventilators. Notwithstanding the central government’s good intentions, the autonomous communities that have been hit hardest accuse it of poorly distributing the equipment and criticize its inability to transfer patients to the least-affected regions. A scandal also erupted after some of the test kits and masks purchased in China proved to be defective.
In an opinion article published in the New York Times, journalist and writer David Jimenez argues that overconfidence in Spain’s healthcare system - considered to be among the best in the world - partly explains the country’s difficulty coping with the crisis. Spain does have the highest life expectancy at birth in Europe, one of the most egalitarian systems and a much higher number of doctors per inhabitant than the OECD average. But the level of its public health expenditure as a proportion of GDP (8.9%) is well below the European average (9.8%). Hospitals appear to be the biggest victims of this underinvestment: the number of hospital beds per 1,000 inhabitants is also below the EU average, and there were 9.7 intensive care beds per 100,000 inhabitants before the crisis, compared to 16.3 and 33.9 units in France and Germany respectively. In the view of David Jimenez and that of other commentators, the overload of Spain’s healthcare system is a direct result of the years of austerity that followed the last financial crisis.
An economic and social crisis response
Though a Spanish recession is inevitable, the kingdom intends to do its utmost to prevent the economy from falling into a situation comparable to that of 2008. The IMF projects that Spain, previously expected to see growth of 1.2% in 2020, is likely to experience an 8% decline in GDP this year before recovering to a 4.3% growth rate in 2021.