more infections than the place where the epidemic began.
Political inaction, the fabric of Spanish society and a historical background of deep cuts to public health budgets have allowed the outbreak to grow at alarming rates.
As the coronavirus spreads with lethal haste around the world, Rafael Bengoa insists the same phenomenon is repeating itself in Spain and other countries: politicians are reacting late to scientific advice.
“It is called denial of normalcy – refusing to believe that something is happening. It is the same now as happened in London 150 years ago,” Mr Bengoa, a former adviser to Barack Obama and the World Health Organisation and a health minister in the Basque regional government, tells The Independent.
“We all acted late – in Spain, Italy, and China when the virus first hit.”
On 6 March, a report from Spain’s Health Emergency Coordination Centre warned the government of the dangers of the spread of the virus as deaths were mounting in nearby Italy.
At this point, there were 280 cases and four deaths in Spain.
The report said: “The way of transmission between humans is similar to other coronavirus types, through secretions from infected people principally by respiratory drops which can be transmitted at distances of up to two metres, on hands or contaminated material from the mouth, nose or eyes.”
Among those involved in compiling the report was Fernando Simon, the health emergency coordinator, who on Monday tested positive for coronavirus. The report came two days before tens of thousands took part in huge marches across Spain to mark the International Women’s Day on 8 March. The same weekend scores of football matches took place, and the far-right party Vox staged a large rally.
Despite its findings, Spain’s left-wing coalition government refused to ban the public gatherings.
Pedro Sanchez, the prime minister, tweeted at the time: “We are with you on this fight to win equality between women and men. Without rest. Without feminism there is no future, without equality there is no democracy.”
Since then two cabinet ministers who joined the Women’s Day march have been diagnosed with the pathogen.
Last week, Victor Valladares, a Spanish lawyer, launched a case against Mr Sanchez in the Supreme Court, claiming he is guilty of administrative malfeasance for allowing the public gatherings in defiance of advice from another report from the European Centre for Control of Diseases. The court has yet to decide on the case.
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An independent scientific inquiry is to be launched into whether this decision might have proved reckless.
“Most people are critical of the decisions of those days. In a month from now an independent expert panel must be set up. I believe then we will have the elements and learn exactly what happened. At present we must concentrate on managing the crisis,” says Mr Bengoa.
Despite the unrelenting fatalities, he applauds the Spanish government’s strategy, which he believes will bear fruit in about 10 days when it reaches the peak of the crisis.
“Spain has not changed its policy. This is important. Other countries like the US have zig-zagged with policy,” Mr Bengoa said.
He insists another factor which explains the country’s high infection rate is how Spaniards live.
“In Sweden, 60 to 70 per cent of people live alone whereas in Spain only 20 to 30 per cent live on their own. Most live with extended family, which also helps the spread of the virus.”
Mr Sanchez announced a state of emergency on 14 March, which meant the country’s 46 million citizens could only leave their homes to see a doctor, buy food, for emergencies or to go to work.
However, as the grim death toll rose day by day, Mr Sanchez introduced tougher restrictions from Monday, confining all but essential workers to their homes until 9 April.
Alex Arenas, an epidemic modeller at the Universitat Rovira i Virgili in Tarragona, is among 70 scientists who has called for tougher measures of confinement in an open letter published last week.
“We have been so badly affected because we acted too late, and because of all the links with Italy.
“Valencia played a football match against Atalanta, for example, a club from the area in Italy [Lombardy] which was worse affected. Lots of Erasmus students returned from Italy to Spain. And when the government closed the schools in Madrid, lots of madrilenos went to their cortijos (country houses). It was a combination of factors.”
Doctors and nurses have complained they are hampered because the Spanish health service is overwhelmed. The lack of testing kits, protective clothing for medical staff and a paucity of beds in intensive care units are the result of years of cuts in Spain’s public health service, say experts.
After the 2008 financial crash, Spain was only able to stave off a full bailout from international lenders by making deep cuts to public services, including health and education.
Intensive care specialists in Spanish hospitals tell The Independentthat units are overwhelmed with a high volume of patients being admitted but without the resources to cope.
“The Spanish health system is not designed in terms of buildings, human resources and material to deal with so many patients at a time,” said Dr Juan Garcia, an intensive care specialist at La Paz Hospital in Madrid.
Spain is one of Europe’s most devolved countries where regional governments provide healthcare. At least six of the 17 regions are at the limit of intensive care beds and three more are close to it, according to the Spanish health ministry. The Ifema exhibition centre in Madrid has been reconverted into a field hospital to house 5,000 patients and others are being built.
Nearly 15 per cent of all those infected in Spain – almost 13,000 people – are among the 646,000 health professionals, making treating patients even more difficult.
Against this background, deep cuts in healthcare budgets in recent years have reduced the capacity of Spain’s public health system to cope.
In 2009, Spain spent 6.8 per cent of GDP on health provision but this had fallen to 5.9 per cent by 2018, the last year figures were available.
“There is little doubt that the cuts over successive years have left Spain’s public health system less able to deal with a global crisis like this,” says Manuel Franco, a professor of epidemiology at the University of Alcala de Henares and Johns Hopkins University in the US.
“When something like this happens, you are starting from behind. It is not very different from what has happened in the UK after cuts to the NHS.”
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