The new year starts on January 1, but in Spain, with its long and unusual Christmas holidays, it doesn’t really get going until January 7, once the Three Kings have departed. On January 7, 2020, the lower house of parliament, the Congress of Deputies, swore in Pedro Sánchez as prime minister. That same day, in China, scientists discovered what was causing strange cases of pneumonia in the province of Hubei: a virus similar to the one that caused SARS, a disease that rocked a number of Asian countries in 2003 and disappeared several months later. The script for 2020 changed forever. Back then, no one could have imagined what was soon to arrive: from the biggest pandemic the world has seen in generations, to a vaccine created in record time to eradicate it. It’s been a year of masks, lockdowns, social distancing, PCR tests and curve-flattening. A year when we could no longer hug one another.
January. A far-off threat
On January 7 no one outside specialist circles was paying much attention to the virus. While it would emerge later that China was hiding evidence that it could be transmitted from person to person, at the time it was thought that it could only move from animals to people. The wet market in Wuhan was closed as a likely source of the outbreak, and from then on, it was thought that there would be no further problems. Several days after the genetic code of the virus was sequenced, it was made public so that other countries could prepare PCR tests to identify it. China, on paper, was being swift and transparent, in contrast to its approach to SARS, when its secrecy delayed a solution to the problem for months.
Everything changed on January 20. And from then on events took place at a vertiginous speed. On that day, China admitted that the virus could be passed from human to human. That turned the strategy for dealing with it upside down. The country was still only officially recognizing 300 cases and six deaths, but the potential for the damage it could cause was now being looked at in a different light – in particular within the borders of the Asian giant. Practically no one at that point was considering the possibility of a pandemic. Three days later, China locked down the city of Wuhan. The virus became front-page news in all newspapers, and – apart from a few moments of respite – would stay there until now.
Millions of people were locked in their homes, unable to leave their city. The world looked on incredulous at what was happening. “This would be unthinkable in a democratic country,” analysts said over and over again. While the World Health Organization (WHO) was debating whether or not to declare an international emergency, something it had only done on five occasions in the 20th century, in Spain the news began to spark interest given that 23 Spaniards who lived in Wuhan were trying to return to their home country. On January 24, Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts (CCAES), made his first statement. He was not a completely unknown figure, given that he was the spokesperson during the 2014 ebola crisis in Spain, but practically no one remembered him.
Almost casually, Simón announced that there had been two suspected cases that were being analyzed. But that tests had come back negative and that Spain would be vigilant for the virus. On January 30, the WHO declared an international emergency and on January 31 Spain’s National Microbiology Center in Majadahonda detected the first positive case. It was a German citizen who was on vacation in the Canary Island of La Gomera. That day, Simón uttered a phrase that will likely follow him around for the rest of his life: “Spain will not have, at the most, more than a few cases diagnosed.”
February. The virus spreads across the world
Silently, the virus was already spreading throughout the globe. While there was only a handful of infections outside of China, later it would emerge that the coronavirus was preparing the ground to explode and become a pandemic, something that the WHO did not recognize until March 11.
February was the month that the Mobile World Congress in Barcelona was canceled, despite the indignation of local administrations and the surprise of the majority of epidemiologists. It was also the month when the virus ripped through Italy. The epidemic was no longer thousands of kilometers away, but rather just hundreds. But in Spain it still felt very far away. “This couldn’t happen to us,” many citizens thought, backed by a government that was trying to convey a sense of calm and that delayed a number of decisions because the virus was, in theory anyway, under control.
But you can’t detect something if you’re not looking for it. Spain had a very limited capacity to carry out tests, meaning that the definition of a case was still very restricted. It was a fish that was eating its own tail – more tests could not be carried out, without more tests more cases could not be detected, and without more cases there was supposedly no need to take drastic measures.
March. The state of alarm
March began with a steady stream of cases, all of them apparently under control. The turning point came on March 8. The central government had opted not to cancel large events, and sports matches, political rallies and demonstrations continued as if nothing had changed. While the 8-M feminist marches – which were attended by many high-profile politicians from the Socialist Party (PSOE)-Unidas Podemos coalition government – were the focus of much media attention and criticism afterward, they were just one of the events that went ahead that weekend. And, given what we now know about how the virus is transmitted, they were not exactly the most dangerous.
But what changed on that day had little to do with these crowds. On the same afternoon, the CCAES received a report from the Madrid region – in Spain, each of the regional governments is in charge of its own healthcare system. That week, the region reported, the number of positive cases had been rising at a steady rate, and on that very Sunday, 234 had been confirmed in a single day. This information was not made public until the next day, and it was the first thing that prompted the central Health Ministry to suspect that the epidemic was out of control.
The health minister, Salvador Illa, made a statement the next day to recommend that citizens did not make unnecessary journeys. And the Madrid region opted to suspend classes in schools and universities. The CCAES did not see the point in this latter measure, given that it would prompt the movement around the country of students and teachers, and would count for little without suspending the rest of the country’s activity.
Preparations began for a decree that would be approved by the Cabinet on March 14, 24 hours after the prime minister made a televised address announcing that a state of alarm was imminent. By that point, the atmosphere in the Spanish capital was already strange. Children weren’t going to school and a lot of companies had already introduced working from home.
On March 14, a state of alarm that would last 98 days began, seeing most of the country’s population confined to their homes for around two months. That night also saw the first round of applause for healthcare workers, a nightly practice that would last for even longer.
But the lockdown was insufficient. The country’s hospitals were already close to being overwhelmed and if more drastic measures were not taken the tragedy would be even greater. That was what prompted Pedro Sánchez, advised by a group of scientists, to hibernate the economy completely, and allow only essential activity to continue. This phase began on March 29, and lasted for 15 days. The last day of that month, Spain saw the highest number of infections reported in this first wave: 9,222, a completely unreal number not just due to the delay in notifications from hospitals but also because around that time it has been estimated that only one in 10 infections were being officially recorded. But it was symbolic: this was the day that the curve was flattened. Two weeks of confinement had done their job, but there was a long road still ahead.
April. Hospitals and senior homes overwhelmed
While new cases had reached their peak and deaths would do so shortly after (950 Covid-related fatalities were reported on April 2), the distress in hospitals and care homes would still continue for weeks. There was a lack of personal protective equipment (PPE), staff, beds and respirators. The state of alarm had arrived in time for most of the regions, and they were able to attend to everyone who needed it. But this was not the case in Madrid, Catalonia, the Basque Country and some cities in Castilla-La Mancha and Castilla y León.
In these locations triage was necessary in order to deal with the sickest patients, and thousands of seniors, in particular in Madrid, were left abandoned to their fate in residences. It was still difficult to conceive the painful toll that the virus would take in senior homes, which were one of the main focal points of the crisis and uncovered structural problems in the system.
Up to mid-November, more than 24,500 died in social services residences (including homes for the disabled) with either confirmed Covid or compatible symptoms. In the first wave, many of these victims did not receive the medical attention they needed, and were unable to say goodbye to their relatives. What’s more, their carers were ever fewer as they also came down with the illness.
This was also the month of one of the symbols of the pandemic: face masks. Until then, international organizations did not consider them to be essential, partly because at that point the virus was unknown and also, to a great extent, demand for the items was having a drastic effect on supply.
Given the possibility that healthcare workers would run out of masks (something that happened), the authorities opted not to recommend their use. But on April 8 the European Center for Disease Control (ECDC) admitted that they could be useful to prevent infections. Two days later, Health Minister Illa recommended their use on public transport and in the workplace, a measure that would soon become obligatory in all public places.
But while the situation was extreme in hospitals in the month of April, there were also the first rays of hope on the horizon. The lockdown in Spain was one of the toughest in the Western world and was starting to take its toll. There were widespread calls for, at least, children to be allowed out after six weeks inside, something that was permitted from April 26. Youngsters could go out for an hour a day, accompanied by an adult, and only a kilometer away from their home. The deescalation process had got off to a timid start.
May. The deescalation
The Spanish government managed to secure the support it needed from other parties to prolong the state of alarm on a fortnightly basis, but it was becoming more and more difficult to do so. A team of advisors was working on the deescalation plan, which was being designed to get the country back to some kind of normality – or the new normality, as the prime minister would describe it. It was to be an asymmetrical and progressive plan that each region would implement according to the epidemiological situation and the pressure on local hospitals. Phase 1 of the plan would begin on May 11 apart from for four of the country’s islands: Formentera, El Hierro, La Gomera and La Graciosa. With no cases reported for some days, they turned into a testing ground a week beforehand.
With the deescalation process, conflict between some regional governments and the central administration broke out. Until then there had been differences and some tugs-of-war, in particular involving the Madrid region. But these were pushed aside due to the severity of the situation. When the worst was over, however, these differences became more and more evident.
Despite reports from her own health department that advised against it, the Popular Party premier of Madrid, Isabel Díaz Ayuso, flew up a flag that she still carries to this day, touting Madrid as a symbol of “freedom” in the face of the government’s restrictions, which she considered to be excessive. As the coronavirus data continued to improve, more and more regional governments called for the state of alarm to be lifted so that they could regain their powers and manage the situation for themselves.
June. The end of the state of alarm
While the deescalation was designed to end at the beginning of July, the lack of support and pressure from opposition parties and regions prompted the government to bring it to an end on June 22. That was the end of the state of alarm and a chance for the regions to take a step toward the new normality. Some restrictions remained in place, but there was a general relaxation when Spain registered eight cases per 100,000 inhabitants over thee previous 14 days, the lowest figure seen since the start of the crisis and one that has not been seen since then – by a long, long way.
July. The start of the second wave
As the measures were relaxed, so the cases began to rise. The second wave started to take shape, very slowly. At this point, as at the start of the pandemic, there was a trickle of cases being detected. The seed was planted among seasonal workers in Aragón, which became the first region that had to reverse the deescalation process, and then it was the turn of Catalonia. From that point all of the regions started to react to the rise in cases with tightened measures.
August. Nightlife is canceled
It seemed impossible to believe, but the situation began to get out of control once more. Without enough capacity for tracking and tracing, Spain was leading a second wave that was yet to arrive in other European countries. The focus was on youngsters and nightlife, prompting the Health Ministry and the regions to approve a raft of measures that included the closure of nightlife – something that remains in force today and is unlikely to be modified for several months yet.
September. Madrid, the epicenter of controversy
Madrid was both the epicenter of the pandemic in Europe and of controversy in Spain. With cases rising non-stop, regional premier Isabel Ayuso was unwilling to take drastic measures and so the central government opted to intervene. At a meeting between the Health Ministry and regional chiefs, a majority voted to impose more restrictive measures on mobility in areas where there were more than 500 cases per 100,000 inhabitants over a 14-day period, where the positivity rate of tests was in excess of 10%, and where the rate of intensive care unit (ICU) beds by Covid patients was above 35%. With these criteria, 10 municipalities in the region, including the capital, were forced to establish perimetral lockdowns among other limitations.
October. Measures, counter-measures and a new state of alarm
The curve was rising or falling depending on the region. Spain’s territories were approving ever-more-restrictive measures in order to slow the second wave, but as the month progressed the trend rose in nearly all of the country. The Health Ministry created a risk map, on which the majority of regions were soon in what was considered a level of extreme risk.
The central government was preparing the ground for a new state of alarm, and more and more regions were calling for the measure, which was finally approved on October 25. To avoid having to seek parliamentary support for it on a regular basis, as was the case in the first wave, this time it was put in place for six months. The effect was to give the regions the powers to limit mobility without risk of the move being challenged in the courts, as had already happened previously. It also permitted for a nighttime curfew, and limits on the number of people who could meet in social settings.
November. The vaccine arrives
In the fight against the second wave, which was seeing the number of infections and fatalities rise, there was some light at the end of the tunnel On November 16, Moderna announced that its coronavirus vaccine was 95% effective. Two days later, Pfizer did the same. And a week after that, Oxford-AstraZeneca confirmed its vaccine worked, albeit with a lower rate of success. It would be a question of weeks before regulatory bodies would give the green light to the vaccination program, which would start to take the world out of the nightmare that began in January.
December. A different Christmas and the first vaccinations
The process to approve the vaccines went quicker than anyone had imagined. In the first half of December, the immunizations began in some countries, such as the United Kingdom and the United States. But with the solution already underway, there were still some problems to be solved. The second wave was still threatening most of Europe, including Spain, and the critical Christmas holidays were approaching. These would provide the virus with its preferred ecosystem: social meetings, dinners in enclosed spaces and high mobility. To avoid a winter as complicated as the previous spring, governments got to work to come up with plans that would allow families to see one another, but with the biggest limits possible on such encounters.
Spain approved a general framework that could be modified by each region. Mobility was permitted to see family members and allegados, a term that caused considerable confusion. The curfew would be pushed back on the major dates of the holiday season and the number of people permitted to meet would be raised. But the virus continued to spread and many regions backtracked on the relaxation of measures. The consensus among experts was that after these dates the number of cases would rise. But few went as far as to predict by how much, in particular in the light of the discovery of a new, more infections strain of the virus in the United Kingdom.
The virus has spent the year surprising us. Everyone’s hopes are now on 2021, but there is still a way to go yet for the pandemic, and the next chapters are far from written.
Fourth coronavirus wave plateaus in Spain, but hospitals remain under pressure
The report released on Thursday by the ministry shows that the 14-day cumulative number of coronavirus cases per 100,000 inhabitants for the country as a whole remains high, at 232.55. But it barely rose three points on the day before, after two days with no change. The experts attribute this to the vaccination campaign and the ongoing social restrictions in most of the country, but they also warn that the situation in Spain is far from good – seven regions and the two North African exclave cities, Ceuta and Melilla, are at “extreme risk” levels, with an incidence above 250, and one in every five intensive care unit (ICU) beds is occupied by Covid-19 patients. Thursday’s report added 132 deaths to the official toll, which now stands at 77,496.
This wave can’t be compared with the previous ones and it appears to be stabilizing now
JESÚS MOLINA CABRILLANA, SPOKESPERSON FOR THE SPANISH SOCIETY OF PREVENTIVE MEDICINE, PUBLIC HEALTH AND HYGIENE
“Caution and prudence,” insists Daniel López-Acuña, a former director of emergencies at the World Health Organization (WHO). After more than a month that has seen the incidence rising – the curve started to go up on March 16 – the 14-day cumulative incidence has plateaued for the last week. On Monday it came in at 230, and by Thursday it had gone up by 2.55 points. “We are in a plateau phase, taking one step forward and one step back,” explains Toni Trilla, head of preventive medicine at the Hospital Clínic in Barcelona. “Perhaps the health system will not suffer so much and I hope that there is a consolidated fall, but we are a bit confused because this wave has not followed the pattern of other waves.”
Some epidemiologists point to the seven-day cumulative incidence, which also confirms the plateau. This data point has been hovering around 108 cases per 100,000 inhabitants in the last seven days, less than 50% of the 14-day figure. “If the seven-day incidence is below 50% of the 14-day incidence, that means that the curve is falling,” explains Jesús Molina Cabrillana, spokesperson for the Spanish Society of Preventive Medicine, Public Health and Hygiene. “This wave can’t be compared with the previous ones and it appears to be stabilizing now. In any case, if there is an uptick, it won’t be a big one. More than a week has now passed since Easter, which is when there could have been an increase in infections, and it is not expected to rise further.”
The speed of transmission of the virus in Spain – the R number, which measures on average how many people a person with the coronavirus infects – is also falling. On April 14, the last day for which there is data, the number had fallen below one for the first time in a month – that is the limit below which the health authorities say that the virus is under control. On that day, it came in at 0.98 – that’s to say, for every 100 positives, another 98 people will be infected. “It is good for this to continue like this,” explains López-Acuña. “But what should guide us is that, if we continue to have a plateau and incidences that are very high and intensive care units with such high occupation, we should be concerned.”
What is clear from the data is that the epidemiological situation varies greatly from region to region. Valencia, for example, is below 40 cases per 100,000 inhabitants, the lowest level in Spain. Galicia, the Balearic Islands and Murcia are also under 100. Madrid and Navarre, however, are as high as 400 cases per 100,000 inhabitants while the Basque Country exceeds 500 cases.
“The overcrowding of people can have a big influence,” explains epidemiologist Joan Caylà. The population density is not the same in Galicia as it is in the metropolitan area of Barcelona. In the case of the Valencia region, what they do very well there is contact tracing and that can be a determining factor for isolating cases and imposing quarantines.”
The toughness of the measures in place – each region can decide its own restrictions – and compliance with the rules, the experts say, constitute another of the determining factors that are seeing the epidemiological curves fluctuate. Valencia, for example, has taken very strict measures and is deescalating very slowly – bars have to close at 6pm, a restriction that is due to be lifted on Monday. Madrid, meanwhile, with an incidence that is 10 times higher, has been a lot laxer with restrictions. Restaurants, for example, are staying open until 11pm.
The experts also assume that the vaccination campaign has also played a key role in the progress of this wave, but there are several nuances here. With just 21.4% of the population so far protected with one shot of the Covid-19 vaccines being used in Spain, above all in the older age groups, the epidemiologists agree that the vaccine has not had such an influence on the infection curve, given that most of the new cases are being registered among young people who have not had the chance to get their shots yet. The big effect, they say, is in terms of the fall in deaths and hospitalizations, where age is a key factor. Vaccination “will have had an influence on the curve of infections,” explains Molina Cabrillana, “but where it has really contributed is with serious illness and mortality. There is currently not the kind of overloading [of hospitals] that we saw in November and January.”
Spain’s ICUs were facing this fourth wave from a starting point of high hospital occupation. On March 16, for example, 20% of beds were occupied by Covid-19 patients, and healthcare professions feared a wave of new cases after Easter week. However, admissions have not, for now, shot up. On Thursday, there were 2,283 coronavirus patients in a critical condition – that is 22.6% of the available ICU beds.
López-Acuña insists on the need for prudence in the current situation. “It is likely that the magnitude of the wave is not so pronounced because there is less mobility than at Christmas, fewer crowds and a segment of the population is protected [by vaccines]. But there are a few worrying elements: community transmission is not under control, and there is an ongoing high occupation of ICUs, with the most severe cases linked to the British strain, which leads to longer hospital stays.” This variant, which is more infectious and was first identified in England, has been predominant in Spain since March.
The experts all coincide with López-Acuña and call for the social restrictions in place and protection measures to be respected, and for people not to drop their guard ahead of time. “The impact on the healthcare system will have to fall if the speed of vaccination accelerates, but it will take time before we see this in terms of infections,” explains Trilla. The European Center for Disease Control (ECDC) has issued a recommendation stating that two people should be able to remove their masks in a closed space if both of them are vaccinated, as well as calling for a relaxation of quarantine and testing requirements for travel for those who have had their vaccine shots. Molina Cabrillana sees this as feasible, but Trilla and López-Acuña say that it is “premature” because it could convey a message of “false security,” and prompt an “excessive relaxation.”
As for the social restrictions, Trilla recommends “asymmetrical measures that are adapted to the scale of each region at any given time.” Molina Cabrillana is calling for people to “hold on a little longer, until we are below 50 cases per 100,000 [inhabitants].” López-Acuña, meanwhile, is insisting that “restrictions continue in closed spaces.” If there is one thing that all the experts consulted by EL PAÍS agree on, it is the major pending task: “Strict contact studies,” Caylà states.
Spain’s coronavirus incidence rate falls for the first time this year, but pressure on ICUs rises
The third wave of the coronavirus has pushed Spain to the breaking point. According to the Spanish Health Ministry’s latest report, released on Thursday, the country has started to flatten the curve of new infections, but it has done so at crisis levels, with pressure on hospitals, especially in intensive care units (ICUs), close to unbearable. This pressure continues to rise across almost all of Spain.
The last 10 months of the pandemic have shown that there is not one but various peaks in a wave. The first is the number of new infections. The second is the spike in hospital admissions, which tends to happen a week later, and takes a little longer to be reflected in ICU figures. The final peak, which indicates a change in trend, is the number of deaths. The Health Ministry added 515 fatalities to the official count on Thursday, a terrible toll that is likely to remain at these levels for days to come while Spain transitions from peak to peak.
The latest data indicates that Spain is starting to see the other side of the peak of new infections in the third wave. A week ago, the Health Ministry reported a record-high 44,357 new coronavirus figures. On Thursday, that figure fell to 34,899. It is also the first day this year that the national incidence rate has fallen: the 14-day cumulative number of cases per 100,000 inhabitants now stands at 890, down from 900 on Wednesday.
Hospital admissions fell for the first time this year on Wednesday, with the percentage of Covid-19 patients in hospital wards dropping to 24.10%, down slightly from 24.03% on Tuesday. This data point fell again on Thursday, although the drop was again only marginal. But pressure continues to mount in Spain’s ICUs, which are the last line of defense of the healthcare system. If they are overwhelmed, authorities may be forced to introduce tougher restrictions, such as home confinement. Making matters worse, the pressure on ICUs is rising amid the uncertainty over how the emergence of new, more contagious strains of the coronavirus, such as the B.1.1.7 variant detected in the United Kingdom, will impact the pandemic in Spain.
“According to the data we have, we can expect that it [the B.1.1.7 variant] will be the dominant one in Spain by the end of February or the first fortnight of March. This has some implications because the strain is more transmittable,” said Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts (CCAES), at a government press conference on Thursday. The health official previously said this would not happen until a later date.
Simón admitted that there are small areas in Spain where the new strain already accounts for 20% of cases, but said nationally this figure was “around 8%.” With respect to restrictions, the health official said that “the measures that must be taken” are the same for the new and old variants of the coronavirus. “More measures can still be implemented without modifying the state of alarm,” he said, in reference to the emergency decree that gives regional governments – which are responsible for managing the health crisis – the power to introduce measures such as perimetral lockdowns, but not home confinement.
The figures released on Thursday also do not reflect how the coronavirus situation differs between each of Spain’s 17 regions. Indeed, the fall in hospitalizations over the past two weeks is mainly due to improvements in two regions: Valencia (which, despite this, remains in a “very critical situation,” said Simón) and Catalonia, which reported 466 fewer occupied beds on Thursday than on Tuesday. In Castilla y León, Galicia and Andalusia, there continue to be more hospital admissions than discharges.
“There are 11 regions where the situation is stabilizing or on a downward trend, but this is not the same as a fall in the hospital occupancy rate. The pressure on hospitals will continue over the coming days,” said Simón.
Andalusia and Galicia, as well as Murcia and Valencia, are some of the regions that are being hardest hit by the third wave of the pandemic, with the situation even worse than what it was during the first wave.
The big problem continues to be in ICUs. On Thursday, the Health Ministry reported 97 more ICU admissions than on Wednesday, and no region has managed to clearly reverse the upward trend. In other words, the peak of ICU pressure is still to come. In more than half of Spain, Covid-19 patients occupy more than 40% of all ICU beds – a similar figure to all other diseases combined. In the Balearic Islands, Castilla y León and Extremadura, the occupancy rate is more than 40%; in Castilla-La Mancha, Catalonia, Madrid and La Rioja, it is more than 50%; and in Valencia, it is 63%, a record high not seen since April last year, during the first wave.
As experts warned, the source of the problem is that Spain entered the third wave – which started after the December 6 long weekend – before the second wave was over. This meant that the ICU occupancy rate of Covid-19 patients, which was below 15% in October when the number of new cases began to rise, was already at around 30% in some regions when the third wave hit.
Covid-19 vaccine doses going to waste in some of Spain’s regions due to unsuitable syringes
Spanish regions such as Andalusia, Catalonia and Madrid are wasting thousands of doses of the Pfizer-BioNTech Covid-19 vaccine by not injecting patients with the sixth dose contained in the vials. Since January 8, when the European Medicines Agency granted authorization, the five initial doses contained in the vials are now officially six, increasing the number of potential recipients.
But this change has not been exploited by a number of Spain’s territories, who are in charge of their own vaccination campaigns. Speaking on Thursday in the regional parliament, Andalusia’s health chief Jesús Aguirre admitted that this was the case. “You could take out up to five doses and there was a wee drop left, and that little bit is used to administer that sixth dose,” he said. “But we are talking about 20% more vaccinations.”
The Andalusian regional government has blamed the failure to use this dose on a “deficit of 0.1-millimeter syringes,” the type that is usually used to inject insulin or in pediatrics, and has promised to solve the issue. The extraction of the sixth dose is more difficult with the 0.2-millimeter syringes also being used to administer the vaccines.
Based on the information offered by Spain’s regions, it is impossible to calculate how much of the vaccine has been wasted. Catalonia, for its part, has admitted it is only using the sixth dose from “two-thirds” of the vials. The region has administered more than 165,000 doses of the Pfizer-BioNTech vaccine so far, which would suggest wastage of around 10,000 doses.
A similar situation is playing out in Madrid, which on Thursday announced the purchase of 280,000 syringes in order to take advantage of this sixth dose. This is a low amount, however, compared to the millions of suitable syringes that have been purchased by regions with a much smaller population, such as Murcia and the Balearic and Canary Islands. The Madrid region has stated that in “the majority of cases” it is managing to use the sixth dose, but it has offered little extra information.
Aragón, which purchased 1,870,000 syringes in September, says that it has managed to use “100% of the first five doses from each vial and 81% of the sixth, which is 97% of the total.” Castilla-La Mancha, meanwhile, puts the percentage at 90%, while Asturias, Castilla y León and the Basque Country opted not to provide figures when consulted by EL PAÍS. The rest of the regions, however, stated that the use of the sixth dose is widespread across their territories.
Meanwhile, Spain’s regions are having to improvise a response to news that politicians, retired health workers and relatives of medical staff are jumping the line and receiving the Covid-19 vaccine ahead of their time. Currently, Spain is still in the first stage of the vaccination campaign, which is focussing on senior home residents, their carers, front-line medical workers and adults with serious disabilities.
The Health Ministry and the country’s regions have been working on the vaccination plan since September, but the scheme has failed to adequately set out how the order of the vaccinations should be supervised, and whether there should be some kind of sanction or punishment for those who jump the line or indeed what to do with unused doses.
The excuses offered so far by those who have got the vaccine early range from “wanting to boost confidence” in the vaccination, to claims of making use of “leftover doses.”
EL PAÍS has requested information from the country’s health departments as to the measures being taken against these irregularities. The majority have not responded. Extremadura, Madrid and Navarre claim that they are observing protocols, while Valencia, La Rioja, Andalusia and the Basque Country explain that they are cross-referencing databases: anyone who is found to have been given the vaccine despite not being on the list of phase one recipients must offer an explanation.
Health Minister Salvador Illa said this week that “proper planning” must be put in place to avoid wasting injections, adding that any sanctions for breaking protocol are the responsibility of the regions. For now, none of Spain’s regional governments have confirmed whether or not they have levied sanctions against offenders.
No second dose
One decision that has been made, however, is that Valencia is opting not to administer the second vaccine dose to anyone who has jumped the line. This includes, for example, the Socialist Party (PSOE) mayors of the municipalities of El Verger, Els Poblets and Rafelbuñol, who were found to have skipped the protocol and were given the vaccines in senior homes.
The PSOE premier of the region, Ximo Puig, has taken the decision not to administer the second dose to the 150 to 185 people thought to have jumped the line. They will instead be fully vaccinated when it is their turn, he insisted.
But Fernando Simón, the director of the Health Ministry’s Coordination Center for Health Alerts (CCAES) and the government’s most visible face during the coronavirus crisis, criticized the approach. “I understand that people who were vaccinated when they shouldn’t have been should admit their responsibility,” he said when asked by reporters about the incidents. “But from my point of view, I believe it would committing two errors: vaccinating people ahead of time and not administering the second vaccine.”
The issue is whether it is worse to waste the first dose by not giving the second one 21 to 42 days later, as stipulated by the manufacturer, or to fully immunize those who jumped the line. The Pfizer-BioNTech vaccine needs two doses for the recipient to develop 94% immunity to Covid-19, according to clinical trials. The regional government has said that it respects Simón’s opinion but that this was “a matter of institutional credibility.” The aforementioned mayors who jumped the line have been suspended from the party and their local councils will be deciding whether or not they should be fired.
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