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Talk:Putting resources into action

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{{ANEEtiqueta|palabrasclave=covid-19, pandemiapandemic, covid19, camas en UCIIntensive Care Units beds, hoteles medicalizadosmedicalised hotels, fuerzas armadas en la pandemiaArmed Forces in the pandemic, Twitter|descripcion=Estudio cartográfico de los recursos movilizadosCartographic study of putting resources into action|url=valor}}{{ANEObra|Serie=Monographs from the National Atlas of Spain|Logo=[[File:Logo Monografía.jpg|left|50x50px|link=]]|Título=The COVID-19 pandemic in Spain|Subtítulo=First wave: from the first cases to the end of June 2020|Año=2021|Contenido=New content}}
{{ANENavegacionCapitulo (monografía COVID-19)|estructura=Estructura temática|seccion=[[The COVID-19 pandemic in Spain|The COVID-19 pandemic in Spain]]|capitulo=Putting resources into action}}
{{ANENavegacionHermanos|anterior=[[First COVID-19 cases]]|siguiente=[[Rising phase of the pandemic]]}}
 
The resources put into action to fight against the COVID-19 pandemic are hard to be quantified because of the many different stakeholders involved, the heterogeneity of the actions taken and their sometimes intangible nature; proof of the latter was the significant solidarity movement that took place during the hardest times of the first wave of the pandemic (see chapter on ''[[Solidarity initiatives | Solidarity initiatives]]''). This chapter focuses, however, on two aspects that may help understand the swift response of the public administrations to the extraordinary situation from March 2020. It first shows some indicators on the effort made in the health field as well as the experience at ''Lozano Blesa University Hospital'' in Saragossa (Zaragoza). Second, the text delves into how the Armed Forces participated in this deployment, what took place under Operation Balmis.
 
There is no reliable record of which new resources were put into action during the first wave of the pandemic aimed at fighting coronavirus and reducing its impact. Some decisive links in the process of building an effective response were for instance the financial efforts of the public administration, the initiatives that came from within society both individually and in groups, the dedication of the medical staff and the donations from companies.
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[[File:Logo MonografíaSpain_Evolution-in-the-number-of-ICU-beds-during-the-first-wave-of-the-pandemic_2020_map_18511_eng.jpg|left|thumb|300px|Map: Evolution in the number of ICU beds during the first wave of the pandemic. 2020. Spain. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Evolution-in-the-number-of-ICU-beds-during-the-first-wave-of-the-pandemic_2020_map_18511_eng.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Evolution-in-the-number-of-ICU-beds-during-the-first-wave-of-the-pandemic_2020_map_18511_eng.zip Data]. [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=s18511.s18511&s=2020-06-30&t=A02&view=map10 Interactive version].]] [[File:Spain_Beds-in-medicalised-hotels-during-the-first-wave-of-the-pandemic_2020_map_18514_eng.jpg|right|thumb|300px|Map: Beds in medicalised hotels during the first wave of the pandemic. 2020. Spain. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Beds-in-medicalised-hotels-during-the-first-wave-of-the-pandemic_2020_map_18514_eng.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Beds-in-medicalised-hotels-during-the-first-wave-of-the-pandemic_2020_map_18514_eng.zip Data]. [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=s18514.s18514&s=2020-06-30&t=A02&view=map10 Interactive version].]]
[[File:Logo Monografía.jpg|left|thumb|300px|Map: Beds in medicalised hotels during the first wave of the pandemic. 2020. Spain.]]
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A first indicator depicting the changes that took place in hospitals was the increased availability of beds allotted to Intensive Care Units (ICUs), which is shown by regions on the map ''[[:File:Spain_Evolution-in-the-number-of-ICU-beds-during-the-first-wave-of-the-pandemic_2020_map_18511_eng.jpg|Evolution in the number of ICU beds during the first wave of the pandemic]]''. There were 150% more ICU beds (excluding newborns) towards the beginning of April 2020 than in January 2020 in the public and private healthcare systems –including both beds with and without respirators–. After the peak of the first wave of the pandemic, a decrease was registered in early June; even so, there were 78% more ICU beds occupied at the end of the first semester of 2020 than at the beginning of the year.
 
[[File:Spain_Messages-on-twitter-in-solidarity-with-the-provisional-Hospital-at-Madrid-Trade-Fair_2020_statisticalgraph_18518_eng.jpg|left|thumb|300px|Statistical graph: Messages on twitter in solidarity with the provisional Hospital at Madrid Trade Fair. 2020. Spain.]]
Some other actions were also taken in order to increase the capacity to accommodate the growing number of infected people requiring hospital admission, e.g. field hospitals were built and hotel beds were medicalised as presented on the map on ''[[:File:Spain_Beds-in-medicalised-hotels-during-the-first-wave-of-the-pandemic_2020_map_18514_eng.jpg|Beds in medicalised hotels during the first wave of the pandemic]]'' pandemic that shows the results of this action, with a large amount of beds being made available in non-medical centres.
The resources put into action Regional authorities strove to fight against multiply the COVID-19 pandemic are hard capacity to be quantified because of the many different stakeholders involvedcare for patients requiring hospital admission. For example, the heterogeneity Region of Madrid set up the actions taken and their sometimes intangible nature; proof of the latter was the significant solidarity movement that took place during the hardest times facilities at Madrid Trade Fair as a provisional field hospital. The particular impact of the first wave of the pandemic (see chapter on Solidarity Actions)this territory shall be taken into account. This chapter focusesNearly 5, however000 patients were admitted and over 1, on two aspects that may help understand the swift response of the public administrations to the extraordinary situation 200 healthcare professionals worked from 23 March to 1 May 2020. It first shows some indicators on the effort made in the health Halls 5 and 7 at Madrid Trade Fair provisional field as well as the experience at Lozano Blesa University Hospital in Saragossa (Zaragoza). Second, the text delves into how the Armed Forces participated in this deployment, what took place under Operation Balmishospital.  There is no reliable record of which new resources were put into action during the first wave of the pandemic aimed at fighting the coronavirus and reducing its impact. Some decisive links in the process of building was also an effective response were for instance the financial efforts of the public administration, the intense solidarity movement based on social initiatives that came from within society both individually . Social networks served to connect demands and in groups, offers; details on the dedication flow of the medical staff and the donations from companies.A first indicator depicting the changes that took place messages on Twitter referring to solidarity deployed in hospitals was the increased availability of Intensive Care Unit (ICU) beds, which is this provisional hospital at Madrid Trade Fair are shown by regions on the map Evolution of ICU beds during the first wave of the pandemic. There were 150% more ICU beds (excluding newborns) towards the beginning of April 2020 than in January 2020 in the public and private healthcare systems –including both beds with and without ventilators–. After the peak of the first wave of the pandemic, a decrease was registered in early June; even so, there were 78% more ICU beds occupied at the end of the first semester of 2020 than at the beginning of the yeargraph.
[[Archivo:Espana_Mensajes-en-Twitter-solidarios-con-el-hospital-de-IFEMA_2020_graficoestadistico_18518_spa.jpg|left|thumb|300px|Gráfico estadístico: Mensajes en Twitter solidarios con el hospital de IFEMA. 2020. España.]]
Some other actions were also taken in order to increase the capacity to accommodate the growing number of infected people requiring hospital admission, e.g. hotel beds were medicalised and field hospitals were built as presented on the map on Beds in medicalised hotels during the first wave of the pandemic that shows the result of this action, with a large number of beds being made available in non-medical centres.
Regional authorities strove to multiply the capacity to care for patients requiring hospital admission. For example, the Region of Madrid set up the facilities at Madrid Trade Fair as a field hospital. The particular impact of the first wave of the pandemic on this territory shall be taken into account. Nearly 5,000 patients were admitted and more than 1,200 healthcare professionals worked from 23 March to 1 May 2020 in Halls 5 and 7 at Madrid Trade Fair.
There was also an intense solidarity movement based on social initiatives. Social networks served to connect demands and offers; details on the flow of messages on Twitter referring to solidarity deployed in this field hospital at Madrid Trade Fair are shown on the graph.
{{ANEAutoria|Autores= José Sancho Comíns}}
{{ANETextoDestacado|titulo=«LOZANO BLESA» UNIVERSITY HOSPITAL IN SARAGOSSA (ZARAGOZA)|contenido=This note is a brief summary of the experience at Lozano Blesa University Hospital in Saragossa (Zaragoza) which may be understood as an example of the situation in many hospitals in Spain during the first wave of the pandemic. This hospital covers a large healthcare area including a population heavily affected by COVID-19 as well as a large number of nursing homes. The COVID‘COVID-19 Group Group’ was created in January 2020 at this hospital and included professionals from Preventive Medicine, Occupational Risk Prevention, Emergency, Microbiology, Internal Medicine, Infectious Diseases and Intensive Care departments, together with representatives from the hospital medical and nursing management teams. This COVID-19 group Group drew up a Contingency Plan for the hospital, whose forecasts were soon largely exceeded. The first COVID-19 case was detected on 3 March 2020.
Special care was taken to ensure that the actions triggered were supported from both a human and a technical perspective. With regard to the former, the high level of professionalism of all health and non-health workers at hospital shall be highlighted: doctors, nurses, laboratory technicians, cleaning staff, technicians who control ventilation circuits and many other professionals worked double shifts, overtime, etc. Protective measures were increased at hospital. All possible scenarios as well as the protective equipment to be worn were defined. Special attention was paid to staff protection training. The so-called Extended Universal Precautions were extended to the entire hospital in order to protect other patients and hospital employees. The workflow was modified and professionals who had never worked together before started to form multidisciplinary teams: neurologists, allergists, haematologists, anaesthesiologists, etc. started to work side by side with internists and intensivists.
From a technical point of view, decisions were made based on new data received. The health system was not prepared for a phenomenon of such magnitude and so long-lasting. Nevertheless, efforts were multiplied to adapt the hospital structure, equipment and organisation. A new intensive care unit was built in record time. The Surgical Block surgical block was adapted to accommodate COVID-19 patients and non-COVID-19 patients, the inpatient area was reorganised with exclusive areas for COVID-19 patients, a separate circuit was set up in the emergency department for possible infected patients, etc..}}
{{ANEAutoria|Autores= María José Amorín Calzada}}
{{ANESubirArriba}}{{ANETextoEpigrafe|epigrafe=Operación BalmisOperation BALMIS}}
[[ArchivoFile:Espana_DatosSpain_GENERAL-generalesDETAILS-deOF-laTHE-OperacionBALMIS-BALMIS_2020_ilustracion_18554_spaOPERATION_2020_illustration_18554_eng.jpg|right|thumb|300px|IlustraciónIllustration: Datos generales de la Operación GENERAL DETAILS OF THE BALMISOPERATION. 2020. EspañaSpain.]]
La intervención de las Fuerzas Armadas (FAS) en la lucha contra la pandemia The intervention of the Armed Forces in the fight against the COVID-19 ha sido un ejemplo de lo que alguien pudiera llamar nuevas misiones de los Ejércitos y la Armada como instrumento clave en la resolución de cualquier tipo de pandemic under Operation Balmis was an example of the so-called ‘new missions’ of the Navy, the Army and the Air Force, as a key tool for solving all kinds of crisis. Realmente ésta y el resto de las misiones asignadas a la FAS no son nuevas ya que están perfectamente definidas en la LO The missions allotted to the Armed Forces were set forth in Spanish Organic Law 5/2005 de la Defensa Nacionalon National Defence, donde en su artículo 15.3, claramente se exponewhich states: «Las Fuerzas Armadas“The Armed Forces, junto con las Instituciones del Estado y las Administraciones públicastogether with the National Institutions and the Public Administrations, deben preservar la seguridad y bienestar de los ciudadanos en los supuestos de grave riesgomust preserve the security and well-being of citizens in case of serious risk, catástrofecatastrophe, calamidad u otras necesidades públicascalamity and other public needs, conforme a lo establecido en la legislación vigente»in accordance with current legislation. Sin embargo” However, aparte de las intervenciones de la Unidad Militar de Emergencias (UME) y del 43 Grupo del Ejército del Aire y puntualmente intervenciones menores de algunas unidadesthe first time that the Armed Forces took on this task was under Operation Balmis, la primera vez que las FAS en pleno asumen este cometido ha sido como parte del esfuerzo global de España para vencer a la as part of the effort to defeat COVID-19(except for interventions of the Military Emergency Unit and 43 Air Force Group as well as minor interventions by some other units in recent years). La Operación Operation Balmis, que ha contado con la participación de más de which involved over188.,000 militaresmilitary professionals, ha supuesto el mayor esfuerzo de las FAS en tiempo de paz de la historiawas the largest peacetime effort in the history of the Spanish Armed Forces.
El empleo de las FAS en la lucha contra la pandemia hay que enmarcarlo dentro del RD Spanish Royal Decree 463/2020 from 14 March 2020, de 14 marzoon the state of alarm, del estado de alarmawas the legal framework for involving the Armed Forces in the fight against the pandemic. En cuanto se recibieron las directivas políticas se decidió iniciar una operación militar al uso yAs soon as the political directives were received, por tanto, bajo la estructura operativa de las FASit was decided to launch a military operation conducted by the Armed Forces. El Mando de Operaciones y el Estado Mayor Conjunto iniciaron el planeamiento y, prácticamente de forma simultánea, la ejecución de la Operación The Operations Command and the Joint Chiefs of Staff began planning and simultaneously executing Operation Balmis, denominada así en honor del médico militar que en el siglo XIX llevó las vacunas de la viruela a América en una iniciativa imaginativa y eficaz. It was named after the Spanish military doctor who had the insight to effectively take the smallpox vaccine from Europe to the Americas in the 19th century.
Several factors were key to the success of Operation Balmis. The unit of command was adapted, the chain of command was simplified and procedures were streamlined from requests for assistance to their fulfillment. All available assets worked under the Operations Command, organised into five Component Commands: Land, Sea, Air, Emergency and Military Health. Even the operation logistics were centralised.[[File:Spain_Interventions-under-Operation-Balmis-by-location_2020_statisticalgraph_18378_eng.jpg|right|thumb|200px|Statistical graph: Interventions under Operation Balmis by location . 2020. Spain.]][[ArchivoFile:Espana_IntervencionesSpain_Evolution-dein-the-number-of-interventions-under-Operation-Balmis_2020_statisticalgraph_18516_eng.jpg|left|thumb|300px|Statistical graph: Evolution in the number of interventions under Operation Balmis. 2020. Spain.]][[File:Spain_Interventions-launder-OperacionOperation-Balmis-segunby-lugar_2020_graficoestadistico_18378_spatype_2020_statisticalgraph_18379_eng.jpg|right|thumb|200px|Gráfico estadísticoStatistical graph: Intervenciones de la Operación Interventions under Operation Balmis según lugarby type. 2020. Spain.]][[File:Spain_Evolution-in-the-number-of-disinfections-at-nursing-homes_2020_statisticalgraph_18517_eng.jpg|left|thumb|300px|Statistical graph: Evolution in the number of disinfections at nursing homes. 2020. EspañaSpain.]]
[[Archivo:Espana_Evolucion-de-las-intervenciones-de-la-Operacion-Balmis_2020_graficoestadistico_18516_spaRequests for support were forwarded directly to the Operations Command through the Government Delegates (the highest representatives of the national government in the different regions), who then forwarded them to the different ministries to manage the crisis. This support was validated, assigned and ordered in a systematic and simple process that allowed the requests to be fulfilled quickly.jpg|left|thumb|300px|Gráfico estadísticoBasically, four main areas of support were considered: Evolución de las intervenciones de la Operación Balmis. 2020logistics, health, security and infrastructures. EspañaThe most common tasks were disinfection, transfer of the sick, building field hospitals, transport of medical equipment by air and land, and presence to contribute to public security.]]
[[Archivo:Espana_Intervenciones-de-la-Operacion-Balmis-segun-tipo_2020_graficoestadistico_18379_spaThis last task was one of the first to be scaled down after the initial phase, as the population accepted the instructions for total mass lockdown.jpg|right|thumb|200px|Gráfico estadístico: Intervenciones de la Operación Balmis según tipoNevertheless, patrols were maintained to support the police in border controls and critical infrastructure security until the end of the Operation. 2020. España.]]
[[Archivo:Espana_Evolucion-de-las-desinfecciones-de-residencias-de-mayores_2020_graficoestadistico_18517_spaThe most delicate task for the soldiers was to transfer and guard the deceased in the temporary morgues set up during the period when the capacity of funeral services was overwhelmed.jpg|left|thumb|300px|Gráfico estadístico: Evolución de las desinfecciones de residencias de mayoresInitially, the Military Emergency Unit was in charge of this mission, which was later joined by other military professionals. 2020One of the most common and critical tasks were military interventions in nursing homes (5,301), given the vulnerability of this population and the great extent to which it was affected by the pandemic. EspañaInitially, major activities included disinfections (11,061), although civilian professionals were also trained during the final stages in this task and were able to take over from the military units.]]
La clave del éxito de la Operación residió en varios factoresTransport was another key requirement, pero sin duda un elemento esencial fueron las premisas que se adoptaron para su planeamiento y ejecución: unidad de mandoespecially in the early stages, la mayor simplificación posible de la cadena de mando y la agilidad de trámite de los apoyos desde las solicitudes de asistencia hasta su realizaciónwhen medical material was brought from China to Spain in military aircrafts. Todos los medios disponibles trabajaron a las órdenes del Mando de Operaciones (MOPS) estructurados en cinco Mandos Componentes (TierraAlso of major importance is the support given to food banks, Mar, Aire, Emergencias y Sanidad Militar), incluso la logística de la operación se centralizówhich used military means to distribute food to the most vulnerable layers of society.
Las solicitudes de apoyos, a través de los delegados del gobierno que las enviaban a los ministerios delegados para la gestión de la crisis, se adelantaban directamente al MOPS. Estos apoyos se validaban, asignaban y ordenaban en un proceso sistemático y a la vez sencillo que permitía la rápida ejecución de las peticiones. Se contemplaron básicamente cuatro grandes áreas de apoyo: logístico, sanitario, seguridad e infraestructuras. Al amparo de estas áreas se agruparon las tareas más habituales: desinfecciones, traslado de enfermos, construcción de hospitales de campaña, transporte de equipo sanitario por vía aérea y terrestre y presencia para contribuir a la seguridad. Esta última tarea fue de las primeras en reducirse, dado el grado de aceptación de las instrucciones de confinamiento por parte de la población; de todos modos, se mantuvieron patrullas de presencia para apoyar a las Fuerzas y Cuerpos de Seguridad del Estado hasta prácticamente el final de la operación en control de fronteras y seguridad de infraestructuras críticasAnother key aspect was the support for the assembly and operation of the provisional field hospitals at Madrid and Barcelona Trade Fairs.
La tarea más triste para los soldados fue el traslado y custodia de fallecidos a los depósitos temporales que hubo que habilitar por razón de queThe entire permanent military hospital network, en un cierto periodoincluding military hospitals in Madrid and Saragossa (Zaragoza), se desbordó la capacidad de los servicios funerarioswas devoted to the care of patients affected by coronavirus. En un principio la UME fue la unidad encargada de esta misión, uniéndoseProducts to combat the virus were produced at the Defence Pharmacy Centre, posteriormenteespecially masks, otros componentesonce the machines purchased in China were received. Las intervenciones en las residencias de mayores fueron una de las tareas más habituales (5Staff shortages in the Military Health Corps did not allow for more significant support in this field.301) y más críticasHowever, it was possible to make up for shortfalls in some parts of Spain; for example, through Galicia hospital ship belonging to the Spanish Navy in Ceuta and Melilla, dada la vulnerabilidad de nuestros mayores y la forma en que se vieron afectadas en los primeros momentos. Las desinfecciones fueron las actividades más solicitadas (11.061) aunque en los momentos finales también se formó en esta tarea a organismos civiles que podían tomar el relevo de unidades militareswhich enabled extending the hospital capacity of both towns.
El transporte es otra de las actividades a resaltar, especialmente en los primeros momentos cuando aviones militares participaron en el traslado de material sanitario desde China a territorio nacionalThe interventions of the Armed Forces under Operation Balmis took place in all Spanish regions. Es de destacar también el apoyo a los bancos de alimentos que emplearon medios militares para la distribución de comida a las personas más necesitadasThis was done without reducing the permanent missions of the Armed Forces and the international missions abroad. En la construcción de infraestructuras temporales sanitarias es preciso destacar el apoyo al montaje y la operación del hospital de campaña en IFEMA, en la Comunidad de MadridThe latter saw, y en el de la Feria de Muestras de Barcelona. En el capítulo de apoyo sanitariohowever, mencionar que toda la red permanente hospitalaria militar con los hospitales militares Gómez Ulla en Madrid y el Hospital General de la Defensa de Zaragoza dedicaron sus esfuerzos a la atención de pacientes afectados por el virus. En el Centro de Farmacia de la Defensa se elaboraron productos para la lucha contra el virus, sobre todo mascarillas una vez recibidas las maquinas adquiridas en China. La escasa dotación de las plantillas del Cuerpo Militar de Sanidad no permitió un apoyo más significativo en este campo, pero se pudieron suplir algunas deficiencias en algunos puntos de España con la presencia de buques de la Armada con capacidad hospitalaria, en concreto el Galicia estuvo atracado en Ceuta y en Melilla para suplementar la capacidad hospitalaria de esas dos ciudades autónomas. Las intervenciones de las Fuerzas Armadas en la Operación Balmis se produjeron en todo el territorio nacional sin distinción de comunidades autónomas, en un esfuerzo total por salvar vidas y aliviar el sufrimiento de la sociedad española. Es de destacar que se desarrolló sin merma de las misiones permanentes de las FAS ni de las misiones en el exterior. Estas últimas, vieron reducidos sus efectivos temporalmente al disminuir la actividad en sus lugares de despliegue por la temporary reduction in those involved as COVID-19reduced activity in their places of deployment. Nevertheless, pero la vigilancia marítima y la vigilancia y el maritime surveillance as well as airspace surveillance and control del espacio aéreo en territorio nacional no sufrieron menoscabo algunoin Spain were not affected. Para las Fuerzas ArmadasThe Armed Forces carried out their work under Operation Balmis, la Operación Balmis ha sido un enorme motivo de satisfacción porque ha permitido que desarrolle la función para la que están entrenados y especialmente cualificadosperformed the role for which they are trained and specially qualified, en apoyo directo al bienestar y la seguridad de la poblaciónand directly supported the well-being and security of the population.
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{{ANEAutoria|Autores= Miguel Ángel Villaroya Vilalta}}
{{ANESubirArriba}}
 
{{ANENavegacionHermanos|anterior=[[Primeros casos]]|siguiente=[[Fase ascendente de la pandemia]]}}
 
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