Difference between revisions of "Talk:Putting resources into action"

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{{ANEEtiqueta|palabrasclave=covid-19, pandemia, covid19, camas en UCI, hoteles medicalizados, fuerzas armadas en la pandemia, Twitter|descripcion=Estudio cartográfico de los recursos movilizados|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}}
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{{ANEEtiqueta|palabrasclave=covid-19, pandemic, covid19, Intensive Care Units beds, medicalised hotels, Armed Forces in the pandemic, Twitter|descripcion=Cartographic 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}}
 
{{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}}
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{{ANENavegacionHermanos|anterior=[[First COVID-19 cases]]|siguiente=[[Rising phase of the pandemic]]}}
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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.
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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 Monografía.jpg|left|thumb|300px|Map: Evolution in the number of ICU beds during the first wave of the pandemic. 2020. Spain.]]
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[[File:Spain_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].]]
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[[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.
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[[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.]]
  
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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.
  
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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 provisional 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 over 1,200 healthcare professionals worked from 23 March to 1 May 2020 in Halls 5 and 7 at Madrid Trade Fair provisional field hospital.
he 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 Actions). 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.  
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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 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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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 provisional hospital at Madrid Trade Fair are shown on the graph.
A first indicator depicting the changes that took place in hospitals was the increased availability of Intensive Care Unit (ICU) beds, which is 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 year.
 
  
[[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}}
 
{{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-19 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 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.
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{{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-19 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 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.
 
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 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.
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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 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.
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}}
 
{{ANEAutoria|Autores= María José Amorín Calzada}}
 
{{ANEAutoria|Autores= María José Amorín Calzada}}
{{ANETextoEpigrafe|epigrafe=Operación Balmis}}
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{{ANESubirArriba}}
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{{ANETextoEpigrafe|epigrafe=Operation BALMIS}}
  
[[Archivo:Espana_Datos-generales-de-la-Operacion-BALMIS_2020_ilustracion_18554_spa.jpg|right|thumb|300px|Ilustración: Datos generales de la Operación BALMIS. 2020. España.]]
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[[File:Spain_GENERAL-DETAILS-OF-THE-BALMIS-OPERATION_2020_illustration_18554_eng.jpg|right|thumb|300px|Illustration: GENERAL DETAILS OF THE BALMIS OPERATION. 2020. Spain.]]
  
La intervención de las Fuerzas Armadas (FAS) en la lucha contra la pandemia 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 crisis. Realmente ésta y el resto de las misiones asignadas a la FAS no son nuevas ya que están perfectamente definidas en la LO 5/2005 de la Defensa Nacional, donde en su artículo 15.3, claramente se expone: «Las Fuerzas Armadas, junto con las Instituciones del Estado y las Administraciones públicas, deben preservar la seguridad y bienestar de los ciudadanos en los supuestos de grave riesgo, catástrofe, calamidad u otras necesidades públicas, conforme a lo establecido en la legislación vigente». Sin embargo, 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 unidades, la primera vez que las FAS en pleno asumen este cometido ha sido como parte del esfuerzo global de España para vencer a la COVID-19. La Operación Balmis, que ha contado con la participación de más de 188.000 militares, ha supuesto el mayor esfuerzo de las FAS en tiempo de paz de la historia.
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The intervention of the Armed Forces in the fight against the COVID-19 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. The missions allotted to the Armed Forces were set forth in Spanish Organic Law 5/2005 on National Defence, which states: “The Armed Forces, together with the National Institutions and the Public Administrations, must preserve the security and well-being of citizens in case of serious risk, catastrophe, calamity and other public needs, in accordance with current legislation.” However, the first time that the Armed Forces took on this task was under Operation Balmis, 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). Operation Balmis, which involved over
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188,000 military professionals, was 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 463/2020, de 14 marzo, del estado de alarma. En cuanto se recibieron las directivas políticas se decidió iniciar una operación militar al uso y, por tanto, bajo la estructura operativa de las FAS. El Mando de Operaciones y el Estado Mayor Conjunto iniciaron el planeamiento y, prácticamente de forma simultánea, la ejecución de la Operación 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.
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Spanish Royal Decree 463/2020 from 14 March 2020, on the state of alarm, was the legal framework for involving the Armed Forces in the fight against the pandemic. As soon as the political directives were received, it was decided to launch a military operation conducted by the Armed Forces. The Operations Command and the Joint Chiefs of Staff began planning and simultaneously executing Operation Balmis. 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.
  
[[Archivo:Espana_Intervenciones-de-la-Operacion-Balmis-segun-lugar_2020_graficoestadistico_18378_spa.jpg|right|thumb|200px|Gráfico estadístico: Intervenciones de la Operación Balmis según lugar. 2020. España.]]
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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.
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[[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.]]
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[[File:Spain_Evolution-in-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.]]
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[[File:Spain_Interventions-under-Operation-Balmis-by-type_2020_statisticalgraph_18379_eng.jpg|right|thumb|200px|Statistical graph: Interventions under Operation Balmis by type. 2020. Spain.]]
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[[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. Spain.]]
  
[[Archivo:Espana_Evolucion-de-las-intervenciones-de-la-Operacion-Balmis_2020_graficoestadistico_18516_spa.jpg|left|thumb|300px|Gráfico estadístico: Evolución de las intervenciones de la Operación Balmis. 2020. España.]]
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Requests 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. Basically, four main areas of support were considered: logistics, health, security and infrastructures. The 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_spa.jpg|right|thumb|200px|Gráfico estadístico: Intervenciones de la Operación Balmis según tipo. 2020. España.]]
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This 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. Nevertheless, patrols were maintained to support the police in border controls and critical infrastructure security until the end of the Operation.
  
[[Archivo:Espana_Evolucion-de-las-desinfecciones-de-residencias-de-mayores_2020_graficoestadistico_18517_spa.jpg|left|thumb|300px|Gráfico estadístico: Evolución de las desinfecciones de residencias de mayores. 2020. España.]]
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The 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. Initially, the Military Emergency Unit was in charge of this mission, which was later joined by other military professionals. One 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. Initially, 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 factores, pero sin duda un elemento esencial fueron las premisas que se adoptaron para su planeamiento y ejecución: unidad de mando, la mayor simplificación posible de la cadena de mando y la agilidad de trámite de los apoyos desde las solicitudes de asistencia hasta su realización. Todos los medios disponibles trabajaron a las órdenes del Mando de Operaciones (MOPS) estructurados en cinco Mandos Componentes (Tierra, Mar, Aire, Emergencias y Sanidad Militar), incluso la logística de la operación se centralizó.
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Transport was another key requirement, especially in the early stages, when medical material was brought from China to Spain in military aircrafts. Also of major importance is the support given to food banks, which 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 críticas.
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Another 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 que, en un cierto periodo, se desbordó la capacidad de los servicios funerarios. En un principio la UME fue la unidad encargada de esta misión, uniéndose, posteriormente, otros componentes. Las intervenciones en las residencias de mayores fueron una de las tareas más habituales (5.301) y más críticas, 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 militares.
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The entire permanent military hospital network, including military hospitals in Madrid and Saragossa (Zaragoza), was devoted to the care of patients affected by coronavirus. Products to combat the virus were produced at the Defence Pharmacy Centre, especially masks, once the machines purchased in China were received. Staff shortages in the Military Health Corps did not allow for more significant support in this field. However, 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, which 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 nacional. Es de destacar también el apoyo a los bancos de alimentos que emplearon medios militares para la distribución de comida a las personas más necesitadas.
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The interventions of the Armed Forces under Operation Balmis took place in all Spanish regions. This was done without reducing the permanent missions of the Armed Forces and the international missions abroad. The latter saw, however, a temporary reduction in those involved as COVID-19 reduced activity in their places of deployment. Nevertheless, maritime surveillance as well as airspace surveillance and control in Spain were not affected.
 
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The Armed Forces carried out their work under Operation Balmis, performed the role for which they are trained and specially qualified, and directly supported the well-being and security of the population.
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 Madrid, y en el de la Feria de Muestras de Barcelona. En el capítulo de apoyo sanitario, 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 COVID-19, pero la vigilancia marítima y la vigilancia y el control del espacio aéreo en territorio nacional no sufrieron menoscabo alguno.
 
 
 
Para las Fuerzas Armadas, la Operación Balmis ha sido un enorme motivo de satisfacción porque ha permitido que desarrolle la función para la que están entrenados y especialmente cualificados, en apoyo directo al bienestar y la seguridad de la población.
 
  
 
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[[Archivo:Espana_Intervenciones-de-la-Operacion-Balmis_2020_mapa_18461_spa.jpg|left|thumb|300px|Mapa: Intervenciones de la Operación Balmis. 2020. España. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Intervenciones-de-la-Operacion-Balmis_2020_mapa_18461_spa.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Espana_Intervenciones-de-la-Operacion-Balmis_2020_mapa_18461_spa.zip Datos]. [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=s18461.s18461&i2=c13023.c13023&t=A02&t2=A02&view=map9 Versión interactiva].]]
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[[File:Spain_Interventions-under-Operation-Balmis_2020_map_18461_eng.jpg|left|thumb|300px|Map: Interventions under Operation Balmis. 2020. Spain. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Interventions-under-Operation-Balmis_2020_map_18461_eng.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Interventions-under-Operation-Balmis_2020_map_18461_eng.zip Data]. [//interactivo-atlasnacional.ign.es/index.php#c=indicator&i=s18461.s18461&i2=c13023.c13023&t=A02&t2=A02&view=map9 Interactive version].]]
 
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[[File:Spain_Geographical-footprint-of-the-Armed-Forces-under-Operation-Balmis_2020_map_18380_eng.jpg|left|thumb|300px|Map: Geographical footprint of the Armed Forces under Operation Balmis. 2020. Spain. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Geographical-footprint-of-the-Armed-Forces-under-Operation-Balmis_2020_map_18380_eng.pdf PDF]. [//centrodedescargas.cnig.es/CentroDescargas/busquedaRedirigida.do?ruta=PUBLICACION_CNIG_DATOS_VARIOS/aneTematico/Spain_Geographical-footprint-of-the-Armed-Forces-under-Operation-Balmis_2020_map_18380_eng.zip Data].]]
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Latest revision as of 13:11, 2 June 2022


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The COVID-19 pandemic in Spain. First wave: from the first cases to the end of June 2020

Monographs from the National Atlas of Spain. New content


Thematic structure > The COVID-19 pandemic in Spain > Putting resources into action

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). 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.

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 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.

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 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.

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 provisional 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 over 1,200 healthcare professionals worked from 23 March to 1 May 2020 in Halls 5 and 7 at Madrid Trade Fair provisional field hospital.

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 provisional hospital at Madrid Trade Fair are shown on the graph.



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Co-authorship of the text in Spanish: José Sancho Comíns. See the list of members engaged


«LOZANO BLESA» UNIVERSITY HOSPITAL IN SARAGOSSA (ZARAGOZA)

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-19 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 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 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.

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Co-authorship of the text in Spanish: María José Amorín Calzada. See the list of members engaged


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Operation BALMIS

Illustration: GENERAL DETAILS OF THE BALMIS OPERATION. 2020. Spain.

The intervention of the Armed Forces in the fight against the COVID-19 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. The missions allotted to the Armed Forces were set forth in Spanish Organic Law 5/2005 on National Defence, which states: “The Armed Forces, together with the National Institutions and the Public Administrations, must preserve the security and well-being of citizens in case of serious risk, catastrophe, calamity and other public needs, in accordance with current legislation.” However, the first time that the Armed Forces took on this task was under Operation Balmis, 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). Operation Balmis, which involved over 188,000 military professionals, was the largest peacetime effort in the history of the Spanish Armed Forces.

Spanish Royal Decree 463/2020 from 14 March 2020, on the state of alarm, was the legal framework for involving the Armed Forces in the fight against the pandemic. As soon as the political directives were received, it was decided to launch a military operation conducted by the Armed Forces. The Operations Command and the Joint Chiefs of Staff began planning and simultaneously executing Operation Balmis. 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.

Statistical graph: Interventions under Operation Balmis by location . 2020. Spain.
Statistical graph: Evolution in the number of interventions under Operation Balmis. 2020. Spain.
Statistical graph: Interventions under Operation Balmis by type. 2020. Spain.
Statistical graph: Evolution in the number of disinfections at nursing homes. 2020. Spain.

Requests 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. Basically, four main areas of support were considered: logistics, health, security and infrastructures. The 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.

This 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. Nevertheless, patrols were maintained to support the police in border controls and critical infrastructure security until the end of the Operation.

The 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. Initially, the Military Emergency Unit was in charge of this mission, which was later joined by other military professionals. One 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. Initially, 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.

Transport was another key requirement, especially in the early stages, when medical material was brought from China to Spain in military aircrafts. Also of major importance is the support given to food banks, which used military means to distribute food to the most vulnerable layers of society.

Another key aspect was the support for the assembly and operation of the provisional field hospitals at Madrid and Barcelona Trade Fairs.

The entire permanent military hospital network, including military hospitals in Madrid and Saragossa (Zaragoza), was devoted to the care of patients affected by coronavirus. Products to combat the virus were produced at the Defence Pharmacy Centre, especially masks, once the machines purchased in China were received. Staff shortages in the Military Health Corps did not allow for more significant support in this field. However, 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, which enabled extending the hospital capacity of both towns.

The interventions of the Armed Forces under Operation Balmis took place in all Spanish regions. This was done without reducing the permanent missions of the Armed Forces and the international missions abroad. The latter saw, however, a temporary reduction in those involved as COVID-19 reduced activity in their places of deployment. Nevertheless, maritime surveillance as well as airspace surveillance and control in Spain were not affected. The Armed Forces carried out their work under Operation Balmis, performed the role for which they are trained and specially qualified, and directly supported the well-being and security of the population.

  • Map: Interventions under Operation Balmis. 2020. Spain. PDF. Data. Interactive version.
  • Map: Geographical footprint of the Armed Forces under Operation Balmis. 2020. Spain. PDF. Data.


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Co-authorship of the text in Spanish: Miguel Ángel Villaroya Vilalta. See the list of members engaged



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You can download the complete publication The COVID-19 pandemic in Spain. First wave: from the first cases to the end of June 2020 in Libros Digitales del ANE site.

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