Downward phase of the pandemic
IGN (2021): 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
The downward phase of the COVID-19 pandemic lasted longer than the rising phase, i.e. from 21 March to 30 June 2020. The evolution of the main variables was brought under control after several weeks of strict lockdown, during which only professionals of essential activities were allowed to work and travel. It shall be borne in mind that Spain ranked second in the international context in terms of the amount of COVID-19 cases and the number of deaths from COVID-19 from the end of March to mid-April 2020.
The effects of the state of alarm and the subsequent lockdown proved effective in deterring the progression of the pandemic in Spain. These public health measures impacted society in many different ways, i.e. from the most obvious ones, such as tempering the negative effects on health and slowing down economic activity, to the more intangible ones, such as the mood of the population.
The highest amount of new COVID-19 cases was registered on 23 March 2020, when 8,444 new cases were recorded. From 1 April onwards, the fall was continuous. After 12 April 2020, the amount of new daily COVID-19 cases stood below 3,000. On 3 May, the amount of cases stood around 500. Lower figures were reached after early June 2020.
The cumulative regional incidence of COVID-19 cases per 100,000 inhabitants was consistent with the spatial patterns observed during the rising phase of the pandemic. The provinces of Castile and León (Castilla y León), e.g. over 1,500 cases per 100,000 inhabitants in Segovia and Soria, Castile-La Mancha (Castilla-La Mancha), e.g. over 1,000 cases per 100,000 inhabitants in Ciudad Real, Extremadura, Madrid, La Rioja, Biscay (Bizkaia), Navarre (Navarra), Huesca, Lleida and Barcelona showed figures well above the national average (362.5 cases per 100,000 inhabitants). In absolute terms, there was a significant rise in the amount of daily COVID-19 cases in the provinces of Madrid and Barcelona, where nearly 17,000 and 12,000 cumulative cases had been recorded by 31 March. By the end of June 2020, these figures had risen to 37,000 in Madrid and 32,000 in Barcelona. Biscay (Bizkaia), Navarre (Navarra), Valencia and Ciudad Real registered figures of around 5,000 cumulative cases during the first half of 2020.
Daily hospital admissions due to COVID-19 reached the highest levels from 21 to 31 March 2020, when over 5,000 admissions were registered every day. From 1 to 3 April 2020, figures stood around 3,000 hospital admissions per day. By 11 April 2020, these figures had been reduced to 1,000 hospital admissions/day, and by the last week of April they stood by 500. From then until late June, daily hospital admissions were below 200/100,000 inhabitants. A very high hospital admission rate due to COVID-19 was observed in the province of Barcelona and in the Spanish hinterland, with figures well above the national average (185.2 hospital admissions per 100,000 inhabitants). The provinces of Segovia, Cuenca and Ciudad Real stood out with over 500 hospital admissions per 100,000 inhabitants. In absolute terms, the provinces of Madrid and Barcelona registered 28,000 and 14,000 hospital admissions in total.
The evolution in the amount of admissions to Intensive Care Units (ICUs) due to COVID-19 peaked on 24 March, when 547 new patients were admitted to ICUs. From this date onwards, figures gradually decreased. On 9 April 2020, nearly 100 admissions were recorded every day. After 9 May, there were less than 10 admissions. The spatial patterns registered in the amount of patients admitted to ICUs is opposite to the spatial distribution observed in the total amount of hospital admissions due to COVID-19. The Northwest, the South and Aragón registered from 10 to 15%, whilst the national average stood by 7.6%. The high percentage registered in the province of Las Palmas shall be pointed out, where 23.0-26.9% of the total amount of patients in hospital due to COVID-19 were admitted to ICUs.
Deaths from COVID-19 registered the highest figures towards the end of March 2020, being 909 the highest amount of deaths registered in one single day. There was a slight drop during the first week of April (between 700 and 800 deaths per day). From 22 April onwards, figures stood below 400. During the first half of May, slightly over 100 deaths were reported every day. From 13 May onwards, figures stood below 100. Towards the end of June 2020 figures were close to ten deaths per day. In absolute terms, the provinces of Madrid and Barcelona registered 7,600 and 5,300 deaths during the first half of 2020. In relative terms, however, the provinces of Castile-La Mancha (Castilla-La Mancha) and the southeast of Castile and León (Castilla y León) registered the highest mortality rates due to COVID-19 (between 100 and 250 deaths per 100,000 inhabitants), whilst the national average stood by 58.9 per 100,000 inhabitants.
The Age-sex pyramid of the deceased from COVID-19 during the downward phase of the pandemic shows the increased vulnerability to COVID-19 of older age groups in both sexes. Women showed higher fatality rates during this period than in the previous phase, especially in the older cohort (over 90 years of age). In the case of men, a higher incidence was observed in groups from 75 to 89 years of age. The amount of deaths in young adult population was very low. From a spatial point of view, a sharp contrast was shown between the North and the South in relation to the amount of deceased over 80 years of age. Galicia, Asturias, Cantabria, the Basque Country (Euskadi/País Vasco), Castile and León (Castilla y León), Aragón and Catalonia (Catalunya/Cataluña) registered figures above the national average (62.6%). The province of Ourense showed the highest percentage: 80% of the deceased were over 80 years of age.
In short, the older age-sex pyramid in northern Spain meant a higher amount of deaths from COVID-19.
The phases in which the analysis of the first wave of the pandemic has been divided is based on the amount of COVID-19 cases registered, i.e. First COVID-19 cases shows data from the beginning of the crisis until 8 March 2020; Rising phase includes data from 9 to 20 March 2020; Downward phase runs from 21 March to 30 June 2020. Data on the amount of COVID-19 cases were downloaded from the National Epidemiological Surveillance Network website in October 2020. Data on other variables were not available for download at that date, so a specific request had to be made for this publication to the National Epidemiological Surveillance Network. It shall therefore be noted that “all results are provisional and shall be interpreted with care as they only furnish evidence of the information available at the time these data were provided”. For the analysis of COVID-19 cases, the amount of cases by symptom onset date as well as the province of residence have been taken into account as follows: “the symptom onset date has been used from the start of the pandemic up to 10 May. From 11 May onwards, when the symptom onset date is not available, the diagnosis date minus 3 days is used in general, and the diagnosis date itself is used if no symptoms are perceived” (National Epidemiological Surveillance Network). Hospital admissions due to COVID-19 as well as admissions to ICUs were registered according to the diagnosis date and province of residence. When the diagnosis date is not available, the date of declaration to the regional authorities is used. Deaths from COVID-19 refer to the date of death. Were this date not available, the date of declaration to the regional authorities or the diagnosis date was used. For all variables and phases shown, data are cumulative for the date represented, given the difficulty to display daily data on the scales used.
Seven weeks after the state of alarm coming into force, the Spanish National Government enacted the Downscaling Scheme at the Cabinet Meeting on 28 April 2020. The Ministry of Health published an Order on 3 May 2020 implementing the Downscaling Scheme based on a ‘co-governance’ or shared government decision-making process amongst the National Administration and the Regional Authorities.
The Downscaling Scheme aimed at “achieving the gradual recovery of daily life and economic activity, whilst keeping public health as a benchmark, in order to minimise the risk of the epidemic and prevent the capacities of the National Health System from being overwhelmed”. The transition to ‘new normal life’ was to be carried out following three basic guidelines, i.e. gradualness, asymmetry and adaptation. Gradualness was shaped on the aforementioned downscaling phases which were progressive. Asymmetry referred to the fact that this process was to be carried out by means of different agreements amongst the National Government and the various Regions. Adaptation referred to eventual changes to be introduced depending on epidemiological indicators.
The decision for a territory to upgrade from one downscaling phase to the next was taken by the National Minister of Health together with the regional authorities of the territory. This entailed at least one bilateral meeting between the national Ministry of Health and the regional authorities responsible for each territory. Regional governments were to submit their proposals for upgrading one week in advance and should include mandatory reports describing the epidemiological situation in their territory. This included a list of measures to be taken if being upgraded, as well as an analysis on the capacity of the regional health system to cope with an eventual rise in the amount of new COVID-19 cases. Basic features of the different downscaling phases are shown on the maps and graphs.
Phase 0 or getting prepared for downscaling. Common easing measures for the whole country were accepted, allowing for out-of-home mobility mainly in the private sphere, as well as implementing measures on activities with little or no risk of infection provided that security instructions were followed. All public places were provided with visual signs and protective measures during this phase. Some small islands [Formentera in the Balearic Islands (Illes Balears) and La Gomera, El Hierro and La Graciosa in the Canary Islands (Canarias)] were allowed to upgrade to phase 1 during this period taking into account that hardly any new COVID-19 cases were being registered in these territories.
Phase 3 or advanced phase. General mobility was allowed. However, the use of masks was recommended in public transports and on the street. Shops, restaurants and bars were to limit their capacity to 50% and social distancing of at least two metres was to be respected.
At least two weeks were to be spent in each phase, and upgrading from one phase to the next depended on specific indicators.
Co-authorship of the text in Spanish: Carmen Bentué Martínez, María Caudevilla Lambán, Carlos López Escolano, Raúl Postigo Vidal, María Sebastián López and María Zúñiga Antón. See the list of members engaged
Adaptation of the text and translation into English for this international version: Andrés Arístegui Cortijo (Translator in chief)