Putting resources into action

From National Atlas of Spain
Jump to: navigation, search

Logo Monografía.jpg

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.

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.


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


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.


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

↑ Top

Operation BALMIS


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.


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

↑ Top


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.