How Spain’s coronavirus outbreak got so bad so fast?

Spain saw a huge leap of almost 5,000 infections in the past 24 hours, placing it in third place in the global ranking of infections behind China and Italy.

Health authorities said on Saturday that the number of people who have tested positive for the pathogen reached 24,926, up from 19,980 the day before. The death rate soared to 1,326, up from 1,002 on Friday.

At least 1,600 patients are in intensive care, health authorities said, admitting that these units are working at their limits.

Madrid is the region with the highest number of infections, with at last 9,000 people testing positive.

Spain has spent a week under a state of emergency in which free movement is tightly restricted. People can only leave their homes to buy food, seek health care, for emergencies or to go to work in essential industries.

Fernando Simón, the Spanish health emergency coordinator, admitted that the authorities expect infections to get worse before the drastic measures can reverse the trend.

He said that in some Madrid hospitals, doctors working in intensive care units were inundated with so many patients that they had to be “a little more selective” about which ones to treat first — as has happened in Italy.

Intensive care units in the Spanish capital were working at double the normal capacity, regional health authorities said.

The Spanish Navy had to intervene in a residential home in Cadiz in southern Spain after 20 members who were looking after the elderly residents were diagnosed with coronavirus.

Care homes for the elderly have been particularly badly hit by the outbreak, with the pathogen claiming at least 80 lives at ten residences across the country.

Spain plans to extend its state of emergency for another 15 days, Prime Minister Pedro Sanchez announced Sunday, as the number of Covid-19 deaths soars in the country.

Sanchez addressed citizens in a televised briefing on Sunday, after meeting with health and security officials.

He said he expected Parliament to approve his request to lengthen the order, which has been in place for over a week.

It comes with the country’s death toll from the virus accelerating. The country’s health ministry said on Sunday that another 394 had died in just the past 24 hours, bringing the total number of confirmed fatalities to 1,720.

Spain now has the world’s fourth-largest Covid-19 outbreak and is second only to Italy in all of Europe. To stop the spread, the government — slow at first to respond to the crisis — imposed a country-wide lockdown last Saturday.

Now the life Hietsch built is on hold. To pass the time, she meditates, does yoga, and chats with her three American roommates. She used to run up and down the building’s stairs for exercise — a neighbor’s young daughter would sometimes cheer her on — but other tenants just put up a sign asking her to stop.

Hietsch’s new normal is fine for the moment. Other than missing her boyfriend, she makes turmeric lattes for her roommates and online videos for her students.

The sudden change, though, remains jarring. “It’s been one of the oddest weeks of my life,” she told me.

It’s similarly odd for the rest of the nearly 50 million people in Spain, where one-fifth of the population is over 65 and thus at increased risk of “getting very sick” from Covid-19, according to the CDC.

Not only does everyone in Spain have to stay inside, but also they have to live with police and drones patrolling the streets to keep pedestrians at home. They have to put up with an uneasy, rare silence. And they have to watch one of Europe’s best health care systems struggle to treat patient after patient.

“What makes me most angry is that we had a month and a half to get ready after our first case, and we had weeks to prepare after watching what’s happened in Italy,” said Ángela Hernández Puente, a top official at a health labor union in Madrid, the country’s outbreak epicenter.

The problem is that Spain’s long-standing political, economic, and historical problems are making a coherent response difficult.

The politics alone are daunting. Prime Minister Pedro Sánchez, weak after forming a minority government, likely didn’t want to risk his fragile hold on power by banning large gatherings, experts say. Instead, he allowed thousands to attend soccer games last week, as well as permitted a 120,000-strong feminist rally in Madrid to proceed.

Hietsch was at that demonstration. “I regret going,” she told me, fearing it may have accelerated the spread. “I’ve felt anxiety ever since that I could be a carrier of the disease.” So far, though, she’s healthy.

The crisis has now reached even the highest levels of Spanish power. On March 14, Begoña Gómez — the wife of the prime minister — tested positive for coronavirus. That news came after two government ministers also contracted the disease. As a precaution, Sánchez does his best to keep away from others as he works and conducts press conferences over a video link. Even Semana Santa (Holy Week) — one of the country’s most cherished traditions and religious ceremonies — had to be canceled for the first time since 1933.

What’s especially worrying is that Spain isn’t an anomaly. Like Italy, it’s a grim warning of what’s to come in countries around the world, including the United States, if their governments don’t act aggressively or quickly enough to confront the crisis. In that sense, Spain is a glimpse into much of the world’s new normal.

“Nobody is ready for this,” Evangelina Martich, a health policy expert at the University of Carlos III in Madrid, told me.

The Spanish government confirmed the nation’s first case of coronavirus on January 31 in the Canary Islands, which lie to the west of Morocco. That same day, Spaniards evacuated from Wuhan, China — where Covid-19 first emerged — arrived in Madrid. Nine days later, another case was reported, this time on the island of Mallorca.

The first positive cases of coronavirus on the Spanish mainland came on February 26, including in both Madrid and Barcelona, the country’s two most important cities. It was then that the heads of Spain’s largest public hospitals told the Health Ministry “more tests had to be done, and as soon as possible.”

“The [health care] system was not prepared for the seriousness of what was coming,” a doctor in a southern Spanish hospital told El País newspaper this week. “Up until at least a week ago, we weren’t able to do a PCR [a diagnostic test] for coronavirus without asking for authorization. I could order a PCR for the flu, but not for the coronavirus.”

Even today, large hospitals, including ones in Madrid, can’t process more than 400 tests a day. “We would like to test everyone but with the diagnostic capability and number of kits we have, that is not possible,” Rafael Cantón, the microbiology chief in the city’s Ramón y Cajal hospital, also told El País.

Cinta Moro, a doctor in the southern city of Seville, believes the lack of foresight and planning doomed Spain from the start. “With tests, we would’ve stopped a lot of the problems we have now,” she told me.

But it wasn’t just a testing failure, it was a cultural and political failure, too.

Those I spoke with noted two aspects of the Spanish lifestyle that complicated the public’s own response. First, the country has a deeply embedded late-night culture, with everyone staying out late to hang out at bars or simply eat dinner. Second, a paranoia stemming back to Spain’s decades-long dictatorship created a palpable friction between the public and law enforcement.

The result was that few in Spain felt compelled to change their ways despite signs of chaos. “The Spanish character is not to believe a crisis is coming,” Moro said. “Once you see people die, that’s when you react — but by then it’s too late.”

Government inaction didn’t help. As mentioned above, Prime Minister Sánchez refused to stop large gatherings like soccer matches and political rallies from proceeding. Some experts I spoke to said that allowing so many people to congregate almost surely spurred a larger outbreak. But Martich, the health policy expert at the University of Carlos III, cautioned that it’s too early to know if that’s truly the case.

Still, it was only last week that the Spanish government really ramped up its response as the number of cases and deaths rose. It shut down the soccer league, closed schools, and asked people to stay home. But even then, people I spoke to said few took it seriously. Many were still going to bars, walking outside, and carrying on as if not much had changed.

The central government had to take more drastic measures. Last Friday, Spain declared a state of emergency, giving the central government the authority to override any decisions made by Spain’s 17 autonomous regions (think of them as more powerful US states). And the next day, Sánchez took an even bigger step, one others in Europe had already taken: imposing a 15-day complete lockdown of the entire country. Some believe it will ultimately last for longer.

Everyone now has to stay home unless they’re going to the grocery store or pharmacy, getting medical treatment, caring for an older or sick person, or walking a pet. To enforce these rules, police and drones roam the streets to reprimand and fine anyone caught wandering outside. Authorities have also set up about 30,000 roadblocks so no one secretly drives to another location.

Now, millions are stuck inside as they wait for the government to lift the restrictions. The hope is that the draconian measures will help stop the spike in the thousands of positive cases and hundreds dead.

While understandable, those moves angered and surprised people like Erika Tepler, a 35-year-old from Maine living in Seville. “It all changed so fast,” she told me. “I’m in Spain, and it sucks.”

A feeling of “anger and abandonment” in Spanish hospitals

Moro, the 35-year-old doctor from Seville, has a deeply personal connection to the crisis.

Her partner Sebastián, also a physician, was in contact with someone who tested positive for Covid-19. For at least the next week, he’s self-quarantining in a separate bedroom and using his own bathroom.

He finally got permission to do that after the Spanish government on Monday authorized doctors who’d been exposed to the virus to stay home. Before then, he’d been forced to keep treating patients even while possibly carrying the disease himself.

That leaves Moro alone to care for her 11-year-old daughter. It hasn’t been too hard, she says, because her child doesn’t require as much attention as a toddler. Were her daughter younger, the quarantine — while necessary — would’ve proven a greater burden on the family. What bothers Moro most, though, is that people can do little more than sit around and wait for this all to be over.

But the nation’s medical workers are anything but idle. Night and day, they contend with patients flooding into their hospitals, and it doesn’t look like that’s going to end any time soon. “The crisis is overwhelming the system,” said Martich, the health policy expert.

Part of the problem is that while Spain has a national health care system, each of the 17 regions actually administer it separately. That, according to health labor leader Hernández Puente, caused a lot of coordination issues early on, including leaving doctors ill-supplied to provide care. The central government has now tried to address this disconnect by temporarily nationalizing all the country’s private hospitals.

Those physicians who receive incoming patients lack masks, gloves, and other protective gear. And those doctors who treat patients with the most severe coronavirus symptoms are short of beds to put them in and respirators to help patients breathe, all in understaffed intensive care units.

The central government still hasn’t addressed these critical needs, Hernández Puente said. “The general feeling among doctors and nurses is anger and abandonment.”

To ensure there are enough workers and resources for coronavirus care, some hospitals in Madrid and elsewhere are suspending services like general family care or cancer-related surgeries. That’s a tough position for health care providers to be in. “I wouldn’t want to be in that situation,” Martich told me.

Fourth-year medical students are also being called in to help address the staffing shortfall, and companies that can produce medical equipment must now contact the Ministry of Health for an assessment of how they might contribute to the national response.

When care fails, Moro says physicians put the dead bodies in special biodegradable bags. They’re closed tightly to ensure bodily liquids don’t spill out and spread the virus on surfaces or onto other people. No autopsies are performed to minimize droplets from landing on a healthy person, possibly getting them sick.

There’s at least a shared national sense of the struggle. Every day, at 8 pm, Spaniards stand on their balconies and clap together for health care workers returning home from their day shifts. At first, that happened at 10 pm, but the time was moved earlier so children could join in. That includes Moro’s daughter.

When she needs to go to the grocery store, Tepler, the American living in Seville, is surprised by what she finds. The streets are eerily quiet, save for the police officer asking her where she’s going. When she finally arrives, she finds the shelves of toilet paper stocked up while the wine aisles are empty. “It’s so demoralizing,” she said.

But there are some signs of optimism.

A social media movement with the hashtag #YoMeQuedoEnCasa — “I’m staying at home” — has found some success convincing people not to yearn for the outdoors. Even police who make announcements on empty roads reminding people to stay inside are now met with applause and chants of “bravo!”

And a doctor from Granada in southern Spain has become something of a national folk hero for boosting the message of what needs to be done to combat the virus in the country. With his YouTube videos, which he posts under the name Spiriman, Jesús Candel especially reprimands the country’s youth.

“I ask young people to stop watching stupid shit on their phones and look up information on the coronavirus,” he says in one of his more famous videos. “Young people need to fucking understand what they have to do.”

“There are young people going to the hospital with some symptoms who ask for a coronavirus test because all they care about is themselves,” he continues. Medical professionals will likely tell you to go home, he explains, “so we can attend to the severely sick people, like the woman I just attended to who was drowning alive, who had a week-long fever, and who’s in bad shape.”

The hardest is yet to come,” Sánchez told a near-empty Parliament on Wednesday.

But in some ways Spain might be one of the lucky ones. It has an advanced economy, a health care system that won’t entirely implode, and many of its citizens have enough resources to weather the crisis.

As the disease spreads further around the globe, those living in less-prepared nations will struggle to even sing from their homes. “It’s going to be much worse in other countries that aren’t as advanced,” Martich told me, referring mostly to countries in Latin America and Africa. “Spain is better prepared than most.”

The hope is that people who will soon face a similar reality can, like those in Spain now, resist.