efe-epaBy Julia R. Arévalo Madrid

Healthcare workers are a shield against Covid-19. This phrase has been repeated time and again by Spanish authorities, and it has proved to be true.

Spain’s healthcare system is ample, with almost 41 doctors per 10,000 citizens, the 13th highest ratio in the world, similar to Italy and Russia but just behind Germany, with 41, Sweden, with 54 and, of course, Cuba, with 82.

Taken as a whole, the European Union has 36 doctors per 10,000 people while the United States has 26, South Korea 24 and China just 18, according to the World Health Organization.

However, the number of nurses in Spain is 55 per 10,000 people, somewhat lower than the EU average of 86.

To deal with the avalanche of coronavirus patients, the Spanish government incorporated some 50,000 recently retired or final year student doctors and nurses into the system and ordered those working in private health care to serve the country’s public network.

In order to centralize its management, all of Spain’s autonomous regions were brought under the auspices of the Spanish Ministry of Health.

But Spain’s inability thus far to flatten the curve is down to its lack of resources.

The ratio of hospital beds per citizen in Spain is roughly 30 for every 10,000, less than the EU as a whole with 56 per 10,000 and far behind Germany, which has 86.

The Armed Forces have erected a field hospital with 5,500 beds inside the huge convention center on the outskirts of Madrid, the worst-hit Spanish region.

And just this week the Spanish government landed a contract with China worth 578 million euros ($645m) for the provision of millions of masks and gloves, and just under 1,000 ventilators.

“This has overrun us. We were unable to imagine the magnitude of this problem. I also thought it was just some type of cold,” a nurse tells Efe on the condition of anonymity.

Iria Suárez, a colleague who works in primary care, says: “This would have overwhelmed anyone. No health professional was ready for a pandemic. It was something unknown to us.”


The mask is a valuable asset nowadays. Everyone thinks they need one, including the healthy person who takes their dog for a walk down an empty street. Medical workers in Spain, on the other hand, have publicly denounced a shortage of equipment.

“We’ve not been lacking but the equipment gets worse every time. We have received overalls that are like raincoats, without a strap. And they are thinking of washing the equipment to reuse it,” the ER nurse says.

“I know I risk being infected, I just want the tools.”

Suárez says they had received plastic aprons instead of proper protective gowns and that they were forced to sterilize masks to reuse them.

The nurse who requested anonymity said the hospital where she works needs more beds and that patients have been forced to sleep on chairs in the corridors, unable to observe social distancing rules.

Personal protective equipment is no longer discarded and changed after each use, given the constant flow of patients.

Some of the older patients especially request a kiss on the cheek.

“They need love, they are along. I no longer think about being infected.

“It’s very hard to see people die without their loved ones around. It breaks my heart. I don’t want them to suffer, nobody deserves this.”


The entire healthcare system is focused on containing the spread of Covid-19 while most of the population has been holed up at home since 15 March, apart from those whose work is deemed essential.

Check-ups, surgeries and prenatal care has been postponed in a system that was running at maximum capacity even before the crisis.

While ER fills up with suspected coronavirus cases at the hospital, the wards have few new admissions, the nurse says.

During the early days of the outbreak, there were only five patients in the normally crowded ophthalmology department of a large Madrid hospital and some were sent home without seeing a doctor.

A gynecologist at a private clinic on the outskirts of the capital tends to their patients over the phone and sends guides by email.

“We’re the rearguard. This has hit us all at one, but life goes on,” they tell Efe.

At 8pm each day, Spaniards come to their balconies and windows to give a round of applause for the health workers on the frontline of the crisis.

They need it. In many hospitals, health workers head for the doors at that time to take in some fresh air and encouragement from the applause. Police cars and ambulances often join in with their sirens.

“You don’t know how thankful we are. In my hospital, all the patients applaud at 8pm. I end up crying every day,” the nurse says.

Suárez feels the same way.

“The gratitude makes me emotional. It gives you the strength to get through another day.”

The situation has revealed the humanity of our healthcare professionals. They get emotional with us. They acknowledge their weaknesses. They, too, get scared.

“We hire new nurses. They’re here one or two days, they see the situation and they quit,” the nurse says.

Suárez observes strict hygiene rules when she leaves or returns to the house. The hardest part, however, was having to send her three children to stay with the grandparents. Many don’t have that option.

“There’s a lot of uncertainty,” an oncologist at a private Madrid hospital says. They now carry out their patient interactions over the phone.

“It’s to protect you and everyone else”.

A manager of a care home in Madrid, many of which became an epicenter for the disease, tells Efe: “What we’re going through is horrible. We have protective gear, but it won’t last that long.”


The most vulnerable older people in Madrid are not admitted to hospital and are instead kept at the care home where those with Covid-19 symptoms are treated with oxygen, serum and medications in their final days.

Some centers let family members briefly say their goodbyes.

Screening for the disease - now a form of triage - is done by primary care centers. They decide whether or not to send a patient with symptoms like pneumonia to the hospital.

Primary care workers also do house visits. When older people show worsening symptoms, most prefer to remain at home with the family, knowing that if they went to hospital they would be alone and bottom of the list for intubation.

Their outlook for survival is virtually nil. In care homes and at home, the seriously ill are given palliative care.

There have been more than 78,000 cases in Spain since the outbreak began. Some 8.1 percent of those who contracted the virus have died while 18.6 percent have recovered so far.

The worst-hit region Madrid, which is home to 6.7 million people and has one of the largest hospital networks in the country, accounts for 22,677 cases, 3,082 deaths - almost half the nation’s tally.

We know these figures are just an approximation of the real situation in the country, given the lack of universal testing and the fact that the reports are handed over to Madrid by each Spanish region at 9pm each night.

From Thursday, authorities in Madrid stopped testing patients with severe symptoms to instead assume they had Covid-19.

Manuel Rodríguez Ureña, who died at 9.20pm on Wednesday 25 March at the age of 81 was a “possible Covid-19 case” but did not feature on the national register as such.

How do we inform the family of his cause of death?


As well as quarantining the population, the WHO considers mass testing essential in order to limit the scope of the pandemic, treat the sick and identify those who have come into contact with them.

Spain, with a population of 47 million inhabitants, has been carrying out between 15,000 and 20,000 daily tests, according to authorities, but they are slow and the system has already become saturated.

It takes 4 hours for each machine to analyze 16 rapid testing kit samples. Even with laboratories working 24 hours a day, centers with few or no machines refer their tests to the larger ones, creating a logjam.

The first batch of these rapid testing kits imported to Spain from China, proved useless.

"It gave 40 percent false positives," says one doctor.

The anger adds to the fatigue.

The first installment of the multi-million dollar deal with China, which includes millions of rapid tests, masks and gloves, began arriving in Spain this week some 14 days after the country went into lockdown.

At Iria Suárez’s center, the rapid test kits have been reserved for health workers and police, those most exposed to the contagion.

But at the regional hospital where the ER nurse works, no tests have been carried out on staff without symptoms.

As of Saturday there were 9,444 confirmed Covid-19 cases among health workers.

“If we are the ones charged with stopping the pandemic, then give us the means to do so. If we are the warriors, then give us the weapons,” the nurse says.EFE-EPA