Spain’s coronavirus crisis: Why the numbers are failing to show the full picture
Differences in reporting methods, a lack of testing and situational challenges mean the daily reports on deaths, infections and hospital admissions do not reflect the scale of the outbreak
Every day at 11.30am, the Spanish Health Ministry gives an update on how the coronavirus outbreak is developing in Spain. But its report on the latest figures of deaths, cases and hospitalizations is far from a complete picture of the crisis. The number of cases does not reflect the true amount of infections in the country, which is unknown, nor all the fatalities caused by the coronavirus. It is not even clear what is meant by the figure of intensive care admissions.
Fernando Rodríguez Artalejo, professor of preventive medicine and public health at the Autonomous University of Madrid, says that the best figure to go by is the number of hospital admissions, and that this is what guides specialists when it comes time to make decisions. But is it possible to slow the pandemic without knowing how many people are infected nor how? “There are measures that we know work beyond these limitations, such as social distancing, respiratory etiquette and hygiene. But it is important to have more precise figures to know how to modify the measures that have been taken,” explains Artalejo.
According to Pedro Gullón, the spokesperson for the Spanish Epidemiology Association, the more accurate the figures, the easier it is to create suitable action plans. “Each figure that is published daily is a partial photo. If there was some contradiction, we would have to question whether they were correct. But as they are all heading in the same direction, together they give us a picture that more or less reflects the trend,” he explains.
This is perhaps the most unrealistic number reported. Even if it were to be accurate, it would be, by its very nature, out of date: more than a week can go by between a person contracting the disease, beginning to present symptoms, asking for a test and receiving the results. What’s more, since the local transmission of the coronavirus began to increase, the ability to test suspected cases has reduced, meaning that only serious cases are tested. That’s why experts believe the number of confirmed cases could be 10 times higher than what has been reported. A study from Imperial College London estimates that up to seven million people in Spain could be infected, although national experts doubt the figure is that high.
Intensive care admissions
The number of intensive care admissions is doubly skewed. On the one hand, the strain on intensive care units (ICUs) has meant that these wards have become increasingly restrictive about which patients are admitted. Medical guidelines recommend that doctors prioritize patients with the greatest chance of survival. Coronavirus patients who are admitted into ICUs require artificial respiration, an invasive and aggressive process that is not recommended for fragile cases. But ICUs have become so overwhelmed that in some instances they have not admitted patients who would have been under other circumstances.
On the other hand, each region in Spain has its own way of reporting the number of ICU admissions. While some count the number of patients admitted since the beginning of the coronavirus outbreak, others provide a daily view of how many are in the ICU at a given moment. The final figure reported by the Health Ministry in its daily report is a mix of these two methods.
Although the number of coronavirus deaths should be the most accurate, the figure does not reflect all fatalities caused by the disease. Those who have died in their homes or in senior residences without being tested for Covid-10 are not included in the official coronavirus death toll. Indeed, there are still no official figures on how many seniors have died in care homes – a number that could be in the thousands.
A report published by the Health Institute of the Carlos III University also found an increase in overall deaths during the coronavirus crisis. This could be for various reasons: an overwhelmed healthcare system that does not have the resources to help other patients, or sick people deciding not to go to hospital and dying as a result.
The Spanish government insists that it is testing between 15,000 and 20,000 people a day. But it is not clear when this began or how many people in total have been tested. Nor does Spain report how many people have tested positive and negative for Covid-19, figures that other countries do provide. On March 22, the Health Ministry announced that it had completed 350,000 tests. That same week, Health Minister Salvador Illa repeated the number: “We have done at least 350,000 tests.”
Adding to the confusion is the issue of fast tests. For two weeks, the Health Ministry has been announcing the imminent release of fast testing, but it is unclear whether they have been rolled out on a large scale. In other words, the public has no idea how many tests have been done in Spain.
The number of health workers who are in isolation because they have contracted the coronavirus or are a suspected case is also unknown. Every so often, the Health Ministry reports how many health workers have tested positive since the beginning of the outbreak. On Tuesday the number was nearly 12,300. But the number of health workers who are awaiting tests or test results has never been reported. Nor how many have returned to work after recovering from the disease.
English version by Melissa Kitson.