Why does Spain have the world’s highest coronavirus mortality rate?

Spain entered its fourth week of confinement on Monday as the country with the highest number of coronavirus deaths relative to its population.

With 13,055 confirmed coronavirus fatalities, or 28 for every 100,000 inhabitants, Spain has already surpassed Italy in terms of the number of deaths compared to the population (not to the number of confirmed cases, which is the more common metric).

Authorities are now placing their hopes on the improving indicators coming out of the emergency rooms, where there has been a drop in the number of admitted patients. This is relieving the pressure on hospitals’ intensive care units, which have been overwhelmed with critical cases in recent weeks.

The way that you determine the cause of death, whether from the virus or from underlying diseases the patient may have had, also plays a role

Pere Godoy, Spanish Epidemiology Society

The downward trend is supported by the overnight death toll, which was 637 on Monday, the lowest figure for a 24-hour period since March 24 (although Monday figures can be lower due to under-reporting during weekends). In any event, it was the fifth day of dwindling fatalities after the peak of April 2, when there were 950 deaths in a 24-hour period. Health Minister Salvador Illa has already described the pandemic as the worst health crisis of the past century.

So why are so many people in Spain dying from coronavirus complications compared with other countries?

An aging population with a high rate of underlying health issues, as well as the impact that the virus has had on senior homes, are some of the reasons, according to Pere Godoy, president of the Spanish Epidemiology Society.

“The way that you determine the cause of death, whether from the virus or from underlying diseases the patient may have had, also plays a role. This is not being done the same way across different countries, and it makes comparisons less reliable,” notes Godoy.

It is possible that our early detection effort has lagged behind that of other countries like Germany or South Korea

José María Martín Moreno, Valencia University

José María Martín Moreno, a professor of medicine and public health at Valencia University, adds another factor to the combination of demographics and counting methodology.

“It is possible that our early detection effort has lagged behind that of other countries like Germany or South Korea, which conducted mass testing that enabled them to isolate infected people and stop the transmission chains,” he says. This early detection may have prevented the virus from reaching particularly vulnerable groups such as the elderly.

Adding to the problem is the fact that “not enough investment has been made” in public healthcare in recent years, adds this expert.

Densely populated areas

Jesús Rodríguez Baño, head of the infectious disease department at Virgen Macarena Hospital in Seville, underscores two other issues.

“Studies still need to be done, but probably it also has something to do with the way we interact socially, with greater physical proximity,” he says. “And the fact that the worst-hit areas are Madrid and Catalonia shares something with northern Italy: these are all densely populated areas.”

“It is true that more tests and greater isolation could have stopped the chain of transmission before reaching the more vulnerable groups. But I want to be very humble here, because in a way, we all got it wrong during the first stages,” he adds. “It’s easy to see things clearly in hindsight, but this should teach us to learn and analyze what happened.”

Tests and gear

Minister Illa has stated that the government allocated “€845 million” in the space of three weeks to purchase testing kits, ventilators and masks. “We have achieved a regular and permanent supply [...] as a complement to regional governments’ own purchases,” he said.

According to the health minister, the one million rapid tests that are being distributed by his department among regional authorities will “serve to conduct quick screenings” that can later be backed up by the slower but more reliable PCR tests inside labs.

As for the recommendation that everyone use a face mask, Illa said that “this is a measure that is currently being analyzed, but no decision has been made.” In any case, “national production is being activated.”

English version by Susana Urra.