Jose Luis Morales Rull, lead coronavirus doctor at one of the main hospitals in the Catalan city of Lleida, took his first time off in months after Spain’s original lockdown ended on June 21.
With a single Covid-19 patient remaining, he looked forward to closing the dedicated ward and going back to normal. But when he returned to work two days later there were 16 infected patients, and the numbers have not stopped rising since.
Dr Morales this week opened a fourth Covid-19 ward to treat the influx of victims after a second wave of infections around Lleida and the regional capital Barcelona prompted authorities to impose new restrictions on the province. Catalonia, with 16 per cent of Spain’s population, has accounted for almost half of its 16,410 Covid-19 cases recorded in the past two weeks.
“They underestimated the enemy,” the doctor said.
Spain was one of the hardest-hit countries when the virus took hold in the spring. But it had contained the original outbreak enough by late June to largely reopen its economy and return healthcare management to regional governments.
That the virus could begin spreading again almost immediately in Catalonia and two other northern regions, Aragón and Galicia, exposes the mis-steps and glaring weaknesses in the official response, critics say.
An image in a Barcelona street depicting a health official holding out a facial mask with the words ‘Put it on’ © Quique Garcia/EPA-EFE/Shutterstock
Most agree that animosity between the separatist-led regional government — the Generalitat — and the Madrid authorities contributed to Catalonia’s problems. But, they say, existing tensions were compounded by a lack of preparation, complacency and a failure to track cases, underpinned by the false assumption that there would be plenty of time before any second wave hit.
“The health authorities thought we’d have a hiatus from the virus in the summer, although I’ve no idea what data this was based on,” said Alex Arenas, an epidemic modeller at Universitat Rovira i Virgili in Tarragona. “That looks to me like a monumental error.”
Among the first to be hit in the second wave were Lleida’s care homes and slaughterhouses. For different reasons, residential centres and meat-processing facilities have been vectors of infections around the world. But they are generally contained systems where infections can be tracked.
But by July, tens of thousands of temporary workers from Morocco and sub-Saharan Africa began arriving in Catalonia for the annual fruit and vegetable harvest. Many were undocumented, living together in crowded apartments or in the open, making them difficult to monitor.
It was in this population that the virus took hold — hidden at first among the young and able-bodied workers who had mild, if any, symptoms. “By the time you realise there’s an outbreak in a group like this, there are already lots of cases. I don’t think anyone thought it was so widespread,” said María José Serra of Spain’s epidemic management agency, who confirmed that up to 700 temporary farm workers were infected in Catalonia.
At one point, 60 per cent of Dr Morales’ Covid-19 patients were labourers, though this has fallen to 15 per cent as the virus has spread more widely.
The most vituperative arguments over Catalonia’s shortcomings have been on the failure to deploy sufficient numbers of contact tracers to track infections. When the Madrid government returned healthcare management to the regions it called on them to develop tracking systems but did not say how many staff each should hire.
Health experts say this was a grave error. “They could have said, ‘Unless you hire tracers we won’t allow you to move to the next stage of de-confinement’,” said Helena Legido-Quigley, a Barcelona-born associate professor of public health at the National University of Singapore.
In the days after the first lockdown ended, Catalonia had fewer than 200 trackers, but Mr Arenas said a minimum of 1,400 was needed. A May contract document from the Generalitat health system, first reported by the news site ElDiario.es, anticipated hiring just 182, which they believe would be enough until a second wave hit in the autumn.
“They said at first that they didn’t have more trackers because the caseload was low,” said Ada Colau, Barcelona mayor, whose party is allied with the far-left Podemos, junior partner in prime minister Pedro Sánchez’s coalition government. “They insisted they were prepared but they weren’t.”
Others say inadequacies were not confined to one region. “It’s equally bad in Madrid and other places . . . The tracing seems to be completely under-developed,” said Miguel Hernán, a professor at Harvard’s Chan School of Public Health who served on the Spanish government pandemic advisory board.
Political infighting was a huge distraction as Madrid handed power back to Catalonia and Spain’s 16 other autonomous regions.
The Catalan government was at odds with Madrid long before Mr Sánchez declared a state of alert on March 14 in an effort to halt the virus’s spread, confining people to their homes and seizing control of security and health services from the regions.
Joaquim Torra, the Catalan government’s president, labelled this a “failure”, saying not only was Madrid very slow to act but that it failed to provide enough personal protection equipment to hospital staff.
But Ms Colau said the Catalan government should take its share of the blame. They “spent a lot of time making statements to the press and little time managing. Now we’re seeing the consequences,” she said.
The Catalan government said it had “prioritised the saving of lives at all times” during the crisis.
This week, as Catalonia continues to grapple with the second wave of infection, the government filled a vacancy for the head of public health, a post that has been empty for almost two months. The regional health service also pledged to hire 500 more trackers and ramp-up virus testing.
Dr Morales said Catalonia’s experience should be a cautionary tale for other parts of Spain.
“I’d be scared if I were from Valencia. When the pear and peach harvests end here, it’s the orange harvest there in September. Then the olive harvest in Andalucía,” he said. “[They] should keep Lleida in mind as a warning, so the same thing doesn’t happen to them.”
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