The 2020 COVID-19 pandemic has redefined what “normal” means and has implemented a “new normal” all around the world. The crisis asks for fast responses and transitions. In a matter of months it pushed the entire world to move to online learning and remote working, debates that have been present for decades but never saw any action.

Speed and adaptability in the response is key for the survival of nations, organizations and communities. It is therefore key for business and political leaders to be prepared for the second wave of infection predicted to come this upcoming fall, and if there is anything that the Spanish Flu pandemic taught us,we better not be caught off guard or it will be deadlier than the initial wave. Identifying best practices and lessons learned is key for drafting an efficient response. We therefore study the weak points in the Spanish response that lead to system collapse to determine potential points of improvement, and identifying best practices around the world to develop recommendation strategies.

Spain rapidly became the hot spot of the pandemic, leading in the highest number of infections and deaths per capita. As well as had the highest number of infected healthcare workers. With a health system in collapse, where there was a lack of resources such as medical material and protective gear. Analyzing the points that lead to system collapse highlights the following best practices and lessons learned in the response.

Prompt Response. “Anticipate the virus, don’t wait for it”

The Spanish governmental response to COVID-19 was highly criticized for its delay, for not using Italy as an incentive to act and prepare and for not taking early initiative. Spain had a 2 week window to take the necessary measures since the virus started spreading in it’s fellow European country, Italy. Instead, no measures were observed even after the virus had already spread in big cities. 

Best Practices

Countries like Singapore and Portugal anticipated the pandemic and took early measures.  Looking closely at Portugal, a neighbouring country of Spain, located in the same Peninsula, with very similar Latin cultures. Both countries have the same affectionate, familiar and physical interactions, it is common in both countries to greet people with two kisses on the face. There is also high human and good transport between the two, and initial cases were reported about the same time (end of February and beginning of March). Regardless of all these cultural similarities and physical proximity, covid had a very different impact. On May 18 Spain recorded a total of 278,188 cases and 27,703 deaths while Portugal stayed in 29,209 cases and 1,231 deaths. 

Portugal adopted strong early measures on March 13 before reaching 50 cases and with no deaths, economic and social activities started to shut down, closing schools, bars, parks, canceling cultural events etc. In Spain this form of measures were observed 12 days after 50 cases were recorded. Countries that suffer the most impact form the virus, in terms of infections and deaths in Europe also saw this delay in the response. Italy took measures 16 days, and the UK 18 days after registering 50 infected cases. All these countries had already had deaths recorded. 

Declaration of State of Emergency

Portugal’s Secretary State for Health, António Sales, reported to the Guardian “The Portuguese response to the global coronavirus outbreak has, since the very beginning, been based on the best scientific advice and on other countries’ experience. It has been regularly reassessed and adapted to a very fast evolution. The country has been preparing for the worst-case scenario”

“Portugal ended up implementing more or less the same measures as other countries – and at the same time – but the epidemic here was at a much earlier stage than in other countries.”

Lessons Learned

• Favor preventing instead of controlling measures. Anticipate the virus, instead of waiting for it to come to implement a response.

• Implement strict measures before the virus spreads

Learn from other countries mistakes

Portugal used Spain as an incentive to act, prepared medical equipment and took early measures. 

When Spain saw its initial wave of cases, northern Italy was in complete lockdown, registering thousands of cases and hundreds of deaths, and with the virus already spreading through the south of the country. 

Comparing critical points that lead to system collapse some share a common identity with the Italian response. 

1. Negative effect of leaving a large time gap between the announcement and enforcement of containing measures. 

In both countries this large time gap led to a flux of people fleeing from the most infected regions and global epicentrics of the virus, relocating themself in other regions of the country and spreading the virus. 

When Italy saw its initial wave of cases, the Italian government established a red zone in northern Italy, putting it on lock down. Measures were announced hours before their enforcement, which lead to citizens traveling to second residences in the south, collapsing train and bus stations, and further spreading the virus. 

Weeks later a similar effect was observed in Spain with the declaration of state of emergency a day before its implementation, leading to a flux of people traveling form the most affected regions to other provinces. 

1. Negative effect of partial lockdowns and school closure. 

Partial lockdowns and independent closure of schools had a similar effect leading to the redistribution of citizens across the country. In Milan, one of Italy’s initial epicentres saw a flux of students travelling to the Alps on skiing vacations after schools closed. Weeks later Madrid, the new epicenter in Spain and in the world, saw that with the closure of schools and universities lead to 300,000 students traveling back to their provinces of origin spreading the virus all around the country. Initial cases were reported in autonomous communities like Galicia.

Lessons Learned

• Large time gaps between the announcement and implementation of measures leads to further spreading and redistributing the virus, giving the population time and the opportunity to flee from infected areas and unknowingly carrying and spreading the virus.

• Partial lockdowns also lead to the further spreading and redistributing the virus around the country.

• Learn from other countries' mistakes and improve on them. Neighbouring and other infected countries should be studied and used as an example of lessons learned, collaborating and improving  each other's responses.

Avoid Politicization of the Crisis, Show a united front

The lack of communication in the Spanish response from the government of Pedro Sanchez and the leader of the opposition for the first two weeks at the beginning of the state of emergency was highly criticized since no communication was reported at all. There were several accusations and blame put in the governmental response from the country’s opposition parties, from allegedly lying and hiding data to blaming the government for the number of deaths. Political parties like “Vox” were also found to be further politicizing the crises, manipulating images to blame the government for the deaths. This type of political behaviors causes a very negative effect in the public, leading to lack of confidence in the governmental response; non compliance with quarantine and other imposed measures; citizen divide in political ideals rather than giving a unified response to the crisis which further leads to manifestations against the government such as the one seen in the Salamanca neighbourhood in Madrid.

Best Practices

In Portugal, the opposition showed public support and unity for the general measures taken to stop the spread of the virus, and limit itself to criticize small details or procediments. They publicly announced that attacking the government in times like this was “anti patriotic and unethical”

“Political parties have adopted a responsible behaviour because everybody understood very well the importance of being united to tackle an unexpected pandemic with dramatic consequences,” said Antonio Sales.

"Rui Rio, the leader of the main opposition party, the PSD [Social Democratic Party], said 'we are not going to cause problems for the country just to cause problems for the government'."

This unified political response for public good led to the sense of unity and compromise to be promoted among the population. Citizen compromise was widely observed with citizens following measures and only 84 people arrested in comparison with the 3,051 arrests and 357,929 fines in Spain. The Portugues government was also an advocate for solidarity for Spain with the European Union, promoting that this was not time to point fingers or blame but to help and collaborate with each other.

Lessons Learned

• Show a united front. Coordination, communication and support between political leaders.

• Avoid the politicization of the crisis and blaming.

Evaluate the Public Health System to Prevent Collapse

The Spanish government was overconfident with their  health system. The minister of health tweeted in early february that they had “the best health system in the world” mistaking the Global economic forum naming Spain the country with longer life expectancy with the quality of its health system. 

In the last decade the spanish public health system experienced a significant cut in their finances due to the 2008 financial crisis. Prior to the pandemic Spain had fewer nurses and hospital beds than the European average. An average of 5.7 nurses per 1,000 inhabitants, being the european average 8.4 and 297 hospital beds per 1000,000 inhabitants, being the european average 541. Countries like Germany that had a different impact in deaths due to COVID19 patients had an average of 12.9 nurses. 

Joint Health System Response, Sharing Resources

In the initial weeks of the response, the government was unable to coordinate a joint response between Spain's different regions and health systems. The country has 17 different health models, one per autonomous community, which were placed at a unified single command with the declaration of state of emergency. Prior to this, the different communities had to make independent decisions, competing with each other and sending contradictory messages to the public. Regional governments had to find their own material at the beginning of the pandemic. 

Under the joint lead, Autonomous Communities shared resources such as respirators and mortgages allocating where they were needed most. The government also called for retirees and students from all around the country to work as volunteers to fill in for staff shortages. Provisional hospitals and morgues were also built in hotels and ice rinks in the country's virus hot spots. A joint public and private health response was also observed around the country.

Quality and Abundant material

Spain was one of the countries during this first wave of the pandemic in Europe that had the most infected healthcare workers. Testing was limiting among these and there was a lack of protective gear. Testimonies report 

“The initial diagnostic strategy was too restrictive and presented the early identification and isolation of potential contagators, puting the health system on edge”

“Our hospitals have been overwhelmed and our health professionals have suffered from lack of necessary supplies and protective equipment, putting their lives at risk”

It was also found that there was a lack of experience and knowledge in buying material in the international market.

“In the Ministry of Health there has been a lack of a committee of technical experts with experience purchasing in international markets, where it is necessary to know the suppliers and the operation of the processes to operate successfully”

As a result the Spanish Government bought faulty testing equipment and had issues with Turkey buying respirators. 

Lessons Learned

• Using data to objectively evaluate the capacity of the public health system.

• Coordinate a joint response between communities and health systems and allocate resources where they are needed most.

• Understand international markets to ensure abundant quality material

Conclusion 

Fast, coordinated, adaptable responses will help us make a positive difference in the expected second wave of the pandemic, leading to more positive and less deadly outcomes. It’s key that we work together and learn from each other, building on improvement and not repeating each other’s mistakes. Global crises require global  solutions. We must learn from this first wave of the crisis and redefine best practices and strategies.