Spain: COVID-19 National Strategy - World Health Systems Facts

Spain COVID-19 National Strategy: New Restrictions Through Christmas Season

“On December 2, the Interterritorial Council agreed on a set of common measures for the Christmas season. The most relevant are referred to mobility across autonomous communities and family gatherings. For the former, from December 23 to January 6, inbound and outbound mobility will be kept prohibited (as regulated in RD 926/2020), except for visiting relatives and next of kins. In turn, familiar gatherings will be limited to ten people from two family units just on 24, 25 and 31 December and January 1. In addition, the current curfew will be extended until 1:30am on Christmas and New Year’s Eve.

“The autonomous communities will be responsible for the adaptation of alleviating measures aimed at alleviating the current restrictions on the different productive sectors, in accordance to their specific epidemiological situation (https://www.mscbs.gob.es/gabinetePrensa/notaPrensa/pdf/02.12031220103636499.pdf; https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5157).”

Source: COVID-19 Health System Response Monitor. A project of the European Observatory on Health Systems and Policies, the European Commission, and the World Health Organization Regional Office for Europe.

Spain COVID-19 National Strategy: Travel Restrictions and Proof of Negative Test Result

“From November 23, travellers arriving at Spanish airports and ports from high-risk countries must have a negative PCR test performed within 72 hours prior to travelling. Hence, a new question asking if you have tested negative for COVID in the previous 72 hours will be included in the Health Control Form, and authorities may request to see at any time the result of the PCR test, which must be an original document, in Spanish or in English, in paper or digitally documented.”

Spain COVID-19 National Strategy: State Of Alarm Declared Anew

“Since October 25, the state of alarm has been anew declared for 15 days (until November 9) with a 6-month extension (until May 9). In this period, the central government is the competent authority, but, unlike the previous state of alarm, regional prime ministers will act as delegated competent authorities.

“The main measure affecting all the Spanish territory, excluding Canary Islands, is the establishment of a curfew from 23:00 p.m. to 6:00 a.m. until November 9. Regional authorities, in their role of delegate competent authorities, are able to shift 1 hour the starting (22:00 p.m. to 00:00 a.m.) and the finishing time (5:00 a.m. to 7:00a.m.).

“This new state of alarm aims at legally backing regional decisions that imply the limitation of fundamental rights (e.g., freedom of movement) when restricting individuals’ mobility within and between regions. In addition, it also entitles regional authorities to tighten restrictions on gatherings and sharply implement policy measures that otherwise would require validation by the judiciary (Royal Decree 926/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-12898).”

Spain COVID-19 National Strategy: Physical Infrastructure

“As of 21 September, the Spanish government will distribute nearly 12 million surgical masks to local councils and 3 million more to non-for-profit organisations and charities (Red Cross, Caritas and CERMI), to reinforce the protection of vulnerable groups coinciding with the schools reopening (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5052).

“On mid-October, the Ministry of Health distributed 755 ventilators to the Autonomous Communities to cover their potential needs. Hence, on October 19, Spanish hospitals had a total of 13,557 ventilators (7,776 handed out by the Minister), meaning 2.9 ventilators per 1,000 inhabitants and guaranteeing the required coverage of 1.5-2 ICU beds with ventilator per 1,000 inhabitants (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5083).

“On October 20, the Spanish government authorized the purchasing of 30.5 million vaccines developed by AstraZeneca, settling the agreement signed last August between the European Commission and the pharmaceutical company. Spain will pay a maximum of 76 million euros when the vaccines are delivered (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5087).”

Spain COVID-19 National Strategy: Teleworking and Caring For Loved Ones Suffering With COVID-19

“On September 23, a Royal Decree-Law regulating teleworking was published. Despite that teleworking working implemented due to COVID-19 causes will keep being regulated by the ordinary law, companies will have to provide those employees working remotely with the required devices, equipment, tools, as well as their maintenance (Royal Decree 28/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-11043; Royal Decree Law 29/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-11415).

“On September 23, the plan “MECUIDA” was extended until January 31 2021. This plan allows the reduction of working hours to care for spouse, common law partner or second degree relatives due to COVID-19 causes related to age, disease or disability (Royal Decree 28/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-11043).”

Spain COVID-19 National Strategy: Response to New Outbreaks

“On September 30, the Interterritorial Council agreed to a set of restrictive measures to be taken in those municipalities with a population larger than 100,000 inhabitants. Those measures will be implemented when the 14-day incidence is higher than 500 cases per 100,000 inhabitants, PCR positivity in the last two weeks is above 10%, and when ICU admissions for COVID-19 patients represent more than 35% of the occupancy rate.

“Among others, the most important mandatory measures are: entry to and exit from the municipality will be restricted to properly justified causes for example commuting to work, healthcare visits or class attendance; gatherings will be limited to six people for non-cohabitants; maximum capacity of retail and services businesses open to the public will be 50% and closing times will be limited to 22:00; occupancy rates in hotels, restaurants, sport facilities and betting shops will be up to 60% outdoors and 50% indoors and their closing time will be 23:00 -this schedule excludes take-away services; and, in turn, places of worship will reduce their turnout to a third.

“It is also recommended avoiding unnecessary travels within the affected municipalities and having a response plan to control transmission in those municipalities with fewer than 100,000 inhabitants in the same circumstances as those mentioned.

“In addition, the Autonomous Communities, where these municipalities are settled, will have to reinforce their capabilities in detection, control and healthcare provision according to the Plan for an early response to control the COVID-19 pandemic (Resolution https://boe.es/diario_boe/txt.php?id=BOE-A-2020-11590; https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Plan_de_respuesta_temprana_escenario_control.pdf).

Spain COVID-19 National Strategy: Transition Measures: Response to New Outbreaks

“As of July 9, due to the numerous community outbreaks occurred within its territory, the regional government in Catalonia has issued the obligation of wearing face masks regardless the ability to keep 1.5 metres of physical distancing (SLT/1648/202 https://portaldogc.gencat.cat/utilsEADOP/PDF/8173/1803867.pdf). In other regions where outbreaks have also been detected, focused restrictive measures (e.g. isolation of exposed people, movement restrictions within the municipality, confinement of condos) have been taken to avoid community transmission.

“As a consequence of the number of outbreaks spreading over all the territory, some of them within institutions (e.g. and some others with a component of community outbreak, regional health authorities have issued different measures depending on their characteristics. For instance, some territories are observing restrictions in mobility to just cover essential activities, others have restricted mobility to enter in or exit from the affected areas, others have limited the turnout of restaurants, shopping centres, museums, theatres, cinemas and other cultural centres or limiting gatherings up to ten people. In those affected territories where mobility is not restricted, there is a general recommendation of avoiding all unnecessary journeys (Aragón: http://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VEROBJ&MLKOB=1122362222020&type=pdf; Catalonia: https://portaldogc.gencat.cat/utilsEADOP/PDF/8176/1804572.pdf: https://portaldogc.gencat.cat/utilsEADOP/PDF/8177A/1804867.pdf; https://portaldogc.gencat.cat/utilsEADOP/PDF/8177A/1804869.pdf; Basque country https://www.euskadi.eus/contenidos/informacion/covid19/es_def/adjuntos/BOPV-salud-15-07-2020-es.pdf). In addition, almost all regions in the country (Catalonia, Extremadura, Balearic Islands, Murcia, Andalusia, Aragon, La Rioja, Navarra, Asturias, Castile León, Basque Country) have issued the obligation of wearing face masks regardless of the ability to keep 1.5 metres of physical distancing.

“On July 15, since many of the outbreaks have been related to temporary workers in the agricultural sector, the Minister of Health and the Minister of Agriculture have met with regional representatives to coordinate a response for future agricultural seasons. The main source of contagion stems from the poor conditions workers are living in rather than from the activity itself. So some regions have already set up premises to accommodate the workers or to isolate them, if required (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5003).”

Spain COVID-19 National Strategy: Transition Measures: Transit, Travel, Facility and Business Reopening, Physical Distancing

“On June 10, the government issued a Royal Decree with preventive, containment and coordination measures aiming to face the COVID-19 crisis when the state of alarm expires next June 21 (or before that date in those territories that had already completed the transition plan) (Royal Decree 21/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5895).

“Main provisions are:
“People over six years old have to wear face masks in transports. Similarly, masks should be wear outdoors or in closed public spaces where a minimum distance of 1.5 meters cannot be assured. As foreseen in previous legislation, people with respiratory disorders, conditions that could worsen because of their use (e.g. mental health disorders) or activities incompatible with their use (e.g. sport practice) are exempted. No observance of this measure will be deemed mild offence and it will be fined with up to €100.

“Work centres have to adopt ventilation, cleaning and disinfection measures, as well as making available water, soap or hydro alcoholic gel for their workers. In addition, work posts, shifts and communal places will be regulated to guarantee a 1.5 m distance between workers. If this is not possible, workers should be provided with the appropriate protective equipment. In addition, massive concurrence of workers, users or clients will be prevented, and remote working will be encouraged whenever possible.

“Regional authorities have to guarantee that social centres (e.g., assisted-living homes, nursing homes, centres for disabled people, tutelary houses) fulfil prevention and reconditioning measures and to coordinate with the healthcare resources in the area. In turn, social centres should implement organizational measures to prevent infections and develop contingency plans aimed at the early detection of cases among users and workers as well as contacts, in coordination with the health services.

“Regional authorities have to guarantee that education centres, shops, hotels, restaurants, cultural centres, sport centres and any public centre fulfil regulation on prevention, reconditioning and limited turnout. Owners will implement organisational and preventive measures, in particular those to guarantee 1.5 meters of physical distancing; should this not be possible, additional measures should be adopted to reduce infection risks.

“Lastly, road, train, sea and air operators selling numbered and assigned seats are required to keep passengers contact information for at least 4 weeks, and they could be required to provide that information to trace contacts.”

Spain’s COVID-19 National Strategy: Transition Measures: Travel, Migration, and Border Restrictions

“On May 11, and as an addition to the current land borders closure measures from May 10 to May 24, the Ministry for Home Affairs issued the temporary reintroduction of air and sea border control from May 15 to May 24. Only Spanish citizens or residents with regular residence in Spain, as well as cross-border workers, healthcare workers or people with proven causes of force majeure will be allowed to enter the country by air or sea (Order INT/401/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4929; https://ec.europa.eu/home-affairs/what-we-do/policies/borders-and-visas/schengen/reintroduction-border-control_en).”

Spain COVID-19 National Strategy: Transition Measures: State of Alarm

“May 6: An extension of the “state of alarm” has been approved by the parliament. The measure will be in place until May 24 (http://www.congreso.es/portal/page/portal/Congreso/Congreso/SalaPrensa/NotPre?_piref73_7706063_73_1337373_1337373.next_page=/wc/detalleNotaSalaPrensa&idNotaSalaPrensa=35909&anyo=2020&mes=5&pagina=1&mostrarvolver=S&movil=null; https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4896).

“As part of the de-escalation process, on May 8, the Ministry of Health announced those territories advancing to stage 1 of the transition plan from May 11 onwards: the whole Autonomous Communities of Galicia, Asturias, Cantabria, País Vasco, La Rioja, Navarra, Aragón, Extremadura, Murcia, Canaries and Balearic Islands, and the autonomous cities of Ceuta and Melilla, as well as some other territories in the remaining Autonomous Communities -six provinces in Andalusia (all except Granada and Málaga), two provinces in Castilla-La Mancha (Cuenca and Guadalajara), ten healthcare areas in Valencia and three regions in Catalonia (Order SND/399/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4911).”

Spain COVID-19 National Strategy: Transition Measures: Physical Distancing

“Since May 4, face masks are mandatory in public transport (that is, trains, buses, airplanes, boats and vehicles with up to nine seats). In private transport (for example, taxi or transfer services), only two people per seat row will be allowed if they wear face masks and maintain the safety distance. In trains or buses, where all passengers must be seated, they should operate at half capacity to assure proper physical distancing (Order TMA 384/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4789).”

Spain’s COVID-19 National Strategy: Transition Measures

“On April 28, the Prime Minister made public the de-escalation Plan. Building on the principles of public health protection, minimising individuals’ health risks and preservation of the national health system response capacity, the strategy will be gradual and asymmetric across territories and coordinated along with the regional authorities. Importantly, the strategy will be adapted, if needed, in accordance with the evolution of the epidemic and the impact (positive or negative) of the measures taken at each stage (https://www.lamoncloa.gob.es/consejodeministros/resumenes/Documents/2020/PlanTransicionNuevaNormalidad.pdf) (see Section 1.2 for details on the Plan).

“The decision for a territory (that is, province, island or healthcare area) to start off the process and the progression across stages will lie on the achievement of several criteria referred to the epidemiological situation and the health system capacity. Regional authorities should send this information to the Minister of Health one week before the decision has to be taken (https://www.lamoncloa.gob.es/consejodeministros/resumenes/Documents/2020/28042020_Anexo%20I%20PANEL%20DE%20INDICADORES.pdf;
Order SND/387/2020
https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4792; https://www.lamoncloa.gob.es/serviciosdeprensa/notasprensa/sanidad14/Documents/2020/08052020_Criterios.pdf).

“Indicators used for this purpose are:
“-Epidemiologic indicators: general outbreak indicators (e.g. number of hospitalisations, ICU hospitalisations, death toll or PCR tests); indicators on public health capacity (e.g. number of professionals doing COVID-19 surveillance) and specific de-escalation indicators assessing the effectiveness of early detection of new cases, isolation and control of contacts.
“-Health system response indicators: acute-care hospitalization and ICUs’ occupation rates for both COVID-19 and non COVID-19 patients; sufficient available stock for personal protective equipment, PCR tests, or antiviral drugs, and ventilators; assurance of labs capacity; and, availability of premises easily adaptable as medical centres.

“In addition to this set of indicators, health authorities will also monitor the population’s mobility (e.g. mobility index within and across provinces or municipalities or public transport use in the most populated cities) and the socioeconomic situation in each territory (e.g. number of workers or self-employed, number of contracts temporarily suspended (ERTEs) or energy supply consumption).

“Decisions made by the national and regional authorities at the different stages of the COVID-19 crisis, from the inception to the transition measures, are following or are adapting the provisions from the international competent bodies such as WHO and the European Centre for Disease Prevention and Control (ECDC).

“Since March 14, when the lockdown started off in the country, mobility and labour activity have been severely restricted and subjected to enforcement and punishment. The transition plan has been designed to restore normal life in a progressive way, minimizing the risk of epidemic relapse. This plan includes progressive measures some of which are mandatory (such as the use of face masks in public transports), while some others are strongly recommended and rely on individuals’ responsibility (e.g. maintaining physical distance).”

Spain’s COVID-19 National Strategy: Transition: Physical Distancing, Facility and Business Reopening

“Since May 2, the general population living in municipalities with more than 5,000 inhabitants will be allowed to go for a walk and do sport by time slots. In particular, from 6am – 10am and from 20.00-23.00, people of 14 years and older can go for a walk with one co-habitant within a radius of one kilometre around their residence once a day or practice solo sports within the limits of the municipality of residence once a day (using transport to reach another spot in the province for this purpose is not allowed) and always keeping the safety distance. Non-institutionalised people over 70 and dependent people can go out from 10am to 12pm and from 7pm to 8pm (Order SND/380/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4767). Besides, children will now be able to go out from 12.00pm to 19.00pm only, in the same conditions as before (maximum 3 children with only one adult) (updating prior Order SND/370/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-4665).

“In those municipalities with fewer than 5,000 inhabitants, time slots do not operate, so that the aforementioned activities will be allowed for everyone from 6am to 11pm (Order SND/380/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4767), keeping the safety distance.

“These measures will not affect the older people in assisted-living or nursing homes, or beneficiaries of home-care, nor modify the quarantines prescribed to those people with symptoms or risk contacts of a patient with COVID-19.

Spain’s COVID-19 National Strategy: Border Closures

“After the “state of alarm” was declared on 14 March (Royal Decree 463/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-3692), Spanish security forces and law enforcement agencies, as well as the regional and local police came under the direct command of the Minister for Home Affairs. The Minister can request the intervention of the armed forces if needed to enforce laws.

“In turn, on 16 March, the country’s land borders were closed to anyone other than residents (https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-4064), and on 22 March, this restriction was also applied to airports and ports in accordance with European Commission policy (https://www.boe.es/boe/dias/2020/03/22/pdfs/BOE-A-2020-3972.pdf). Hence, only Spaniards or residents are allowed to enter the country if they are able to prove that they are returning to their place of residence.

“On 20 April, the Ministry for Home Affairs has issued an extension of borders’ closure until 15 May, following the recommendations of the European Commission to the European Parliament and the EU Council (Order INT/356/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4539).

Spain’s COVID-19 National Strategy: Physical Distancing, Facility and Business Closing:

“3 March: The first community outbreak was declared, prompting progressive physical distancing measures. From this date, all professional sport events with potentially high numbers of supporters from COVID-19 high-risk areas would be staged behind closed doors. Furthermore, all health professionals were requested not to attend conferences, courses or seminars in order to assure their availability in the days that followed (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4803).”

“14 March: the ‘State of Alarm’ was declared and freedom of movement was severely restricted throughout the country, initially for 15 days, and then extended for 15 more days, until 11 April (Royal Decree 463/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-3692). During this period, citizens are required to stay at home and are only allowed to use public roads to carry out very specific activities: namely, acquiring food, pharmaceuticals or basic needs; going to work; attending health centres; travelling to work; returning to their regular residence; assisting and caring for elderly people, minors, dependents, people with disabilities or especially vulnerable people; visiting financial institutions; or other justified reasons due to necessity. Similarly, private vehicles are only allowed on public roads to carry out the aforementioned activities, or to refuel at petrol stations. These activities must be carried out by one person at a time, except in the case of dependent or disabled people who are allowed to be accompanied.

“Regarding education, face-to-face activity has been formally suspended for all the territory and for all grades, courses and levels of education, both in public and private centres. The norm provided that classes and educational activities have to continue online.

“Additionally, non-essential retail stores have been closed, excluding stores selling food, beverages, optical and orthopaedic products, hygiene products, pharmacies, launderettes, newsagents, petrol stations, tobacconists, technological and telecommunications equipment shops, or pet food shops. Limits have been placed on the number of people allowed inside stores at any given time, so queueing outside is mandatory and people are required to keep a minimum of 1-meter apart.

“Cultural centres such as museums, libraries and theatres, as well as local celebrations and parades, have been cancelled. In turn, hotels and restaurants, except if they have been recruited to serve healthcare workers or truck drivers, have also been closed. Attending places of worship, civil and religious ceremonies and funerals has been prohibited if the minimum distance measures cannot be complied with.”

“29 March: national lockdown measures have been tightened. All workers, except those providing essential services, must stay at home between 30 March and 9 April. Essential services include jobs needed to guarantee food, beverages, hygiene products, medicines, healthcare products and equipment, animal feed and energy supply, those providing healthcare and caregiving services, those related to security (e.g. civil protection, prison workers, private security), transport of goods, media, financial services or telecom services (Royal Decree Law 10/2020 https://www.boe.es/buscar/act.php?id=BOE-A-2020-4166).

“9 April: The Parliament has approved a lockdown extension until 26 April (https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4406) with the same conditions established on 14 March (see above). Hence, non-essential workers, who stayed at home from March 30 to April 9, are now entitled to come back to work, following the distancing and protection measures provided in the 11 April update of Good Practices at Work (Buenas prácticas en los centros de trabajo).”

Health Systems Facts is a project of the Real Reporting Foundation. We provide reliable statistics and other data from authoritative sources regarding health systems in the US and several other nations.

Page last updated May 12, 2021 by Doug McVay, Editor.

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