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ANALYSIS: How bad is Spain’s fourth coronavirus wave?

Even though almost all of Spain has infection rates in the high or very high risk categories, epidemiologists believe the fourth Covid wave the country is currently enduring won’t be as severe as previous ones.

ANALYSIS: How bad is Spain's fourth coronavirus wave?
Healthcare workers accompany Carlos, 52, sick from Covid-19, as he meets his wife and daughter for the first time after his admission three months ago and one week after leaving the Intensive Care Unit (ICU) at the Hospital Del Mar in Barcelona, on January 25, 2021. Josep LAGO / AFP

On March 29th 2021, just as the Easter holidays were about to start in Spain, the country’s Health Emergencies Coordinator Fernando Simón said for the first time that Spain was indeed entering the fourth wave of the coronavirus, but that it could end up being “a little wave”.

This diminutive categorisation, which was seen as a misplaced joke by other Spanish epidemiologists, was dependent according to Simón on whether restrictions on mobility over Holy Week worked in stopping the spread of the virus. 

The evidence suggests that this did not pan out as hoped by Spanish authorities. After lowering the national fortnightly infection rate below the high risk level by mid march March (127 cases per 100,000 people), it started inching up again even before Easter and by mid-April stood at “extreme risk” levels in half of Spain: over 250 infections per 100,000 people over 14 days.

Despite the alarming figures, Simón’s forecast seems to be coming true this time. 

Unlike Spain’s other waves, in which the rebound from the minimum infection rate was immediate, this new increase has been a much smoother and irregular rise . 

There have been days in which the infection rate has even decreased within its general upward trend. 

By April 23rd 2021, Spain’s Health Ministry reported that the incidence of the virus had plateaued, referring to it as “the start of stabilisation”. 

Spain’s fortnightly infection rate has risen by 100 points in a month but a look at the incidence data from the past seven days shows that it stands at 108 cases per 100,000 people, whereas the 14-day rate is around 235 infections per 100,000. 

 “If the seven-day incidence is below 50 percent of the 14-day incidence, that means that the curve is falling,” Jesús Molina Cabrillana, spokesperson for the Spanish Society of Preventive Medicine, Public Health and Hygiene, is quoted as saying in El País. 

COVID-19 patients at rehab in Madrid. Photo: PIERRE-PHILIPPE MARCOU/AFP

Why is Spain’s fourth wave not as severe as others?

Inter-regional border closures over Easter may have played their part in helping to make this latest wave of coronavirus in Spain not as serious overall, but Spain’s vaccine campaign is likely to have been even more crucial.

Over 80s in Spain have now practically all been fully vaccinated and the regions are now vaccinating their over 70s population, meaning that those that are generally most vulnerable to the virus and most likely to die or be admitted to the ICU, have been immunised.

According to Spain’s Daily Mortality Monitoring System (MoMo), the country’s excess mortality has been reduced by 60 percent during the fourth wave when compared to the first one. Their graph above shows Spain’s monthly excess mortality numbers from before and during the pandemic.


The R number, the rate which measures on average how quickly and how many people a person with Covid infects others, has also fallen below 1.0, levels the Spanish government feels it can control.

Pressure on hospitals has increased slightly up to 22.6 percent of occupancy of ICU beds but health centres are not as overwhelmed as they were in March and April of 2020. 

However, despite the evidence suggesting that fewer people in Spain are being hospitalised or dying from Covid-19 during this fourth wave, daily infections are still at very high levels. 

From Thursday to Friday of last week, 11,731 new cases were reported in Spain over that 24-hour period.

How does the fourth wave compare to Spain’s previous waves?

Spain’s first wave, which began in March 2020 when the world was coming to terms with the reality of the pandemic, has been the country’s worst to date in terms of deaths, hospitalisations and infections. 

The true rate of infections in these early days of testing are not fully known, but a study conducted by Eurosurveillance found that 62 percent of over 80s who caught Covid-19 during the first wave in Spain died. 

Following two and a half months of lockdown and a deconfinement plan which led Spain to ease restrictions and restart tourism over summer, the second wave developed in November 2020.  Fortnightly infection rates exceeded 500 cases per 100,000 inhabitants and without strict lockdowns in place, the speed of descent of the infection curve slowed down.

In fact, Spain’s segunda ola (second wave) almost overlapped with the third, which began to skyrocket at the beginning of January 2021 after travel and gatherings were greenlighted by the government over Christmas.

By that stage, hospitals were better prepared and Spain’s testing capacity had been reinforced, meaning that Covid deaths were lower than during the first wave and ICUs weren’t as overwhelmed.

The higher number of PCR tests being carried out did result in the number of reported infections being considerably higher during Spain’s third wave than during its first and second ones, as seen in the graph above by Spain’s epidemiological society

But in terms of actual coronavirus deaths, Spanish health ministry data shows more than 45,000 for the first waveFrom July to December 2020, which encompasses the second wave, more than 20,500 Covid deaths were reported by Spain’s Health Ministry. 

There is no official recount of total deaths from Covid-19 for Spain’s third wave but a total of 19,200 people did lose their lives to Covid-19 between December 2020 and February 2021, according to data provided by Spain’s National Epidemiological Surveillance Network (RENAVE). Almost the same amount of people died in two months as in about six during the second wave.

As of April 26th 2021, Spain’s total number of coronavirus infections since the pandemic began stands at 3.46 million and the number of deaths has reached 77,591.

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Spain rules out EU’s advice on compulsory Covid-19 vaccination 

Spain’s Health Ministry said Thursday there will be no mandatory vaccination in the country following the European Commission’s advice to Member States to “think about it” and Germany’s announcement that it will make vaccines compulsory in February.

Spain rules out EU's advice on compulsory Covid-19 vaccination 
A Spanish man being vaccinated poses with a custom-made T-shirt showing Spain's chief epidimiologist Fernando Simón striking a 'Dirty Harry/Clint Eastwood' pose over the words "What part of keep a two-metre distance don't you understand?' Photo: José Jordan

Spain’s Health Minister Carolina Darias on Thursday told journalists Covid-19 vaccines will continue to be voluntary in Spain given the “very high awareness of the population” with regard to the benefits of vaccination.

This follows the words of European Commission chief Ursula von der Leyen on Thursday, urging Member States to “think about mandatory vaccination” as more cases of the Omicron variant are detected across Europe. 

READ ALSO: Is Spain proving facts rather than force can convince the unvaccinated?

“I can understand that countries with low vaccine coverage are contemplating this and that Von der Leyen is considering opening up a debate, but in our country the situation is absolutely different,” Darias said at the press conference following her meeting with Spain’s Interterritorial Health Council.

According to the national health minister,  this was also “the general belief” of regional health leaders of each of Spain’s 17 autonomous communities she had just been in discussion with over Christmas Covid measures. 

READ MORE: Spain rules out new restrictions against Omicron variant

Almost 80 percent of Spain’s total population is fully vaccinated against Covid-19, a figure which is around 10 percent higher if looking at those who are eligible for the vaccine (over 12s). 

It has the highest vaccination rate among Europe’s most populous countries.

Germany announced tough new restrictions on Thursday in a bid to contain its fourth wave of Covid-19 aimed largely at the country’s unvaccinated people, with outgoing Chancellor Angela Merkel speaking in favour of compulsory vaccinations, which the German parliament is due to vote on soon.

Austria has also already said it will make Covid-19 vaccines compulsory next February, Belgium is also considering it and Greece on Tuesday said it will make vaccination obligatory for those over 60.

But for Spain, strict Covid-19 vaccination rules have never been on the table, having said from the start that getting the Covid-19 jabs was voluntary. 

There’s also a huge legal implication to imposing such a rule which Spanish courts are unlikely to look on favourably. 

Stricter Covid restrictions and the country’s two states of alarm, the first resulting in a full national lockdown from March to May 2020, have both been deemed unconstitutional by Spain’s Constitutional Court. 

READ ALSO: Could Spain lock down its unvaccinated or make Covid vaccines compulsory?

The Covid-19 health pass to access indoor public spaces was also until recently consistently rejected by regional high courts for breaching fundamental rights, although judges have changed their stance favouring this Covid certificate over old Covid-19 restrictions that affect the whole population.

MAP: Which regions in Spain now require a Covid health pass for daily affairs?

“In Spain what we have to do is to continue vaccinating as we have done until now” Darias added. 

“Spaniards understand that vaccines are not only a right, they are an obligation because we protect others with them”.

What Spanish health authorities are still considering is whether to vaccinate their 5 to 11 year olds after the go-ahead from the European Medicines Agency, with regions such as Madrid claiming they will start vaccinating their young children in December despite there being no official confirmation from Spain’s Vaccine Committee yet.

READ MORE: Will Spain soon vaccinate its children under 12?

Spain’s infection rate continues to rise day by day, jumping 17 points up to 234 cases per 100,000 people on Thursday. There are now also five confirmed cases of the Omicron variant in the country, one through community transmission.

Hospital bed occupancy with Covid patients has also risen slightly nationwide to 3.3 percent, as has ICU Covid occupancy which now stands at 8.4 percent, but the Spanish government insists these figures are “almost three times lower” than during previous waves of the coronavirus pandemic.