Extremadura-Spain Country Report

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Kanika Chatkara https://www.linkedin.com/in/kanika-chatkara-a06550210/ (Emory Rollins School of Public Health)
2021-10-26

The COVID-19 pandemic started spreading rapidly in early 2020. Many countries were affected by it and began adopting measures to protect their citizens and curb the spread of this virus. The Government of Spain first announced a national lockdown before implementing a National Four Phase De-Escalation Plan designed to gradually relax strict policies aimed to reduce the spread of Covid-19 1. The national de-escalation plan was announced on March 14 and lasted until June 21 of 2020 2. The national plan was asynchronous; each Spanish province progressed through the four stages of de-escalation at a different pace, based on the province’s epidemiological situation. The loosened restrictions offered by the national government were not mandates, rather options for the provinces to adopt if desired; the process is individualized for each province 3. Each region’s progression through the de-escalation plan is based on their health system’s capacity, the epidemiological situation, collective compliance, and socioeconomic data 4.

Spain has 17 autonomous communities 5. Extremadura, for example, is located in the western region bordering Portugal 6. The community had a population of approximately 1.064 million residents in 2020 7. Extremadura has registered 1,835 deaths 8 and 92,737 confirmed cases 9 of COVID-19 as of August 10, 2021. 834,638 many residents of Extremadura have been vaccinated as of June 14, 2021 10. Like the rest of Spain’s provinces, Extremadura is co-governing its residents with the national government in order to curb exposure and reduce transmission of the virus. This is being done through various policies and lockdowns.

General regulated activities included transportation in public and private vehicles, public walks and exercise, business regulation, lockdown, mask mandates, and social distancing, among others. Spain implemented tough containment measures for its lockdown, including children not being allowed outside for six weeks 11. The Spanish Prime Minister outlined a full de-escalation plan for each region to follow at their own time 12. Each of the four phases would last at least two weeks, with the whole process taking a minimum of six weeks and hopefully a maximum of eight 13. Whether provinces were allowed to progress to the next, less restrictive, phase would depend on their infection rates, local hospital capacity, and how well the province’s residents were adhering to distancing measures 14.

All regions began Phase 0 at the same time spanning from May 4 to May 11 (2020) and it served as a foundation for the following phases. During this preparatory period, small businesses were allowed to reopen with restrictions based on store size and number of customers allowed in 15. This includes “shops of less than 400 square meters” open by appointment only with hours that “coincide with the time frame assigned to [priority citizens] for walks” with no more than one customer per employee” 16. Phase 1 began on May 11 (2020) and allowed scheduled and staggered walks for its citizens, eased restrictions on restaurants and other businesses, and allowed limited gatherings, among other things 17, 18. For example, businesses like hotels were allowed to open at limited capacity and outdoor gatherings were limited to 200 people as long as they remained seated 19. Phase 2, which began on May 25, saw more types of businesses, like theaters and cinemas, allowed to open with restrictions on capacity, places of worship had been allowed open previously but saw leniency in their capacity restrictions, among more 20. Phase 3 saw looser restrictions on gathering, businesses, and travel; this final de-escalation stage began on June 8 21. The start of Phase 3 marks the transition from co-governance to full governance; regional governments will assume power to control de-escalation from here on 22. The final extension to the state of alarm ended on June 21, 2020; Spaniards will recover more freedoms, such as freedom of movement across the country 23.

The Spanish economy has been devastated by the coronavirus and confinement measures. The nation’s economy had been recovering from the lingering effects of The Great Recession that began in 2008, when the pandemic hit and further damaged the financial and socio-economic situation 24. Specifically, Extremadura’s economy was estimated to have shrunk 9.2% in 2020 and is estimated to grow 4.2% in 2021 and 7.0% in 2022 as consumption and investment grows 25. According to the Living Conditions Survey published by the National Statistics Institute (INE), data collected in the fourth quarter of 2020 reflected 3.3 million Spaniards at the time faced a severe lack of necessities 26. In context, this means Spaniards lacked up to four necessities of nine, including: an inability to deal with unexpected expenses, an inability to afford a meal with meat or fish every two days, an inability to maintain an adequate home temperature, among more11. Extremadura was one among three regions with 12.7% of respondents having the most difficulty making it to the end of the month in 2020 27.

A 2021 study about social inequality focused on Madrid, a region of Spain hit very hard by the pandemic. The decline in mobility was found to be spatially patterned, with more mobility seen in the more deprived, poorer southern areas than the less deprived, richer northern areas 28. During the strictest part of lockdown, those allowed to telework were doing so, while those in essential jobs were required to commute to work 29. Examples of essential sectors include healthcare, grocery, and transportation; while vital, these essential employees worked in-person with little accommodation 30. Many of these positions are low-wage occupations; many are worked by migrants and minorities 31. They were also vulnerable to the health and economic risks brought on by the pandemic. Social distancing and ability to take proper measures to combat the pandemic were more available for those in a privileged position and/or location 32. Economic policies in Spain that target mobility do little for those working in essential sectors. Policies targeting mobility aim to stop exposure to the virus and curb infection, but cannot be fully effective due to social inequality. These types of policies may have negative impacts on residents in poorer areas, who likely have to work in person 33.

Socioeconomic problems like social mobility and vulnerability of certain groups to the virus are one factor of many when it comes to well-being during a pandemic. Inability to telecommute or take time off work not only increase exposure and incidence of infection but affect mental health. A 2021 study was conducted, studying the COVID-19 health crisis’ impact on social well-being, mental health, and financial security and resulting impact on suicide rates. The study focused on what impact confinement during the Spanish lockdown had on the incidence of deaths by suicide (DBS) in Extremadura. While the study found no significant difference in DBS in the 2020 confinement or post-confinement periods in the autonomous region, a greater impact on DBS can still be expected 34. The researchers studied mental health and DBS rates during previous instances of social and economic crises and can expect a similar impact during the ongoing COVID-19 pandemic 35. The researchers recommended more assistance programs and more vigilance to prevent an increase in suicides due to the pandemic 36.

The Spanish lockdown saw an overall reduction in infection rates two or three weeks after it was instituted 37. Even with national and local enforcement, some regions saw increased rates of mortality, partly associated with high mobility and high population density 38. The impact of social inequality on mobility and mental health was studied and, along with measures to curb the virus’ spread, social assistance is recommended [Glodeanu A, Gullón P, Bilal U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70(102580):102580.],[Puig-Amores I, Cuadrado-Gordillo I, Martín-Mora Parra GM-M. Suicide and health crisis in Extremadura: Impact of confinement during COVID-19. Trauma Care. 2021;1(1):38-48]. Though Spain’s economy suffered a major setback during the pandemic, it is expected to recover in the coming years 39.

  1. BBC News. Coronavirus: Spain plans return to “new normal” by end of June. BBC. https://www.bbc.com/news/world-europe-52459034. Published April 28, 2020. Accessed August 20, 2021↩︎

  2. Pablo Linde EP. Health Ministry will allow social meetings of up to 10 people under Phase 1 of Spain’s deescalation plan. Elpais.com. Published May 2, 2020. Accessed August 20, 2021. https://english.elpais.com/society/2020-05-02/health-ministry-will-allow-social-meetings-of-up-to-10-people-under-phase-1-of-spains-deescalation-plan.html↩︎

  3. BBC News. Coronavirus: Spain plans return to “new normal” by end of June. BBC. https://www.bbc.com/news/world-europe-52459034. Published April 28, 2020. Accessed August 20, 2021↩︎

  4. Pablo Linde EP. Health Ministry will allow social meetings of up to 10 people under Phase 1 of Spain’s deescalation plan. Elpais.com. Published May 2, 2020. Accessed August 20, 2021. https://english.elpais.com/society/2020-05-02/health-ministry-will-allow-social-meetings-of-up-to-10-people-under-phase-1-of-spains-deescalation-plan.html↩︎

  5. Nationsonline.org. Accessed August 20, 2021. https://www.nationsonline.org/oneworld/map/spain-administrative-map.htm↩︎

  6. Nationsonline.org. Accessed August 20, 2021. https://www.nationsonline.org/oneworld/map/spain-administrative-map.htm↩︎

  7. Población por comunidades y ciudades autónomas y tamaño de los municipios. Ine.es. Accessed August 20, 2021. https://www.ine.es/jaxiT3/Datos.htm?t=2915↩︎

  8. Spain: coronavirus deaths by region 2021. Statista.com. Accessed August 20, 2021. https://www.statista.com/statistics/1103955/deaths-related-to-coronavirus-by-region-spain/↩︎

  9. Spain: COVID-19 cases by region. Statista.com. Accessed August 20, 2021. https://www.statista.com/statistics/1102882/cases-of-coronavirus-confirmed-in-spain-in-2020-by-region/↩︎

  10. COVID-19: vaccination doses administered in Spain by region 2021. Statista.com. Accessed August 20, 2021. https://www.statista.com/statistics/1195701/covid-19-vaccination-doses-administered-in-spain-by-region/↩︎

  11. BBC News. Coronavirus: Spain plans return to “new normal” by end of June. BBC. https://www.bbc.com/news/world-europe-52459034. Published April 28, 2020. Accessed August 20, 2021.↩︎

  12. BBC News. Coronavirus: Spain plans return to “new normal” by end of June. BBC. https://www.bbc.com/news/world-europe-52459034. Published April 28, 2020. Accessed August 20, 2021.↩︎

  13. BBC News. Coronavirus: Spain plans return to “new normal” by end of June. BBC. https://www.bbc.com/news/world-europe-52459034. Published April 28, 2020. Accessed August 20, 2021.↩︎

  14. BBC News. Coronavirus: Spain plans return to “new normal” by end of June. BBC. https://www.bbc.com/news/world-europe-52459034. Published April 28, 2020. Accessed August 20, 2021.↩︎

  15. Thelocal.es. Accessed August 20, 2021. https://www.thelocal.es/20200508/what-you-can-and-cant-do-during-phase-1/↩︎

  16. Thelocal.es. Accessed August 20, 2021. https://www.thelocal.es/20200508/what-you-can-and-cant-do-during-phase-1/↩︎

  17. Pablo Linde EP. Health Ministry will allow social meetings of up to 10 people under Phase 1 of Spain’s deescalation plan. Elpais.com. Published May 2, 2020. Accessed August 20, 2021. https://english.elpais.com/society/2020-05-02/health-ministry-will-allow-social-meetings-of-up-to-10-people-under-phase-1-of-spains-deescalation-plan.html↩︎

  18. Sevillano EG. A practical guide for going out on the Spanish streets from today. Elpais.com. Published May 2, 2020. Accessed August 20, 2021. https://english.elpais.com/society/2020-05-02/a-practical-guide-for-going-out-on-the-spanish-streets-from-today.html↩︎

  19. Thelocal.es. Accessed August 20, 2021. https://www.thelocal.es/20200508/what-you-can-and-cant-do-during-phase-1/↩︎

  20. Pablo Linde EP. Health Ministry will allow social meetings of up to 10 people under Phase 1 of Spain’s deescalation plan. Elpais.com. Published May 2, 2020. Accessed August 20, 2021. https://english.elpais.com/society/2020-05-02/health-ministry-will-allow-social-meetings-of-up-to-10-people-under-phase-1-of-spains-deescalation-plan.html↩︎

  21. Carlos E. Cué EP. Spain’s PM puts final stage of coronavirus deescalation in hands of the regions. Elpais.com. Published May 31, 2020. Accessed August 20, 2021. https://english.elpais.com/politics/2020-05-31/spains-pm-puts-final-stage-of-coronavirus-deescalation-in-hands-of-the-regions.html↩︎

  22. Carlos E. Cué EP. Spain’s PM puts final stage of coronavirus deescalation in hands of the regions. Elpais.com. Published May 31, 2020. Accessed August 20, 2021. https://english.elpais.com/politics/2020-05-31/spains-pm-puts-final-stage-of-coronavirus-deescalation-in-hands-of-the-regions.html↩︎

  23. Carlos E. Cué EP. Spain’s PM puts final stage of coronavirus deescalation in hands of the regions. Elpais.com. Published May 31, 2020. Accessed August 20, 2021. https://english.elpais.com/politics/2020-05-31/spains-pm-puts-final-stage-of-coronavirus-deescalation-in-hands-of-the-regions.html↩︎

  24. Maqueda A. Coronavirus pandemic pushed poverty in Spain to highest levels since the Great Recession. Elpais.com. Published July 16, 2021. Accessed August 20, 2021. https://english.elpais.com/economy-and-business/2021-07-16/coronavirus-pandemic-pushed-poverty-in-spain-to-highest-levels-since-the-great-recession.html↩︎

  25. BBVA Research. Spain. Bbvaresearch.com. Published March 9, 2021. Accessed August 20, 2021. https://www.bbvaresearch.com/en/publicaciones/spain-extremadura-economic-outlook-2021/↩︎

  26. Maqueda A. Coronavirus pandemic pushed poverty in Spain to highest levels since the Great Recession. Elpais.com. Published July 16, 2021. Accessed August 20, 2021. https://english.elpais.com/economy-and-business/2021-07-16/coronavirus-pandemic-pushed-poverty-in-spain-to-highest-levels-since-the-great-recession.html↩︎

  27. Maqueda A. Coronavirus pandemic pushed poverty in Spain to highest levels since the Great Recession. Elpais.com. Published July 16, 2021. Accessed August 20, 2021. https://english.elpais.com/economy-and-business/2021-07-16/coronavirus-pandemic-pushed-poverty-in-spain-to-highest-levels-since-the-great-recession.html↩︎

  28. Glodeanu A, Gullón P, Bilal U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70(102580):102580↩︎

  29. Glodeanu A, Gullón P, Bilal U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70(102580):102580↩︎

  30. Glodeanu A, Gullón P, Bilal U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70(102580):102580↩︎

  31. Glodeanu A, Gullón P, Bilal U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70(102580):102580↩︎

  32. Glodeanu A, Gullón P, Bilal U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70(102580):102580↩︎

  33. Glodeanu A, Gullón P, Bilal U. Social inequalities in mobility during and following the COVID-19 associated lockdown of the Madrid metropolitan area in Spain. Health Place. 2021;70(102580):102580↩︎

  34. Puig-Amores I, Cuadrado-Gordillo I, Martín-Mora Parra GM-M. Suicide and health crisis in Extremadura: Impact of confinement during COVID-19. Trauma Care. 2021;1(1):38-48.↩︎

  35. Puig-Amores I, Cuadrado-Gordillo I, Martín-Mora Parra GM-M. Suicide and health crisis in Extremadura: Impact of confinement during COVID-19. Trauma Care. 2021;1(1):38-48.↩︎

  36. Puig-Amores I, Cuadrado-Gordillo I, Martín-Mora Parra GM-M. Suicide and health crisis in Extremadura: Impact of confinement during COVID-19. Trauma Care. 2021;1(1):38-48.↩︎

  37. 15. Siqueira CAdS, Freitas YNLd, Cancela MdC, Carvalho M, Oliveras-Fabregas A, de Souza DLB (2020) The effect of lockdown on the outcomes of COVID-19 in Spain: An ecological study. PLoS ONE 15(7): e0236779. https://doi.org/10.1371/journal.pone.0236779↩︎

  38. 15. Siqueira CAdS, Freitas YNLd, Cancela MdC, Carvalho M, Oliveras-Fabregas A, de Souza DLB (2020) The effect of lockdown on the outcomes of COVID-19 in Spain: An ecological study. PLoS ONE 15(7): e0236779. https://doi.org/10.1371/journal.pone.0236779↩︎

  39. J. S. González. LP. Spanish economy forecast to bounce back to pre-pandemic levels in 2022. Elpais.com. Published July 28, 2021. Accessed August 20, 2021. https://english.elpais.com/economy-and-business/2021-07-28/spanish-economy-forecast-to-bounce-back-to-pre-pandemic-levels-in-2022.html↩︎