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It's been over a month since Spain declared its constitutionally-exceptional state of alarm. Since then, the health ministry has been providing updated totals of the Spanish coronavirus death toll and the number of infections every day. A distorted calculation, which up until now has been unreliable, because the instruction of the Spanish government to the health authorities in each autonomous community has been to count only those who lost their lives in hospital centres. Now, after the Catalan government decided on Tuesday to modify its system, incorporating deaths in senior citizens' residences and private homes, the Spanish ministry has also ordered a change of criteria.

Via a ministerial order published today in the state gazette, the regional authorities which manage the Spanish health system on the ground, are being given new guidelines, under which they will have to provide much more extensive and detailed epidemiological information than most have been sending so far, including the following daily statistics for Covid-19 in their community:

  • Cumulative total of confirmed cases of Covid-19 (tested and showing symptoms at the time of the test).
  • Cumulative total of confirmed cases that were asymptomatic when tested.
  • Cumulative total of confirmed cases that have been hospitalized (including ICU), in permanent or special hospitals.
  • Cumulative total of confirmed cases that have been admitted to ICUs, in permanent or special ICU facilities.
  • Cumulative total of confirmed cases who have been given a medical all-clear based on the applicable epidemiological criteria.
  • Cumulative total of confirmed cases who have died, independent of the place of death.
  • Cumulative total of confirmed cases among healthcare professionals.
  • Each of the above figures is to broken down by the type of test used to confirm the virus in each case (PCR test/rapid antibody test)

How much does this change things?

One key change is in the criteria for including deaths in the count, which, in part, parallels the change made by the Catalan health system this week: it asks for data on the cumulative total of deaths from the virus, regardless of the place of death. Only a day ago, the Spanish government publicly asked the Catalan authorities not to be "speculative with the death toll". Now, the instruction is that all victims can be reported, whether they died in hospitals, senior citizens' residences or their homes. 

However, there is an important condition: the new system imposed by the Spanish ministry of health makes it clear that only fatalities who have been tested can be added to the coronavirus death column. That is, those who have been diagnosed by a doctor cannot be counted due to their symptoms alone. Thus, it does not accept the new practice introduced by the Catalan health service of including both those who have died after a positive test and those who died untested but probably infected (after a diagnosis by a doctor). These people will still not be included in the Spanish statistics.

Apart from these figures on deaths, the new data requested also includes extra information on the confirmed cases that have been detected: the type of test used in their diagnosis, either a PCR or rapid antibody test; also, the numbers of symptomatic and asymptomatic patients found in those tested. 

But again, there is no attempt to ​obtain further information on non-confirmed but "possible" cases - showing symptoms. Such a category, introduced this week into the Catalan coronavirus figures, yielded numbers that have dwarfed the numbers of confirmed cases, eg on Thursday it was reported that there had been 59,195 possible cases in Catalonia and 39,736 confirmed cases.

Days later, a clarification

One other change in Spain's new protocol: with regard to numbers of hospitalizations, the Spanish health ministry had noted up till now in its daily reports that different regions had been providing data in one of two different ways - either daily or cumulative figures. Now, after many days have gone by, the ministry finally makes it clear that both sets of data are required: daily figures on Covid-19 patients in ICUs, as well as the total number of patients who have passed through the intensive care units since the onset of the epidemic.

Below, today's revised form setting out the daily information to be supplied by Spain's regional health authorities:  

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