Abstract
BackgroundThe first wave of the coronavirus disease (COVID-19) pandemic spread rapidly in Spain, one of Europe’s most affected countries. A national lockdown was implemented on 15 March 2020.AimTo describe reported cases and the impact of national lockdown, and to identify disease severity risk factors.MethodsNational surveillance data were used to describe PCR-confirmed cases as at 27 April 2020. We compared case characteristics by severity categories (hospitalisation, admission to intensive care unit (ICU), death) and identified severity risk factors using multivariable regression.ResultsThe epidemic peaked on 20 March. Of 218,652 COVID-19 cases, 45.4% were hospitalised, 4.6% were admitted to ICU and 11.9% died. Among those who died, 94.8% had at least one underlying disease. Healthcare workers (HCWs) represented 22.9% of cases. Males were more likely to have severe outcomes than females. Cardiovascular disease was a consistent risk factor. Patients with pneumonia had higher odds of hospitalisation (odds ratio (OR): 26.63; 95% confidence interval (CI): 25.03–28.33). The strongest predictor of death was age ≥ 80 years (OR: 28.4; 95% CI: 19.85–40.78). Among underlying diseases, chronic renal disease had highest odds of death (OR: 1.47; 95% CI: 1.29–1.68).ConclusionsCOVID-19 case numbers began declining 6 days after the national lockdown. The first wave of the COVID-19 pandemic in Spain had a severe impact on elderly people. Patients with cardiovascular or renal conditions were at higher risk for severe outcomes. A high proportion of cases were HCWs. Enhanced surveillance and control measures in these subgroups are crucial during future COVID-19 waves.
Highlights
As at 27 April 2020, 2,878,196 confirmed coronavirus disease (COVID-19) cases were notified globally, including 198,668 deaths, of which 1,359,380 cases and 124,525 deaths occurred in Europe [1]
COVID-19 cases with symptom onset before the first local transmission case on 26 February were retrospectively identified in samples swabbed for other diagnostic purposes or in hospitalised cases with pneumonia who were posteriorly screened for COVID-19 after a change in testing policy
A probable case was defined as a suspected case for whom testing for SARS-CoV-2 was performed, but the results reported by the laboratory were inconclusive
Summary
As at 27 April 2020, 2,878,196 confirmed coronavirus disease (COVID-19) cases were notified globally, including 198,668 deaths, of which 1,359,380 cases and 124,525 deaths occurred in Europe [1]. National universal surveillance of confirmed COVID-19 cases of any severity was implemented. The first wave of the coronavirus disease (COVID-19) pandemic spread rapidly in Spain, one of Europe’s most affected countries. Aim: To describe reported cases and the impact of national lockdown, and to identify disease severity risk factors. We compared case characteristics by severity categories (hospitalisation, admission to intensive care unit (ICU), death) and identified severity risk factors using multivariable regression. Of 218,652 COVID-19 cases, 45.4% were hospitalised, 4.6% were admitted to ICU and 11.9% died Among those who died, 94.8% had at least one underlying disease. The first wave of the COVID19 pandemic in Spain had a severe impact on elderly people. Patients with cardiovascular or renal conditions were at higher risk for severe outcomes. Enhanced surveillance and control measures in these subgroups are crucial during future COVID-19 waves
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