An hour or so before lunch on Thursday, Ángela Falcón stepped out of the church of Our Lady of the Assumption and on to the hot and busy streets of Parla.
“I’m scared and I very seldom come out but when I do, I stop by the church to pray,” said the 71-year-old.
Like many in Parla, a satellite city of 130,000 people a half hour’s drive southwest of Madrid, Falcón is taking no chances with the coronavirus and its second wave.
On Monday, Spain raced past an unenviable milestone, becoming the first western European country to register 500,000 Covid cases, almost a third of them in the Madrid region.
According to figures from the regional government, Parla is the Madrid municipality with the highest accumulated incidence of the virus: in the fortnight from 24 August to 6 September, it had 876.1 cases per 100,000 inhabitants. Over roughly the same period, Spain as a whole had 265.5 cases per 100,000 people, France 140.6, the UK 41.7, and Italy 31.9 .
The rise in newly diagnosed cases is equally arresting, with more than 112,364 fresh cases detected in Spain over the past fortnight alone.
Despite the surge in numbers, however, there is little obvious panic to be found on the streets of Parla. People, both old and young, still shop, chat and stop to remove their masks for a mid-morning coffee or beer.
Clues as to the huge rise in cases – and the apparent, and counterintuitive, lack of fear – can be found in the city’s demographics.
Statistics from the Carlos III public health institute in Madrid show that 25% of new cases across Spain are being detected in people aged 15-29, while those aged 15-59 account for 71% of new cases. The most overrepresented groups are men and women aged 15-44 and women aged 89 and over. As Parla’s mayor, Ramón Jurado, points out, residents of the municipality are young, with an average age of just 34.
“During the first wave, there were hardly any cases here because they were only testing older people who went into hospital,” he says.
“We had one of the lowest rates in the Madrid region. But we’ve got a lot of cases now. The thing that counts in our favour is also something that counts against us: the number of young inhabitants.
“Young people move about more and they need to get to work – and, to do that, they need to use public transport.”
It is a pattern that is being repeated in other towns around Madrid and in the poorer, working class areas of the capital itself.
Daniel López Codina, a lecturer at the Polytechnic University of Catalonia, Barcelona, and member of its computational biology and complex systems research group, says the differences between the first and second waves of the virus are stark.
“They’ve got nothing to do with each other,” he says. “The virus is the same – the changes in it are not significant – there are still a huge number of people who are susceptible to it, so the situation is similar to the first wave. But the difference now is that we have learned how we need to act.”
López Codina and his colleagues recently completed a study into the second wave and identified three key factors in the coronavirus’s resurgence in Spain.
First, the country’s stringent, three-month lockdown was lifted a month too soon and should probably have remained in force until mid-July. Second, people treated the virus as a seasonal phenomenon like the flu and were overly, if understandably, keen to get back to bars and beaches. And, third, the medical contact tracking systems weren’t primed. Or, to put it more pithily: “We opened up again too soon, we were too relaxed and we didn’t have surveillance ready at a local level.”
But second time around, says López Codina, things are panning out quite differently. In March and April, about 50% of diagnosed cases ended up in hospital.
“Now, because we’re diagnosing a lot of mild or asymptomatic cases, it’s about 5%,” he says, adding that admissions to hospital and deaths are “more objective tools” – especially given the massive increase in testing since the previous peak.
For the time being at least, the numbers in hospital are nowhere near where they were in the spring, when many Spanish intensive care units – especially in Madrid – came perilously close to collapse.
The proportion of hospital beds occupied by Covid patients currently stands at 7.5% nationally, although the figure in Madrid is almost three times that, at 18%.
The death toll, too, remains relatively stable. By Friday evening, Spain had recorded a total of 29,747 coronavirus deaths, 241 of them over the previous seven days.
None of that, though, has stopped the squabbling, abuse and point-scoring that has characterised much of the political reaction to the pandemic.
The Madrid regional government, led by Isabel Díaz Ayuso of the conservative People’s party, took exception recently when both the prime minister and Spain’s health emergencies chief expressed concerns over the situation in and around the capital.
Ayuso accused the socialist-led coalition government of cruelly singling out the region, claiming its “irresponsible obsession with destabilising us will jeopardise the whole country’s recovery”.
Antonio Zapatero, deputy health minister in Ayuso’s government, also argues that Madrid is a case apart – not least because of its transport links, such as Barajas international airport.
“Madrid has seven million inhabitants – it’s a very small region that’s very densely populated – so managing the outbreak in Madrid isn’t the same as managing it in Asturias,” he says.
“Madrid is also doing more than 20,000 PCR tests a day, or about 150,000 a week. And a lot of people this time are asymptomatic, and that’s one of the big differences with March and April.”
While the Madrid government has recently promised to double the number of contact tracers to almost 1,100, and earlier this week ordered a ban on indoor meetings of more than 10 people, Zapatero insists “this isn’t the exponential tsunami we had in March and April”.
Francisco García, a doctor of internal medicine at Parla’s Infanta Cristina university hospital, remembers just how close to collapse Madrid’s health system was in March. “We weren’t prepared; we didn’t have the capacity to test people and we didn’t know which treatments worked,” he says.
“There was also a huge shortage of personal protective equipment. The hospital management was looking all over the place, but there was none left to buy.”
Since June, García and his colleagues have been working on protocols to counter a second wave and the hospital has been stockpiling protective gear.
The problem this time is that there just aren’t enough health workers to go round as the country confronts the virus again.
At the moment, says García, things are stable at the hospital, with Covid admissions mirroring daily discharges. “That’s actually pretty good in a pandemic situation, because it means we’re not overwhelmed,” he says. But medical staff are still tired from their efforts in the spring and dread the prospect of another onslaught.
“We were just battered during the first wave and were finding the energy to carry on out of nowhere. Now, although people are far less overloaded than before, we’re still pretty spent from the last time and we’re looking at having to go back to all that again.”