Spain’s hospitals are beginning to see patients struggling to breathe returning to their wards, less than two months after suppressing Covid-19.
A military emergency brigade set up a field hospital in Zaragoza this week, although authorities said it is just a precaution.
But it comes after scenes of hospitals filled to capacity and the daily death toll reaching more than 900 fatalities just a few months ago.
While an enhanced testing effort revealed a majority of the infected are asymptomatic and younger, making them less likely to need medical treatment, concern is increasing as hospitals begin to see more patients.
Experts are searching for reasons why Spain is struggling more than its neighbours after western Europe had won a degree of control over the pandemic.
“The data don’t lie,” Rafael Bengoa, the former health chief of Spain’s Basque Country region and international consultant on public health, said.
“The numbers are saying that where we had good local epidemiological tracking … things have gone well,” he said.
“But in other parts of the country where obviously we did not have the sufficient local capacity to deal with outbreaks, we have community transmission again, and once you community transmission, things get out of hand.”
Except for teenagers and young adults, Spaniards largely comply with mandatory face mask rules.
The health ministry also embarked on one of the world’s largest epidemiological surveys.
Randomly testing more than 60,000 people, it found the virus prevalence to be 5%, showing the population was far from “herd immunity”.
Spain, with a population of 47 million, leads Europe with 44,400 new cases confirmed over the past 14 days.
This compares with just 4,700 new cases registered by Italy, with 60 million inhabitants, which was the first European country to be rocked by the virus.
The number of hospital patients with Covid-19 has risen fivefold in Spain since early July, when cases were down to a trickle after a severe lockdown stopped a first wave of the virus that had pushed the health care system to breaking point.
On Tuesday, Spain’s ministry reported 805 people nationwide were taken to hospital over the past seven days.
Half of the 64 people who died over the previous week were from Aragon, the region surrounding Zaragoza.
Mr Bengoa believes social customs and traits prevalent in Mediterranean cultures, which emphasise physical contact and smaller personal space, have worked against Spain.
“Family gatherings are dangerous in Spain,” he said.
“We are being anti-Spanish in social gatherings if Spaniards don’t kiss, hug and touch one another.”
He added Spanish and Italian families live in larger, more multi-generational groups than in northern European countries, making contagion inside households more likely.
Some authorities seem to agree, with the Canary Islands government issuing a public awareness advert that shows a family gathering to celebrate a grandfather’s birthday.
People take off masks and embrace, only to end with the grandfather in a hospital bed.