The first wave of the COVID-19 pandemic in Spain: characterisation of cases and risk factors for severe outcomes, as at 27 April 2020

Working group for the surveillance and control of COVID-19 in Spain, Members of the Working group for the surveillance and control of COVID-19 in Spain, Lidia Redondo-Bravo, María José Sierra Moros, Elena Vanessa Martínez Sánchez, Nicola Lorusso, Alberto Carmona Ubago, Virtudes Gallardo García, Pilar Sánchez Villanueva, Adela Puy Azón, Joaquín Guimbao Bescós, An Ld Boone, Ana Fernández Ibáñez, Blanca Álvarez Fernández, Antonio Nicolau Riutort, Magdalena Salom Castell, Jaume Giménez Duran, Domingo Núñez Gallo, Magdalena Lucia Rojo Moreno, Aniceto Blasco de la Fuente, Luis Javier Viloria Raymundo, Marcos Hernández Pereña, Matilde Chico Mena, Sonia Humanes Aparicio, Maria Soledad Illescas Fernández, Socorro Fernández Arribas, Mª Del Henar Marcos Rodríguez, Isabel Martínez-Pino, Mireia Jané, Ana Martínez, Pilar Ciruela, Katja Villatoro Bongiorno, Aina March Yagüe, Jordi Pérez Panadés, María Del Mar López-Tercero Torvisco, Cecilia Gordillo Romero, Beatriz Caleya Olivas, Sara De Miguel García, Esther Córdoba Deorador, Elisa Gil Montalbán, Manuel Del Valle Arrojo, Luisa Abraira García, Antonio Boullosa Cortés, Ana García-Fulgueiras, Mª Dolores Chirlaque, Mª Isabel Barranco, Itziar Casado, Jesús Castilla, Manuel García-Cenoz, Fernando Gonzalez Carril, Amaia Soraluce Olañeta, Mª Jesús Lázaro-Carrasco de la Fuente, Eva Martínez Ochoa, Ana Carmen Ibáñez Pérez, Ángela Blanco Martínez, Ana Isabel Rivas Pérez, Violeta Ramos Marín, Margarita Medina Vinuesa, Daniel Castrillejo Pérez, Atanasio Alfonso Gómez Anés, Francisco Pozo, Inmaculada Casas, Belén Peñalver-Argüeso, Despina Pampaka, Jesús A Oliva Domínguez, María Sastre García, Amparo Larrauri, Working group for the surveillance and control of COVID-19 in Spain, Members of the Working group for the surveillance and control of COVID-19 in Spain, Lidia Redondo-Bravo, María José Sierra Moros, Elena Vanessa Martínez Sánchez, Nicola Lorusso, Alberto Carmona Ubago, Virtudes Gallardo García, Pilar Sánchez Villanueva, Adela Puy Azón, Joaquín Guimbao Bescós, An Ld Boone, Ana Fernández Ibáñez, Blanca Álvarez Fernández, Antonio Nicolau Riutort, Magdalena Salom Castell, Jaume Giménez Duran, Domingo Núñez Gallo, Magdalena Lucia Rojo Moreno, Aniceto Blasco de la Fuente, Luis Javier Viloria Raymundo, Marcos Hernández Pereña, Matilde Chico Mena, Sonia Humanes Aparicio, Maria Soledad Illescas Fernández, Socorro Fernández Arribas, Mª Del Henar Marcos Rodríguez, Isabel Martínez-Pino, Mireia Jané, Ana Martínez, Pilar Ciruela, Katja Villatoro Bongiorno, Aina March Yagüe, Jordi Pérez Panadés, María Del Mar López-Tercero Torvisco, Cecilia Gordillo Romero, Beatriz Caleya Olivas, Sara De Miguel García, Esther Córdoba Deorador, Elisa Gil Montalbán, Manuel Del Valle Arrojo, Luisa Abraira García, Antonio Boullosa Cortés, Ana García-Fulgueiras, Mª Dolores Chirlaque, Mª Isabel Barranco, Itziar Casado, Jesús Castilla, Manuel García-Cenoz, Fernando Gonzalez Carril, Amaia Soraluce Olañeta, Mª Jesús Lázaro-Carrasco de la Fuente, Eva Martínez Ochoa, Ana Carmen Ibáñez Pérez, Ángela Blanco Martínez, Ana Isabel Rivas Pérez, Violeta Ramos Marín, Margarita Medina Vinuesa, Daniel Castrillejo Pérez, Atanasio Alfonso Gómez Anés, Francisco Pozo, Inmaculada Casas, Belén Peñalver-Argüeso, Despina Pampaka, Jesús A Oliva Domínguez, María Sastre García, Amparo Larrauri

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.

Keywords: COVID-19; SARS-CoV-2; Spain; pandemic; risk factors; surveillance.

Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Number of confirmed COVID-19 cases and relevant national and WHO announcements, RENAVE, Spain, January–April 2020 (n = 218,652)
Figure 2
Figure 2
Age-adjusted cumulative incidence of COVID-19 cases by Autonomous Region, RENAVE, Spain, January–April 2020
Figure 3
Figure 3
Distribution of COVID-19 cases by age and severity categories, RENAVE, Spain, January–April 2020

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