Policy responses for Spain - HSRM

Spain


Policy responses for Spain

1.2 Physical distancing

9 April: Non-essential workers, who stayed at home from March 30 to April 9, are now entitled to come back to work, following the distancing and protection measures provided in the April 11 update of Good Practices at Work (https://www.mscbs.gob.es/gabinetePrensa/notaPrensa/pdf/GUIA110420172227802.pdf).

As of April 26, children under 14 will be allowed to go for a 1-hour walk with an adult within a radius of one kilometre around their residence, from 9 a.m. to 9 p.m.  (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4877; Order SND/370/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-4665).

On April 28, the Prime Minister made public the de-escalation Plan. Building on the principles of public health protection, minimising individuals’ health risks and preservation of the national health system response capacity, the strategy will be gradual and asymmetric across territories and coordinated along with the regional authorities. Importantly, the strategy will be adapted, if needed, in accordance with the evolution of the epidemic and the impact (positive or negative) of the measures taken at each stage (https://www.lamoncloa.gob.es/consejodeministros/resumenes/Documents/2020/PlanTransicionNuevaNormalidad.pdf).

The presented Plan comprises four stages, each one lasting at least two weeks (that is, COVID-19 incubation time). The decision for a territory (that is, province, island or healthcare area) to start off the process and the progression across stages will lie on the achievement of several criteria referred to the epidemiological situation and the health system capacity. In addition to the de-escalation indicators, health authorities will monitor the population’s mobility and the socioeconomic situation in each territory (https://www.lamoncloa.gob.es/consejodeministros/resumenes/Documents/2020/28042020_Anexo%20I%20PANEL%20DE%20INDICADORES.pdf; Order SND/387/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4792). In the eventual success of the strategy at the end of the third stage, mobility will be allowed across territories.

In any case, once stage 3 is over, individual protection measures, physical distancing, epidemiological surveillance, and the reinforcement of the health system will be maintained sine die (https://www.lamoncloa.gob.es/consejodeministros/resumenes/Documents/2020/PlanTransicionNuevaNormalidad.pdf).

Since May 2, the general population living in municipalities with more than 5,000 inhabitants will be allowed to go for a walk and do sport by time slots. In particular, from 6am – 10am and from 20.00-23.00, people of 14 years and older can go for a walk with one co-habitant within a radius of one kilometre around their residence once a day or practice solo sports within the limits of the municipality of residence once a day (using transport to reach another spot in the province for this purpose is not allowed) and always keeping the safety distance. Non-institutionalised people over 70 and dependent people can go out from 10am to 12pm and from 7pm to 8pm (Order SND/380/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4767). Besides, children will now be able to go out from 12.00pm to 19.00pm only, in the same conditions as before (maximum 3 children with only one adult) (updating prior Order SND/370/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-4665).  
   
In those municipalities with fewer than 5,000 inhabitants, time slots do not operate, so that the aforementioned activities will be allowed for everyone from 6am to 11pm (Order SND/380/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4767), keeping the safety distance.

These measures will not affect the older people in assisted-living or nursing homes, or beneficiaries of home-care, nor modify the quarantines prescribed to those people with symptoms or risk contacts of a patient with COVID-19.

Beyond alleviation measures such as children’ or co-habitants’ walks and solo practice of sport, some of the de-escalation measures at each stage are detailed below (https://www.lamoncloa.gob.es/consejodeministros/resumenes/Documents/2020/28042020_Anexo%20II%20FASES.pdf):
Stage 0 Readiness. Conditioned to indicators’ compliance, this stage is expected to start off on May 4 all over the territory, except in the islands of La Gomera, El Hierro, La Graciosa (Canary Islands) and Formentera (Balearic Islands), that will enter directly to stage 1. At this stage, social workers will go back to work and urban public transport will increase its frequency. Stores and businesses will be allowed to operate with prior appointment, and restaurants with take-away services available will be allowed to open. In turn, federated athletes will be able to start individual training (Order SND/388/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4793).

Since May 4, face masks are mandatory in public transport (that is, trains, buses, airplanes, boats and vehicles with up to nine seats). In private transport (for example, taxi or transfer services), only two people per seat row will be allowed if they wear face masks and maintain the safety distance. In trains or buses, where all passengers must be seated, they should operate at half capacity to assure proper physical distancing (Order TMA 384/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4789; Order TMA 424/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5192).

Stage 1 Start. At this stage, gatherings up to ten people are allowed without age restrictions. In terms of mobility, travelling and moving to the second home are permitted, although only within the province or island. Social services will resume their outreach activity prioritising the most vulnerable people. Public transport will operate over 80% of its capacity. At this stage, companies will develop safety protocols for their workers to go back to in-site work at Stage 3. In addition, small retail businesses and terraces in restaurants (only up to 50% of capacity) and hotels (excluding communal areas) will be allowed to open. Food, agriculture and fishing sectors will resume those activities that were kept with restrictions during the lockdown. Places of worship will open with a maximum turnout of a third of their actual capacity. High-performance sport centres for athletes will be allowed to open reinforcing hygienic and protective measures (https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4911).

Due to their specific epidemiological situation and geographical advantages, the islands of La Gomera, El Hierro, La Graciosa (Canary Islands) and Formentera (Balearic Islands) will enter stage 1 on May 4 (Order SND/386/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4791).

Stage 2 Intermediate. Although face to face learning will resume in September, educational centres will open at this stage under three circumstances: students in grades awarding a certificate if learning reinforcement activities are needed, children under six whose parents cannot telework, and the day where the access-to-college exam takes place. In turn, shopping centres will open with a turnout up to 40% and the inner spaces in restaurants up to one third of their capacity, in case they guarantee physical distancing rules. Cinemas, theatres and similar facilities will be allowed to open with assigned seats up to a third of their capacity; the same turnout will be allowed for museums and exhibitions centres. At this stage places of worship will be allowed to increase capacity up to 50%. Professional sports competitions will be allowed behind closed doors.

Stage 3 Advanced. At this stage, nursing and living-assisted homes will start de-escalation. Mobility within the territory will be relaxed although keeping recommendations on masks usage. Public transport will be 100% operational. Turnout capacity in shopping centres will increase up to 50%, if 2-meter physical distancing can be attained. Likewise, in restaurants, capacity restrictions will be relaxed but not physical distancing measures.

When it comes to progressing to a new phase, regional health authorities will be responsible for the assessment of a territory and for a formal proposal to the Ministry of Health, which should include details on transition measures, the tentative timeline for their implementation, as well as measures to reduce transmission risks. The Ministry of Health will hold full responsibility for the final decision on upgrading the de-escalation in a specific territory.  
The Ministry of Health decision-making process will be based on the information provided by the regions with regard to the epidemiological status of the territory at the time of the submission of the proposal, the availability of health resources and the capacity of a rapid response in the eventual case of an epidemiological relapse; specifically, maintaining the current healthcare workforce and the ability to increase ICU beds between 1.5 and 2 per 10,000 inhabitants,  and hospitalization beds between 37 and 40 per 10,000 inhabitants, in 5 days maximum (Order SND/387/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4792).

May 6: An extension of the “state of alarm” has been approved by the parliament. The measure will be in place until May 24 (https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4896). 
As part of the de-escalation process, on May 8, the Ministry of Health announced those territories advancing to stage 1 of the transition plan from May 11 onwards: the whole Autonomous Communities of Galicia, Asturias, Cantabria, País Vasco, La Rioja, Navarra, Aragón, Extremadura, Murcia, Canaries and Balearic Islands, and the autonomous cities of Ceuta and Melilla,  as well as some other territories in the remaining Autonomous Communities -six provinces in Andalucía (all except Granada and Málaga), two provinces in Castile-La Mancha (Cuenca and Guadalajara), ten healthcare areas in Valencia and three regions in Catalonia (Order SND/399/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4911).

On May 18, the remaining territories in Andalusia, Valencia and Castile La Mancha, as well as some regions in Catalonia (except Barcelona) and some healthcare areas in Castile Leon have entered stage 1, while the islands of La Gomera, El Hierro, La Graciosa (Canary Islands) and Formentera (Balearic Islands) have progressed to stage 2.

Although initially foreseen to restart at stage 2, some activities have been authorised to restart earlier at stage 1; so, shops bigger than 400 square meters are allowed to reopen if they limit their selling space, sales are permitted if crowds can be avoided, and hunting and fishing are authorised.

As an alleviation measure, the remaining territories still at stage 0 (Madrid, Barcelona and remaining healthcare areas in Castile Leon), are able to reopen some shops and businesses and professional sport training has been granted, in the same conditions as if they would have progressed to stage 1 (Order SND/414/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5088).

From May 20, the use of face masks (preferably, hygienic or surgical face masks) are mandatory outdoors and indoors, if a minimum physical distance of two meters cannot be guaranteed. The norm, though, has some exceptions; for example, children under six years old and people with respiratory disorders or conditions that could worsen because of their use (e.g. mental health disorders) are exempted. In addition, activities incompatible with their use (e.g. sport practice) are also excluded. This measure will be in place while the state of alarm is ongoing (Order SND/422/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5142).

On May 20, the fifth extension of the “state of alarm” was approved by the Spanish Parliament. The measure will be implemented until June 7 (RD 537/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5243).
On May 22, the Ministry of Health issued an order relaxing certain restrictions in smaller municipalities (less than 10,000 inhabitants and with a population density less than 100 inhabitants per square kilometre) currently at stage 0 or 1. Mainly, time slot constraints for children and non-professional physical activities and sport practice have been removed, restaurants, hotels and tourist resorts are allowed to open as well as street-markets, though they should maintain occupancy rates restrictions and physical distancing measures, respectively (Order SND/427/2020, https://boe.es/boe/dias/2020/05/22/pdfs/BOE-A-2020-5218.pdf) 
When it comes to progressing de-escalation, on May 25, Madrid, Barcelona and the remaining healthcare areas in Castile Leon still at stage 0 entered stage 1. The remaining healthcare areas in Castile Leon, the health regions of Girona and Pla de Lleida, the region of Valencia, and the provinces of Málaga, Granada, Toledo, Ciudad Real and Albacete remained at stage 1, while all the other territories progressed to stage 2 (Orden SND/442/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5267).

In addition, as of May 25 some of the restrictions foreseen at the beginning of the de-escalation plan have been modified. For instance, those territories at stage 1 are now allowed to adjust museum occupancy from 30% to 50% or to open cultural centres up to one third of their occupancy.  In turn in those territories at stage 2, visits to assisted-living or nursing homes are allowed under each region’s requirements and conditions and the occupancy rates of bars and restaurants’ terraces has increased to 50%.

Furthermore, access and the use conditions of beaches and leisure baths have been further specified  (Order SND 440/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5265; Order SND 445/2020 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-5323) following the recommendations issued by the Ministry of Health (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4936; https://www.mscbs.gob.es/gabinetePrensa/notaPrensa/pdf/24.05240520094526477.pdf).

Along the same lines, some restrictions have been alleviated, as of May 27, in those territories at stage 2. For example, physical activity for children and adults will no longer have neither the frequency nor the one kilometre restriction (Order SND 445/2020 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-5323).
On June 1, the islands of La Gomera, El Hierro, La Graciosa (Canary Islands) and Formentera (Balearic Islands) progressed to stage 3, while the autonomous community of  Valencia, Granada and Malaga in Andalusia, Toledo, Ciudad Real and Albacete in Castile La Mancha, Girona, Alt Penedès, El Garraf, Catalunya-Central in Catalonia, Totana in Murcia and El Bierzo in Castile Leon entered stage 2 (Order SND 458/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5469). 70% of the Spanish population is still at stage 2.

In those territories entering stage 3, free movement along the territory will be allowed without any time slot restriction as it used to be at stage 2, gatherings up to 20 people will be permitted and restrictions in shops, restaurants, hotels, cultural centres, museums, cultural and sports events will be gradually loosened (Order SND 458/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5469).

On June 3, the Spanish Parliament approved the last (and sixth) extension of the “state of alarm” expected to come to an end on June 21, three months and seven days after the lockdown started off (Royal Decree 555/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5767).

On June 8, the autonomous communities and regions of  Andalucía, Aragón, Asturias, Baleares, Canaries, Cantabria, Guadalajara and Cuenca in Castile La Mancha, Alt Pirineu i Arán, and Tarragona in Catalonia,  Extremadura, Galicia, La Rioja, Navarra, Melilla, Murcia and Basque Country, progressed to stage 3. Madrid, Castile Leon and the health regions of Barcelona and Lleida entered stage 2 (Order SND/507/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5795). Currently, 52% of the Spanish population is at stage 3 (25 million people).

Despite the continuation of the state of alarm within stage 3, a co-governance instrument has been implemented, devolving decision-making mechanisms, once in hands of the Central Government, to the Presidents of the autonomous communities, who will act as the Delegate Competent Authority. So, Presidents, in agreement with the Central Government, have taken over the decisions on how to manage the transition period (de-escalation process) in their regions, deciding what measures have to be taken, modified or alleviated, as well as for how long those measures should hold in their territories (Royal Decree 555/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5767).

As of June 8, 100% turnout in public transport (bus or train) is allowed. In the case of urban transports, standing passengers are permitted at a maximum of two users per square meter (Order SND/507/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5795)

On June 10, the government issued a Royal Decree with preventive, containment and coordination measures aiming to face the COVID-19 crisis when the state of alarm expires next June 21 (or before that date in those territories that had already completed the transition plan) (Royal Decree 21/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5895).

Main provisions are:
People over six years old have to wear face masks in transports. Similarly, masks should be wear outdoors or in closed public spaces where a minimum distance of 1.5 meters cannot be assured. As foreseen in previous legislation, people with respiratory disorders, conditions that could worsen because of their use (e.g. mental health disorders) or activities incompatible with their use (e.g. sport practice) are exempted. No observance of this measure will be deemed mild offence and it will be fined with up to EUR 100.

Work centres have to adopt ventilation, cleaning and disinfection measures, as well as making available water, soap or hydro alcoholic gel for their workers. In addition, work posts, shifts and communal places will be regulated to guarantee a 1.5 m distance between workers. If this is not possible, workers should be provided with the appropriate protective equipment. In addition, massive concurrence of workers, users or clients will be prevented, and remote working will be encouraged whenever possible.

Regional authorities have to guarantee that social centres (e.g., assisted-living homes, nursing homes, centres for disabled people, tutelary houses) fulfil prevention and reconditioning measures and to coordinate with the healthcare resources in the area. In turn, social centres should implement organizational measures to prevent infections and develop contingency plans aimed at the early detection of cases among users and workers as well as contacts, in coordination with the health services.

Regional authorities have to guarantee that education centres, shops, hotels, restaurants, cultural  centres, sport centres and any public centre fulfil regulation on prevention, reconditioning and limited turnout. Owners will implement organisational and preventive measures, in particular those to guarantee 1.5 meters of physical distancing; should this not be possible, additional measures should be adopted to reduce infection risks.
Lastly, road, train, sea and air operators selling numbered and assigned seats are required to keep passengers' contact information for at least 4 weeks, and they could be required to provide that information to trace contacts.

On June 15, Galicia finished the transition period, so the state of alarm was no longer in place in this region. In addition, Comunidad Valenciana, Ceuta, Ciudad Real, Toledo, Albacete, León, Zamora, Palencia, Valladolid, Burgos, Girona and Catalunya Central progressed to stage 3, the last stage of the transition plan (Order SND/ 520/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-6088).

On June 18, Barcelona and Lleida also progressed to stage 3 (Order SND/535/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-6310), so that the whole region of Catalonia is already at the last stage of the transition plan;  thus, only 22% of the Spanish population remains at stage 2 (that is, Madrid, Salamanca, Segovia, Ávila and Soria) (Order SND/535/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-6310).

On June 21, after 14 weeks, the state of alarm came to an end. All responsibilities were fully devolved to the autonomous communities, once in hands of the Spanish government and more recently, in a co-governance system. Since then, all Spanish citizens are allowed to travel freely across the territory. When it comes to public health decisions, the Departments of Health at regional level, in coordination with other regional health authorities and the Ministry of Health, have taken over any decisions derived from changes in the epidemiological situation. So, for example, the regional government of Aragon has decided to move back four municipalities to stage 2 as a consequence of new outbreaks (Order SAN/477/2020 http://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VERDOC&BASE=BOLE&PIECE=BOLE&DOCS=1-29&DOCR=29&SEC=FIRMA&RNG=200&SEPARADOR=&&PUBL=20200622; Order SAN/481/2020  http://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VERDOC&BASE=BOLE&PIECE=BOLE&DOCS=1-28&DOCR=28&SEC=FIRMA&RNG=200&SEPARADOR=&&PUBL=20200623).
     
As of July 9, due to the numerous community outbreaks occurred within its territory, the regional government in Catalonia has issued the obligation of wearing face masks regardless the ability to keep 1.5 metres of physical distancing (SLT/1648/202 https://portaldogc.gencat.cat/utilsEADOP/PDF/8173/1803867.pdf).
In other regions where outbreaks have also been detected, focused restrictive measures (e.g. isolation of exposed people, movement restrictions within the municipality, confinement of condos) have been taken to avoid community transmission.

As a consequence of the number of outbreaks spreading over all the territory, some of them within institutions (e.g.  and some others with a component of community outbreak, regional health authorities have issued different measures depending on their characteristics. For instance, some territories are observing restrictions in mobility to just cover essential activities, others have restricted mobility to enter in or exit from the affected areas, others have limited the turnout of restaurants, shopping centres, museums, theatres, cinemas and other cultural centres or limiting gatherings up to ten people. In those affected territories where mobility is not restricted, there is a general recommendation of avoiding all unnecessary journeys (Aragón: http://www.boa.aragon.es/cgi-bin/EBOA/BRSCGI?CMD=VEROBJ&MLKOB=1122362222020&type=pdf;  Catalonia: https://portaldogc.gencat.cat/utilsEADOP/PDF/8176/1804572.pdf: https://portaldogc.gencat.cat/utilsEADOP/PDF/8177A/1804867.pdf; https://portaldogc.gencat.cat/utilsEADOP/PDF/8177A/1804869.pdf; Basque country https://www.euskadi.eus/contenidos/informacion/covid19/es_def/adjuntos/BOPV-salud-15-07-2020-es.pdf). In addition, almost all regions in the country (Catalonia, Extremadura, Balearic Islands, Murcia, Andalusia, Aragon, La Rioja, Navarra, Asturias, Castile León, Basque Country) have issued the obligation of wearing face masks regardless of the ability to keep 1.5 metres of physical distancing.

On July 15, since many of the outbreaks have been related to temporary workers in the agricultural sector, the Minister of Health and the Minister of Agriculture have met with regional representatives to coordinate a response for future agricultural seasons. The main source of contagion stems from the poor conditions workers are living in rather than from the activity itself. So some regions have already set up premises to accommodate the workers or to isolate them, if required (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=5003).
 
In the last two weeks of July, Castile-La Mancha, Valencia, Galicia and Madrid have also issued the obligation of wearing face masks regardless of the ability to keep 1.5 metres of physical distancing.

On August 13, Galicia and Canaries extended the need for the use of the mask in any case, practically prohibiting the possibility of smoking on terraces or open spaces when a sufficient safety distance cannot be maintained (Galicia-DOG N16bis https://www.xunta.gal/dog/Publicados/excepcional/2020/20200812/2393/AnuncioC3K1-120820-1_es.html and  Canarias-BOC 164 http://www.gobiernodecanarias.org/boc/2020/164/004.html).  Other measures, including further restrictions to nightlife, are being implemented across several regions.

On August 14, the Interterritorial Council agreed on passing several measures and recommendations aimed to tackle the increase of Covid-19 cases in the country. Main measures include: limiting nightlife businesses opening hours, restricting access to crowded events, prohibiting alcohol binge drinking in the streets (so called ‘botellón’ in Spanish), prohibiting smoking on public spaces where safe distance could not be maintained, and discouraging gatherings of over ten people (https://www.mscbs.gob.es/gabinete/notasPrensa.do?metodo=detalle&id=5025).   

On September 30, the Interterritorial Council agreed to a set of restrictive measures to be taken in those municipalities with a population larger than 100,000 inhabitants. Those measures will be implemented when the 14-day incidence is higher than 500 cases per 100,000 inhabitants, PCR positivity in the last two weeks is above 10%, and when ICU admissions for COVID-19 patients represent more than 35% of the occupancy rate.

Among others, the most important mandatory measures are: entry to and exit from the municipality will be restricted to properly justified causes for example commuting to work, healthcare visits or class attendance; gatherings will be limited to six people for non-cohabitants; maximum capacity of retail and services businesses open to the public will be 50% and closing times will be limited to 22:00; occupancy rates in hotels, restaurants, sport facilities and betting shops will be up to 60% outdoors and 50% indoors and their closing time will be 23:00 -this schedule excludes take-away services; and, in turn, places of worship will reduce their turnout to a third.

It is also recommended avoiding unnecessary travels within the affected municipalities and having a response plan to control transmission in those municipalities with fewer than 100,000 inhabitants in the same circumstances as those mentioned.
In addition, the Autonomous Communities, where these municipalities are settled, will have to reinforce their capabilities in detection, control  and healthcare provision according to the Plan for an early response to control the COVID-19 pandemic (Resolution  https://boe.es/diario_boe/txt.php?id=BOE-A-2020-11590; https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov/documentos/COVID19_Plan_de_respuesta_temprana_escenario_control.pdf).

3 March: The first community outbreak was declared, prompting progressive physical distancing measures. From this date, all professional sport events with potentially high numbers of supporters from COVID-19 high-risk areas would be staged behind closed doors. Furthermore, all health professionals were requested not to attend conferences, courses or seminars in order to assure their availability in the days that followed (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4803).

9 March: The Inter-territorial Council of the National Health System (Ministry of Health with Autonomous Communities representatives) agreed on new measures to slow down the spread of the new coronavirus (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4806). In those regions where a community outbreak was declared, e.g. Madrid, parts of the Basque Country (Vitoria) and La Rioja (Labastida), schools and universities were closed and remote working (teleworking) was recommended. In addition, for the entire country, the official advice was to avoid non-essential travel. Particularly high risk groups (that is, elderly people, chronic patients or immunosuppressed patients) were advised to stay at home and, whenever they had to go outdoors (e.g. for shopping, care visits), to maintain a distance of at least 1-meter from others. For those people with respiratory symptoms, there were specific recommendations to confine themselves at home, irrespective of the causes of the infection.

10 March: The Spanish cabinet approved additional measures to complete those taken the previous day in the Inter-territorial Council (https://www.lamoncloa.gob.es/consejodeministros/resumenes/Paginas/2020/100320-consejo-ministros.aspx). According to these new measures, all direct flights to and from Italy were suspended; publicly-subsidized travel for pensioners (namely travel under the IMSERSO programme which providers older people holidays in coastal areas and other parts of Spain) were cancelled for a month; sports events had to be staged behind closed doors; and, other celebrations or gatherings had to be individually assessed by the health authorities -  although, events with more than 1000 people were banned in those regions with community transmission. In addition, the Ministry of Inclusion, Social Security and Migrations ordered that Centres for Temporary Stays of Migrants (CETI) had to establish specific areas for isolation.

12 March: The Inter-territorial Council agreed on deepening physical distancing measures across the whole country advocating, among others, the suspension of face-to-face educational programs and teleworking. These recommendations were brought to the Conference of Presidents (that is, Prime Minister and the Presidents of the ACs) who decided to endorse the measures (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4808).

14 March: the ‘State of Alarm’ was declared and freedom of movement was severely restricted throughout the country, initially for 15 days, and then extended for 15 more days, until 11 April (Royal Decree 463/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-3692). During this period, citizens are required to stay at home and are only allowed to use public roads to carry out very specific activities: namely, acquiring food, pharmaceuticals or basic needs; going to work; attending health    centres; travelling to work; returning to their regular residence; assisting and caring for elderly people, minors, dependents, people with disabilities or especially vulnerable people; visiting financial institutions; or other justified reasons due to necessity. Similarly, private vehicles are only allowed on public roads to carry out the aforementioned activities, or to refuel at petrol stations. These activities must be carried out by one person at a time, except in the case of dependent or disabled people who are allowed to be accompanied.
Regarding education, face-to-face activity has been formally suspended for all the territory and for all grades, courses and levels of education, both in public and private centres. The norm provided that classes and educational activities have to continue online. 

Additionally, non-essential retail stores have been closed, excluding stores selling food, beverages, optical and orthopaedic products, hygiene products, pharmacies, launderettes, newsagents, petrol stations, tobacconists, technological and telecommunications equipment shops, or pet food shops. Limits have been placed on the number of people allowed inside stores at any given time, so queueing outside is mandatory and people are required to keep a minimum of 1-meter apart.

Cultural centres such as museums, libraries and theatres, as well as local celebrations and parades, have been cancelled. In turn, hotels and restaurants, except if they have been recruited to serve healthcare workers or truck drivers, have also been closed. Attending places of worship, civil and religious ceremonies and funerals has been prohibited if the minimum distance measures cannot be complied with.

29 March: national lockdown measures have been tightened. All workers, except those providing essential services, must stay at home between 30 March and 9 April. Essential services include jobs needed to guarantee food, beverages, hygiene products, medicines, healthcare products and equipment, animal feed and energy  supply,  those providing healthcare and caregiving  services,  those related to security (e.g. civil protection, prison workers, private security), transport of goods, media, financial services or telecom services (Royal Decree Law 10/2020 https://www.boe.es/buscar/act.php?id=BOE-A-2020-4166).

9 April: The Parliament has approved a lockdown extension until
26 April (https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4406) with the same conditions established on 14 March (see above).

22 April: A third lockdown extension has been approved by the parliament. The measure will be in place until May 9 (http://www.congreso.es/portal/page/portal/Congreso/Congreso/SalaPrensa/NotPre?_piref73_7706063_73_1337373_1337373.next_page=/wc/detalleNotaSalaPrensa?idNotaSalaPrensa=35709&mostrarvolver=N; https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-4648).