2. Ensuring sufficient physical infrastructure and workforce capacity
ENSURING SUFFICIENT PHYSICAL INFRASTRUCTURE AND WORKFORCE CAPACITY is crucial for dealing with the COVID-19 outbreak, as there may be both a surge in demand and a decreased availability of health workers. The section considers the physical infrastructure available in a country and where there are shortages, it describes any measures being implemented or planned to address them. It also considers the health workforce, including what countries are doing to maintain or enhance capacity, the responsibilities and skill-mix of the workforce, and any initiatives to train or otherwise support health workers.
2.1 Physical infrastructure
The Minister of Health continues distributing surgical masks to reinforce the strategic reserve of the autonomous communities, securing 5 weeks of supply. More than 3.8 million masks have been allocated in the past few days. Furthermore, more than 3 million surgical masks have been distributed to non-for-profit organisations and charities (Red Cross, Cáritas and CERMI) to guarantee vulnerable people protection (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4947).
Once the state of alarm expires, manufacturers and distribution agents will have to guarantee the supply of the drugs deemed essential in the COVID-19 crisis. In addition, they have to report to the Spanish Agency of Medicines and Medical Products (AEMPS) on production capacity, available stock, volume supplied the week before and forecasts on short-term drugs inbound and outbound. The Ministry of Health is entitled to prioritise the manufacturing of this kind of essential medicines if needed (Royal Decree 21/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5895, https://boe.es/diario_boe/txt.php?id=BOE-A-2020-6474).
The AEMPS will continue licensing factories for the manufacturing of surgical masks and protective gowns until July 31 (Royal Decree 21/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-5895).
On 10th March, the Central Government modified the Law on Public Health in order to enable centralised purchasing of medicines and health products of any kind for the whole country's needs (Royal-Decree Law, Documento BOE-A-2020-3434).
Since 14th March, after the declaration of the “state of alarm”, the Minister of Health is entitled to determine the best distribution of technical resources (including those from the military forces, the private health sector and private business such as hotels), and to issue the necessary orders that ensure the market supply of any product needed for public health protection. Thus, the Minister of Health can temporarily take over industries, factories, or premises of any nature, including those related to the pharmaceutical sector, and is able to seize any goods needed to protect public health (Royal Decree 463/2020, https://www.boe.es/buscar/doc.php?id=BOE-A-2020-3692).
Well soon after the crisis started off, shortage of personal protective equipment (especially masks and gowns) has been extensively documented and recognised by the health authorities. The Spanish and Regional governments have faced unprecedented difficulties to find and purchase PPE, both in the national and the international markets.
From 10 March to 10 April, the central government has distributed among regions: 38.7 million of face masks, 22.9 million nitrile gloves, more than 163,400 safety goggles, 287,500 disposable gowns and 269,000 coveralls. In addition, up to 253 invasive and 1,602 non-invasive ventilators have been distributed across regions (https://www.mscbs.gob.es/gabinete/notasPrensa.do?id=4856).
Since April 6, Spanish licensed companies and factories are entitled to manufacture surgical masks and protective gowns considering both as health products (Order SND/326/2020 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-4322), as a complementary measure for the upcoming lockdown exit strategies.
The ICU’s bed capacity in public hospitals has increased at the expense of using resources from other units (e.g. post-surgical awakening units) or adapting hospitalization or surgical beds, when needed. Furthermore, as a consequence of the “state of alarm”, all ICU beds from private hospitals have been made available as part of the regions’ healthcare capacity.
In addition, three speed trains have been converted to transfer out up to 24 critical patients to ICU based in Autonomous Communities with lower ICU beds occupation (https://www.lamoncloa.gob.es/serviciosdeprensa/notasprensa/transportes/Paginas/2020/080420-trenes.aspx).
Since March 23, manufacturers and authorized distribution agents have to guarantee the supply of a number of drugs considered essential in the COVID-19 crisis. In addition, they have to report on a daily basis to the Spanish Agency of Medicines and Medical Products (AEMPS) about available stock, volume supplied in the last 24 hours and forecasts on short-term drugs inbound and outbound. The Order also issues that the Ministry of Health is entitled to prioritise the manufacturing of this kind of essential medicines (Order SND 276/2020 https://www.boe.es/buscar/doc.php?id=BOE-A-2020-4011). The list of COVID-19 essential drugs has been updated April 19 (Order SND 353/2020 https://www.boe.es/diario_boe/txt.php?id=BOE-A-2020-4517).
In April 19, a Ministerial Order has entitled the Ministry of Health to intervene in the market, fixing the prices for products aimed at containing COVID-19 spreading. Products affected are nitrile gloves, hand-washing sanitisers, and surgical and hygienic masks. The latter should be properly labelled with information on protection properties and adequate usage
(Order SND/234/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4525).
On April 23, the Interministerial Price Commission fixed the price for the unitary surgical mask at EUR 0.96 each and for hydroalcoholic gels and solutions at EUR 0.021/ml up to 150 ml (VAT included) (https://boe.es/boe/dias/2020/04/23/pdfs/BOE-A-2020-4577.pdf). On May 5, a new resolution from the Interministerial Price Commission updated the price for hydroalcoholic gels and solutions to EUR 0.025/ml up to 150 ml, EUR 0.021/ml up to 300 ml. Likewise, the Commission fixed the price for topical antiseptic solutions at EUR 0.032/ml up to 150 ml, EUR 0.023€/ml up to 300ml, and 0.015€/ml up to 1,000ml (VAT included) (https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4815).
From April 21 to July 31, national or intra-Community health products will be taxed with 0% VAT when purchased by hospitals or not-profit organisations (RD 15/2020 https://boe.es/diario_boe/txt.php?id=BOE-A-2020-4554).
On April 23, in order to increase the supply of personal protection equipments (PPE), the General Secretariat for Industry and Small and Medium-sized Enterprises, under the Ministry of Labour, issued a resolution authorising the commercialisation of PPE without the CE marking, so that translating the specifications and recommendations of the European Commission to that respect (EU 2020/403 https://eur-lex.europa.eu/legal-content/ES/TXT/?uri=CELEX:32020H0403; https://boe.es/boe/dias/2020/04/25/pdfs/BOE-A-2020-4651.pdf).