Overburdened hospitals and a shortage of protective measures and tests are taking a toll on Spanish medical professionals who are contracting Covid-19 - the illness caused by the new coronavirus - at an alarming rate.
To date, more than 15,000 health professionals in Spain - about 14 per cent of the national total - have been infected. In contrast, Italy reported that health workers accounted for about 10 per cent of its infections.
"I have tried to be careful, but when you work in a hospital, no one can guarantee that one of your colleagues doesn't have the virus in the asymptomatic phase," said ambulance crew member Xevi Mateu, who tested positive for the virus a week ago.
Mateu, who lives and works in Catalonia, said he thought he might have got infected during a meal break at the hospital or while on duty in the cramped space of an emergency vehicle.
Information on how to protect himself from the rampaging pandemic was conflicting, he said, and with no guarantee on future supplies he was forced to ration his use of protective equipment as soon as the demand for ambulance services began to exceed capacity.
Albert Gual, another emergency worker in Catalonia, said protocols had changed since he first started transferring Covid-19 patients to hospital, and he believes the shortage of protective equipment is to blame.
"At the beginning of the crisis, we threw away the glasses, the medical suit and the mask after one use. Now we are using one mask per day, until the stock runs out," Gual said.
"Yesterday I talked to a colleague from the emergency service who told me they are overwhelmed - without material, without resources, without people. The medical suits are reused and sterilised until they have holes," he said.
There have also been reports of doctors and nurses in Spain making their own protective clothing out of bin liners.
To ease the burden on Spain's medical workforce, retirees have been asked to return to practice and newly licensed personnel have been recruited to make up the shortfall. One of the new recruits is Candela Lebrero, who completed her medical degree last year and is now a nurse at a hospital in Madrid.
The Spanish capital has seen the country's largest number of infections - with more than 36,000 - and staff at the Madrid Principe de Asturias Hospital, where Lebrero works have been among those falling ill from the disease.
Reports of an overload of patients were very real, she said, with emergency rooms forced to send less serious cases to "medicalised hotels" and additional hospital wards switched to caring for Covid-19 patients.
As for rapid testing, it "hadn't arrived yet" at Lebrero's hospital, which was relying on PCR tests - the swab technique which identifies the presence of any genetic material belonging to the virus - as a diagnostic for both patients and health personnel who presented with symptoms, she said.
Similar problems have been reported across Spain and last week the health ministry's coordinator for the emergency response, Fernando Simon, acknowledged the difficulties for health care workers to access protective equipment.
On March 25, Simon admitted the jump in infections among medical staff was due to "a market access problem" as supplies "are scarce and there is non availability" - a problem not limited to Spain.
"We are on the way to a solution," he said. On Monday, Simon also tested positive for the disease.
While equipment shortages are a global problem, Spain was hit particularly hard after its two largest distributors of medical supplies - located in France and Germany - were ordered to stop selling by their governments in early March, fearful of depleted stocks in their own countries as the pandemic spread.
The decision, which was criticised for being contrary to the spirit of the European Union, forced the Spanish government to turn to other measures, including the purchase of Euro432 million (US$467 million) worth of supplies from China.
A freight corridor was also opened to speed deliveries, and Spanish manufacturers were put on a "war footing" to urgently switch to making medical supplies. The car industry is now turning out respirators and gels, while textile manufacturers have turned their hand to producing gowns and face masks.
Sports equipment chain Decathlon has even adapted its snorkel goggles for medical use and donated its entire stock to Spanish hospitals.
The scramble to address shortages in Spain's overstretched health system has not been without problems. Last week, the government withdrew 58,000 Covid-19 rapid test kits it bought from a Chinese company, after their accuracy rate was reported to be just 30 per cent.
China said the kits were not approved for sale and not included in supplies sent by Beijing to Spain.
It is not clear if the supplies from China have arrived, but on the ground medical personnel said they had not yet seen the equipment.
"It is assumed that the new ones have already arrived, but they have to pass the approval of the Carlos III Public Health Institute (a Spanish public health research institute), and their use is not yet widespread," Laura DIez, press officer for the State Confederation of Medical Unions said.
"Their arrival will improve the situation since at least it would be known if someone in contact with the infected could transmit the disease, especially health personnel," she said.
Several health organisations have appealed to the courts in their desperate bid to get hold of protective equipment. A Madrid court did accept the argument by an association of doctors that the authorities should be forced to provide adequate supplies to all health personnel.
But the Supreme Court refused to support the claim, saying it recognised the government was doing everything it could.
"We presented precautionary measures and they were dismissed, we have filed an appeal," DIez said.
"At the moment we have no answer. Authorities said that planes with the material are arriving, but at the hospitals, they are not seen."
Meanwhile, the General Councils of Dentists, Nurses, Pharmacists, Doctors, and Veterinarians, which represent more than 700,000 health professionals in Spain, expressed its "absolute rejection" of new guidelines for medical workers set by the health ministry.
In a notice issued on Friday, the ministry said that health professionals that had not been tested for Covid-19 but who took time off should return to work seven days after the onset of symptoms as long as they did not have a fever or respiratory problems.
Once back at work, they should wear a surgical mask for 14 days from the onset of symptoms and avoid contact with other people.
The general councils said some of the guidelines represented "a serious risk" to the health of professionals and their patients.
Ambulance worker Mateu is currently in isolation at home as he recovers from the disease, but his thoughts are with his colleagues and their daily struggle. He said he thanked his supervisors and coordinators for working hard every day.
With so many of the staff themselves sick, there was a lot of stress on those who were still at work, he said.
"I have the feeling that the effort and management is not being done from the top down, but from the bottom up: from us who work directly with the patients, our supervisors and they are continuing the chain of gestures and efforts," he said.
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