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Spain Recounts Coronavirus Deaths – The New York Times

MADRID — Spain is recounting its dead.

Like many nations across the world trying to measure the toll that the coronavirus pandemic has taken, Spain has been stymied by unreliable figures.

But in a politically fragmented society, the confusion has led to recrimination and sinister claims, with opposition politicians accusing the fragile coalition government of covering up the real numbers.

“Spaniards deserve a government that doesn’t lie to them,” said Pablo Casado, the leader of the opposition Popular Party.

Speaking in Parliament last week, Mr. Casado addressed a direct challenge to Prime Minister Pedro Sánchez: “Tell us if it is true that the real number of victims could double the official figures.”

Officially, Spain’s death toll, which remains among the world’s highest, is closing in on 20,000. But there is evidence that it could be far higher, with many deaths — especially those in nursing homes — not properly classified as stemming from the coronavirus.

Mr. Sánchez and other officials reject accusations that they have intentionally underreported Covid-19 fatalities, but the authorities have begun trying again to measure the losses.

Last week, Spain’s justice ministry told civil registries to comb through their death records dating back to March 14, when the country went into lockdown, to find unaccounted-for coronavirus victims.

Spanish officials are not the first to take another look at how they count the dead. In New York City, the official death toll jumped sharply, to over 10,0000, when the authorities began including people who had not tested positive for Covid-19 but were presumed to have died from it.

A debate over the reliability of coronavirus data has been taking place almost since the beginning of the outbreak and extends from China to the United States. Many countries have not tested enough people to track infections, let alone establish how many deaths have been caused by the virus.

But the debate is taking place with singular ferocity in Spain.

The far-right political party Vox has pushed the cover-up accusations hardest. Last week, it posted on social media a manipulated photo of Madrid’s Gran Vía thoroughfare filled with coffins draped in Spanish flags. The government, Vox claimed, was hiding “the suffering of this tragedy.”

Helena Legido-Quigley, an assistant professor of public health at the University of Singapore, said there were many reasons that the authorities worldwide should improve the counting of their dead. One is the brutal nature of the pandemic. Untold numbers of people have been forced to remain apart from loved ones as they died — and then unable to hold proper funerals for them.

“We know how important death rituals are in Spain and so many other countries,” Ms. Legido-Quigley said. “So the authorities should help reduce the huge impact on a society of having now been forced to dehumanize the process of dying.”

It is not just a matter of lacking testing capability. The problems of counting the dead are also compounded because not all nations have followed the same methodology.

In France, for instance, the counting was changed in early April to add nursing home deaths, which raised the toll by more than 3,000.

“It would have been very useful if we had at least some clearer European Union guidance on how to count deaths, so as to make the numbers more comparable from the start,” Ms. Legido-Quigley said.

Some countries were late in labeling Covid-19 as an official cause of death.

The United States announced a code for recording Covid-19 on March 24, weeks after the first American coronavirus fatality was reported. In Britain, Covid-19 joined the list of infections to be mentioned on death certificates only at the same time as the country recorded its first victim.

Spain announced its first coronavirus death on March 3. But the infection was identified only in a post-mortem examination conducted weeks after the patient died from what appeared to be pneumonia. And once Spanish hospitals started filling with patients and staffing resources grew scarce, health officials did away with such post-mortems.

While the central government has yet to adjust its official death figure, numbers released by some of Spain’s regions have been shocking, particularly because they have revealed the extent to which nursing homes have been decimated behind closed doors.

Last week, the regional government in Madrid estimated that almost 3,500 people had died in its nursing homes after displaying probable symptoms of the virus. Since they had not been tested, they had not been included in the official tally for Madrid nursing homes — 781.

Past experience with other epidemics like swine fever suggests that it may take several months, if not longer, for nations to have a true understanding of the coronavirus death toll.

On April 7, the Institute for Health Metrics and Evaluation at the University of Washington released its forecast for several countries, including Spain. It predicts that the country’s death toll will reach 19,000 by August, when the first worldwide wave is expected to have ended. The institute used reported deaths rather than coronavirus cases as more reliable data.

“The main reason for getting right the numbers of this disease is that we have a substantial risk of a second wave,” said Dr. Christopher Murray, the institute’s director. “The faster we learn,” he said, “the better our chances” to be prepared for another wave.

Dr. Murray said he expected public pressure to force governments to move faster than in the past to provide more accurate counts, and also to loosen restrictions on the disclosure of death statistics, which are often applied because of privacy rights.

In several countries, the internal flow of information has been problematic.

In Spain, the central government says it had to rely on numbers provided by the regional administrations that manage the country’s public hospitals. That has set off a blame game, and some regional leaders have been among the most outspoken critics of the government.

José Antonio Monago, the conservative leader in the western region of Extremadura, suggested this month that there had been a government order to “hide the real number” of coronavirus victims. “Whoever dies from the disease does not deserve to fall into oblivion,” he said.

Spain’s interior minister, Fernando Grande-Marlaska, rejected the accusation as “very serious” and unfounded.

About 88 percent of Spaniards want politicians to set aside their differences during the national health emergency, according to a survey published on Wednesday by Spain’s public center for sociological research.

Yet as more new figures emerge from the regions, the mutual recriminations have continued. This week, health officials in Catalonia almost doubled their own tally of deaths in the region — to 7,097 — after reviewing data collected by undertakers.

Quim Torra, the region’s leader, said on Thursday: “We now have a much clearer situation in Catalonia. I wish the rest of the state would do the same.”

Amid the political bickering, those whose days are spent overseeing the dead, like priests and pallbearers, have taken to making their own back-of-the-envelope calculations. They have been trying to understand the true numbers behind why Spain has had to convert some buildings into emergency morgues, including the country’s largest skating rink, the Ice Palace in Madrid.

“I think the official numbers of the dead obviously don’t add up,” said Juan Antonio Alguacil, who heads a Spanish association of funerary employees.

He said that in late February, before Spain officially registered its first coronavirus death, his colleagues had already been handling an “illogical” increase in the number of pneumonia cases.

“If we want to heal the moral and psychological wound that this pandemic will leave,” Mr. Alguacil said, “we have to get the full truth as soon as possible from our authorities about what really occurred.”


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