The covid virus leaves between 21% and 53% more deaths in Madrid than in Catalonia

Barcelona / MadridThe demographers assure that the statistics of natural movement and excess mortality have never awakened so much general interest as in the last eleven months, since the covid pandemic broke out. Deaths are the bitterest face of the epidemic and, at the same time, the indicator that best reflects the degree of penetration of the virus in the long term: the higher the transmission, the more fatalities there are. Spain is one of the countries that has suffered the greatest loss of life due to covid, a total of 58,319 according to the government headed by Pedro Sanchez, and Madrid is the most affected community after a first virulent wave and a steady and sustained trickle of cases since August.

In the report issued every day by the Ministry of Health, which unifies data from all communities, Madrid drags 12,578 deaths since March, two out of every ten victims in the state. But the impact is much greater according to the Daily Mortality Monitoring System (MoMo), the tool that radiographs the excess deaths compared to other years. In Madrid, between March and December, 49,559 people died, 16,865 more than those expected by the MoMo (32,694) for 2020.

Catalonia also experienced a very raw first wave, some complicated outbreaks in summer and an incidence of 800 cases per 100,000 inhabitants in October. Therefore it accumulated 9,404 deaths (16% of the entire state) and an excess mortality of about 15,928 victims. Some 51,398 deaths were expected, but in the end there were 67,326. It should be borne in mind that the Community of Madrid has 6.7 million inhabitants - and Catalonia has 7.7 million.

Although in both communities the passage of the virus is very bleak, the records show that the Madrid data are significantly higher than the Catalan one, especially during the first wave. The report of the Moncloa notes that the covid has left 53% more deaths in Madrid per every million of inhabitants than in Catalonia. The Community has registered 1,855 victims per million of inhabitants. On the other hand, and taking into account that one million more people live here, in Catalonia there have been 1,208 deaths per million of inhabitants. If Catalonia, with its population, had had the same mortality rate as Madrid, a total of 14,283 people would have died - 4,879 Catalans more.

According to the MoMo data, the difference in mortality is not so high, but it remains at a resounding 21%. The 15,928 victims in Catalonia represent an excess of 2,047 deaths per million of inhabitants, while in Madrid the 16,865 deaths represent 2,487 more victims per million of inhabitants.

Also the National Institute of Statistics (INE), the main producer of demographic data, reveals that Madrid has suffered more mortality, but the data are provisional and only correspond to the first half of 2020. The study confirms that in Catalonia there were 31% more deaths between January and June compared to the same period of 2019, while in Madrid the increase was of 64%. The increase pointed out by the INE data (33%) is within the range of mortality offered by the Health Department (53%) and MoMo (21%).

"There is no doubt that almost all the excess corresponds to the covid", the director of the Centre d'Estudis Demogràfics (Demographic Studies Centre), Albert Esteve, says. "And we have to go back many years to find precedents for such a large increase in mortality from one year to the next. Probably back to the Civil War", he adds.

Different restrictions

The mortality curves in Madrid and Catalonia followed a very similar pattern during the first wave. "In both territories, in Madrid a little earlier, the virus had been circulating undetected for some time and, when the state of alarm was declared on 15 March, the curve of deaths had already grown a lot", Esteve explains. Both experience exponential growth within a few days of each other (March 3 and March 17, respectively) but culminate in peaks of different heights: while Catalonia reaches its peak on March 30, in Madrid it occurs three days earlier.

Once the decrease in cases begins and the autonomous governments regain control, each region regulates itself and shortly afterwards experiences a second, quite different wave. Catalonia recorded a new peak in summer, just after the state of alarm ended, due to outbreaks in Segrià (Lleida) and the metropolitan area of Barcelona. Between July and December, the Government decrees municipal lockdowns, vetoes to economic activity, and limits the hotel business up to seven times to control the curve.

Experts say that imposing restrictions is closely linked to a reduction in the spread of the disease, contagions, hospitalizations and, therefore, deaths. "The communities that make an effort to control get lower incidences and deaths", the biophysicist of the Computational Biology and Complex Systems Group of the UPC Daniel Lopez says. However, and after a convulsive September due to the social relaxation in summer and the return to work and school, the incidence has shot up again in Catalonia for the second time and, with it, the death toll has increased.

In Madrid the curve recovers the upward trend in July too, but for two months it manages to stay at the same level and with small oscillations. "These months are generating a more considerable excess of deaths that can cause a single high peak, but the curve does not just shoot up," the doctor of preventive medicine and public health at the University Hospital of Mostoles, Javier del Aguila, says. And from this break the Madrid miracle is born: The idea that the pandemic can be stopped without practically affecting mobility and ensuring the opening of sectors of high social interaction as the hospitality industry, as advocated by the president of the Community, Isabel Diaz Ayuso.

"It is true that for weeks there are reductions, but not enough, because the minimum we had was 200 cases per 100,000 inhabitants", the epidemiologist of the Madrid Association of Public Health, Pilar Serrano, explains. Progressively, however, the incidence is escalating again and the State decrees a state of alarm for the Community in the face of government inaction. "The restrictions have been much less forceful than the Catalan ones. No expert can properly endorse the Madrid measures", Del Águila denounces.

The experts' hypotheses

How can it be explained that Madrid has had a trickle of deaths but Catalonia experienced a great peak in October if they had been deploying tougher restrictions? No one knows. None of the experts consulted dares to point to a cause.

Demographers and epidemiologists anticipate that making comparisons between regions is very complex because a great multiplicity of factors are at play in the epidemiological evolution. "The situations may be 95% comparable, but this small margin of difference, the singularities, make it impossible to draw conclusions", Del Águila confirms. "It is very difficult to isolate the specific and real causes to understand the differences between communities", Esteve confirms. "In each region there is a different dynamic, you can only make hypotheses", the head of population studies of the Consejo Superior de Investigaciones Científicas (CSIC) (Superior Council of Scientific Investigations), Diego Ramiro, seconds.

According to Ramiro, the transmission pattern of covid in Madrid is quite similar to that of the 1918 flu pandemic. Then the Community was also one of the first areas to have the strongest peak of mortality, but the second wave affected more in other places, including Catalonia and Castilla y León. "This second wave was quite long and some territories experienced waves very close together in a short period of time", Ramiro says. Surprisingly, this is what happened in Catalonia in October and December with the second and third waves of covid.

However, fast-forward again to 2021, no expert consulted can find an explanation for the Madrid miracle. Demographers say that we must take into account aspects such as population density, territorial distribution of the most vulnerable people, internal mobility (conurbations), and the greater or lesser ability of the authorities to monitor that the restrictions are being met.

Geriatric homes would also have an important role to play. A third of the deaths in Catalonia in the last two months have taken place in one of the 1,045 care homes in the country. Madrid, which has only half a thousand centers, has only recorded 75 deaths in the same period. "We would have to see if in Madrid the virus has been affecting younger people", Del Aguila says. Another option would be that of immunity: the virus spread so much the first months in the capital that a study found that 18% of the population in Madrid had antibodies. In Catalonia the figure was 11%.

At this point, however, in the middle of the third wave, it seems that things are changing again: while the curve in Catalonia is bending, slowly but surely, Madrid has it skyrocketing. The government of Diaz Ayuso is registering 5,000 daily infections, a very high figure which Catalonia managed to lower with restrictions. "The current incidence in Madrid is brutal, approaching a thousand diagnoses per 100,000 inhabitants, and the increase in deaths is practically inevitable. The damage is already done: we will have an unbearable and shameful number of deaths", Serrano regrets, and advocates for the closure of the hospitality industry to cope with the coming "difficult weeks".