Spain has been hit hard by COVID-19, with more than 300 000 cases, 28 498 confirmed deaths,1 and around 44 000 excess deaths, as of Aug 4, 2020.2 More than 50 000 health workers have been infected, and nearly 20 000 deaths were in nursing homes.3 With a population of 47 million, these data place Spain among the worst affected countries. Spain is also reported to have one of the best performing health systems in the world4 and ranks 15th in the Global Health Security index.5 So how is it possible that Spain now finds itself in this position?

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