Table 2.

Events in the first wave of COVID-19 in the Community of Madrid

Date of the event	Events
January 30	Reporting of a COVID-19 case to the Public Health Direction of the Community of Madrid (DGSPCM-Direccion General de Salud Publica de la Comunidad de Madrid). The Unit assessed the need for hospitalization using four criteria
February 25	First hospitalization of a suspected case in the CoM
February 27	The first known case of COVID-19 in the Community of Madrid was confirmed
March 3	The first death from COVID-19, a 99-year-old woman living in an LTCF, was confirmed
March 3	Closing Day Social Care Centers and LTCFs was considered a priority by the DGSPCM
March 7	Centralized management of hospital beds initiated
March 8	LTCFs were locked down. Residents were not allowed to leave LTCFs. Visits from family members or friends were banned (see [29] page 42). The DGSP brief also recommended that elderly persons or persons with chronic diseases stay at home or in the LTCF where they live
March 12	According to the Plan de Accion contra el coronavirus (Action plan against coronavirus) published by the Consejeria de Salud de la Comunidad de Madrid (CSCM—Ministry of Health of the Government of Madrid) LTCF residents were to be treated within LTCFs premises. No evidence of medicalization of LTCFs were found
March 12	LTCF managers informed the Consejera de Politicas Sociales de la Comunidad de Madrid (CPSCM – Ministry for Social Policies of the Community of Madrid) that they were experiencing problems with the residents’ hospital admissions
March 17	Local LTCF administration reported that LTCF residents’ referrals were impossible. Many of them died thereof
March 18—25	The first administrative directive restricting the hospitalization of LTCF residents was issued by the CSCM. Residents with moderate disabilities or severe cognitive impairments were excluded from transfers to the hospital. At each hospital, a liaison geriatrician was responsible for the triage of potential patients living in LTCF requesting hospitalization. Consultations with the liaison geriatrician were initiated by the LTCF staff and carried out by phone Four versions of the protocol were issued between March 18 and March 25. Triage criteria were changed with marginal consequences for admission to hospitals. Administrative directives were applied for several weeks and entered gradually into disused The Spanish Geriatricians (SEGG) published an extended protocol for the management of care in LTCFs in times of COVID-19
March 22	The first patients were admitted to the hospital IFEMA, a 1300-bed field hospital. Until its closing on May 1, four thousand patients were admitted at the IFEMA. The March 18–25 administrative directives were enforced in the case of referrals of LTCF residents to IFEMA
March 26	The Government of the Community of Madrid announced in a press release a “Shock Plan” for LTCFs. Changes in the responsibility for the delivery of care were planned. No changes to the exclusion criteria for hospital referrals of LTCF residents were proposed
April 7	The March 18–25 administrative directives restricting access and delivery of hospital care were never withdrawn officially by the GCM. However, the head of the CSCM, Enrique Ruiz Escudero, in a radio interview, mentioned their gradual retreat
April 28	The Spanish government issued the Plan Para la Transicion Hacia una Nueva Normalidad (Transition Plan for a renewed normality). Four phases were defined from the state of the COVID-19 epidemic on April 28 to the full normalization expected at the end of June. Indicators for the transition between phases were defined. Regional authorities were not expected to transit at the same pace from one phase to another
May 23	The Community of Madrid was authorized to access Phase 1 on May 23 and Phase 2 on June 8