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The Lowy Institute, an independent international policy think tank, ranked Spain in the lower quartile measuring the comparative effectiveness of countries’ handling the 2020 COVID-19 pandemic (ranking as of January 9, 2021 was 78 out 98, and of March 13, 2021 was 80 out 102) [1]. Recently, a multi-country study examined excess mortality in 2020 across five European countries showing that excess mortality in 2020 varied widely between countries and within countries. Still, Spain experienced the largest excess mortality among the five countries studied [2]. A robust public health system and organisation might have influenced the response to the pandemic [3]. However, public health and social care services in Spain were not efficient during the first pandemic waves [4, 5].