Spain’s coronavirus death toll passed 1,000 people on Friday, health authorities confirmed, as infections surged to nearly 20,000.

The spread of the COVID-19 continues to put significant strain on Spain’s health system, with more than 1,100 people fighting the disease in intensive care.

“It is true that in serious patients that belong to high risk groups, the number of fatalities is going to be higher,” said Fernando Simon, director of Spain’s Centre for Coordination of Health Alerts and Emergencies.

“We are trying with the autonomous regions and with the health ministry to guarantee the highest amounts of survival, but in some cases this cannot be guaranteed.”

Among European nations, only Italy — the worst hit in the world — has recorded more COVID-19 infections and deaths than Spain.

Spain is in the first week of a nationwide lockdown. People are only allowed to leave their homes for work that cannot be done from home, grocery shopping, and to care for pets or vulnerable persons. Police checks have started across the country to enforce the containment measures.