Spain has become the country in Europe where the coronavirus outbreak is expanding fastest. It’s second only to the United States in the number of new cases reported.

Spain’s Health Ministry reported 8,578 new infections and 655 deaths on Thursday, bringing the total infections to 56,188 and more than 4,000 fatalities.

Italy’s initial steep rise in confirmed cases has started to level off more than two weeks into a nationwide lockdown. On Wednesday, the country reported 5,210 new cases and 683 deaths.

The outbreak is straining Spain’s health care system, with medical staff struggling to treat the infected amid a shortage of protective gear and enough ventilator machines and other medical equipment.

One out of 10 of the country’s COVID-19 fatalities have been recorded in nursing homes.