The little visible death of the epidemic in Mexico

Burial of a deceased by covid-19, this Tuesday in Ciudad Juárez LUIS TORRES / EFE

Since the pandemic began, 71% of the thousands of COVID positives in Mexico who have undergone intensive care (ICU) or intubation for respiratory support have died.

The figure rises to 82% between confirmed and suspected treated in the largest public health providers in the country for people with formal work (IMSS, ISSSTE).

This figure varies by state, but never falls below four out of ten, and in some cases it is close to 90%.

A recent compilation of mortality studies of covid patients in ICUs from China, Italy, the United States, Denmark or Spain placed the percentage for all of them at much lower values: between 25% and 40%.

Is the epidemic twice as deadly in Tijuana as in Madrid, or is there something else explaining these abnormally high values?

A detailed analysis of the official figures today points to the second: it would not be so much that the treatments fail, nor that the virus affects more Mexicans, but that many would not be accessing the necessary care for their condition.

Lack of access

At the most critical point of the epidemic (May-June), the data pointed to a problem that remains: a great majority of confirmed deaths or those under study of infection appeared in the official database as not treated by ICU, or by intubation.

The lack of codified treatment is greater among IMSS and ISSSTE patients than among those who accessed care through other channels, such as private.

In sum, two thirds of positive deaths would not have had access to what is still considered today as basic care for critically ill patients with a condition that, despite showing systemic referrals, is still considered markedly respiratory in its severe versions.

When all categories of critical patients (confirmed or suspected) are assembled by input sector to the system, the image is much sharper: in the end, the majority group is the one that appears without intensive care or respiratory support treatment.

Unless the Ministry of Health itself is ceasing to codify access to care, this perspective helps to understand why the percentage of deaths after going through the ICU is so high: it simply seems that a large number of patients with severe evolution of covid He does not have access to the necessary medical support, which suggests that whoever comes to him before recovering or dying does so in a situation of considerable deterioration.

From this perspective, the map can be recovered by entities, but now locating each of them in both dimensions: not only the percentage of deaths among critics, but also the other side of the coin: the proportion of deceased who would not have received treatment critical.

The territories in the upper right part of this graph (Sonora, Coahuila) probably have the worst discovery, reporting and access conditions for COVID patients.

Deaths to be counted

The care analyzes are limited by the problems inherent in the official database: an extraordinarily detailed one in the information it offers for each individual, but also very incomplete.

Last Sunday, the director of the National Center for Preventive Programs and Disease Control (CENAPRECE) presented at the daily press conference the latest update of the estimates of excess deaths that the entity has been carrying out.

This method consists of comparing the number of deaths this year with those expected as observed in previous years.

In this way, the calibration of the impact of the pandemic does not depend on the number of diagnostic tests for SARS-CoV-2 infection carried out, which in Mexico are comparatively.

The latest version of the excess death figure is more complete and detailed than the previous ones: now it does include the 32 states.

In addition, it distinguishes between confirmed deaths, suspicious or attributable to covid, and not attributable with the information available today.

It is likely that these numbers will continue to move, but until the end of September they were more than 190,000 deaths above those expected since January 1, 2020;

Of these, two thirds can be considered as directly caused by a coronavirus infection and of these 130,000, just over 50% were included as confirmed in the database of individual cases.

As already seen in the provisional data up to June, the excess is particularly intense among middle-aged men, something that would fit both with the greater exposure to risk due to the recovery of economic activity in the middle of the contagion, and with the structure of comorbidities (obesity, diabetes) distinctive of the Mexican population, capable of interacting both with the virus and with the worst access to care in the context of a pandemic to produce a differential in this segment.

Many of these deaths, tens of thousands of them, do not appear in care data that by themselves already suggests incompleteness and lack of access.

Once we incorporate them, if we succeed, they will probably only deepen the impression that what is lethal in the country is not only the virus itself, but the way it interacts with the context, and with the policies, of Mexico. .