The image that has most contributed to transmitting a dimension of the crisis that Venezuela is suffering is that of the deterioration of the health system. Healthcare, like all other public services, has been on the brink of collapse for years. It never completely collapsed and the aid of Nicolás Maduro's allies such as Cuban cooperation allowed the Chavista regime to maintain a kind of optical illusion. The hospitals are open and have not stopped receiving patients, but at the same time all the centers are suffocated by the lack of personnel and the cyclical shortage of medicines. The emergence of covid-19 has broken that perception. The government closed the borders in March and applied drastic confinement measures, which have not yet been lifted, but it stuck to the only area in which it had scope for action, that related to security and social control. Neither the detection of cases nor the administration of the clinics allow us to trust what is most important: the evolution of the pandemic and the capacity to respond.
If there are two essential tools to face a rapidly contagious epidemic, they are data and water. The former allow you to monitor, even if it is imperfect, the outbreaks that are emerging in your territory, so that you can act to control them. The second makes it possible for your population to wash their hands frequently to cut the chain of transmission, starting with health personnel and other essential workers.
Venezuela does not have either of these two instruments and the official cases, which according to the authorities are more than 33,000 with less than 300 deaths (it depends on when we are going to give it), represent for the experts - who are mostly linked to the opposition led by Juan Guaidó - just the tip of the iceberg of the health emergency.
Three reasons not to trust data
The coronavirus has joined a very serious structural crisis. During the first weeks of the pandemic, Maduro had to ask Iran for help because the country ran out of gasoline despite having the largest oil reserves in the world. The quarantine has deepened the agony of millions of people who, despite having a formal job, even a public job, need to leave home because their salary does not reach four dollars a month and their livelihood depends on informal activities. The government eventually established an alternate isolation system and deployed security forces in search of a solution whose effectiveness has been harshly criticized by the opposition. "It is not with FAES [the special police forces], with Sebin [the intelligence service], with improvisations that will save the lives of Venezuelans," said José Manuel Olivares, doctor and deputy appointed by Guaidó as responsible for monitoring the emergency.
Although the official data show a clear exponential increase, the aggregated figures would indicate an incidence of the virus significantly below the Latin American average: just 0.07% of the population would have been infected. There are at least three indications to suspect its agreement with reality.
1. Lack of reliable diagnostic tests
"The problem in Venezuela is that there are few tests, there are few places where they are processed (so the results take a long time)." Who says it? The government prohibited private laboratories and universities from conducting tests. Until the end of July, there was only one center in Caracas authorized to carry out tests, the National Institute of Hygiene. Later the Venezuelan Institute of Scientific Research joined. In any case, insufficient, especially to analyze the samples that arrive from the interior of the country.
On August 2, the executive vice president, Delcy, Rodríguez affirmed that 1.5 million tests had been carried out, which would place Venezuela above countries such as Mexico or even neighboring Colombia. But most are not molecular-type tests (PCR), which are the ones that offer greater precision with respect to active infections. So this figure is not really comparable to the rest. The latest available from PCR indicated that as of May 22, 16,577 had been made, according to a report from the Venezuelan chapter of the United Nations Office for the Coordination of Humanitarian Affairs. By that date, the total tests were just under 700,000: just over 2% are PCR.
For comparison purposes: at the same time, Colombia accumulated 4.4 CRP per 1,000 inhabitants, and Argentina was around 2.5. The ratio for Venezuela was below 0.6.
2. Very few confirmed deaths
When it had 20,000 cases confirmed by the authorities, Venezuela had fewer than two hundred deaths. Aggregate studies like this one show that the lethality of the total number of infected with the virus is between 0.5% and 1%, depending on the conditions and demographic structure of each country. The simple division of 169 by 19,433 is in this band. In other words, if we take the official data as reliable, Venezuela would be one of the few countries in the world that is detecting cases and deaths perfectly. It would be on par with Costa Rica or Paraguay, two Latin American nations that have stood out for their ability (for now) to handle the epidemic. The diagnostic limits described above suggest that this is not the case.
The simple observation of the number of infections between the authorities adds more doubts. There are a dozen senior officials, in some cases very close to Maduro, who began to announce that they were infected in early July. Among them, the Minister of Communication, Jorge Rodríguez, the economic vice president, Tareck El Aissami, or Diosdado Cabello, president of the National Constituent Assembly and considered number two in Chavismo. They are joined by almost 50 workers from the state television. And last Thursday, Darío Vivas, head of the Government of Caracas, an important figure of the regime, died.
What is serious, moreover, is that unlike what happens in other countries, where the underreporting of mild or asymptomatic cases is common due to the inherent difficulty of their detection (without symptoms, or with just a little cough or fever, it is a case is likely to go unnoticed even by the most precise epidemiological radar), in Venezuela this exercise suggests that the largest number would be deaths. In other words, if we assume that due to lack of evidence, the country has a problem reporting cases at least equal to or greater than that of its neighbors, the very low ratio between declared deaths and officially confirmed cases indicates that the problem in deaths is even greater.
“Historically, the Maduro regime has been opaque with regard to health data. Since 2016 there are no epidemiological data ”and this is particularly pronounced with those of deaths, indicates Tamara Taraciuk, of Human Rights Watch (HRW). The organization has documented cases of threatened doctors so as not to include certain causes in the death systems. Likewise, the inability to get to the hospital or the non-reporting of deaths is frequent. "We believe that the figures, the statistics provided by the Government of Venezuela, Maduro's statistics, are absolutely absurd," said José Miguel Vivanco, director for the Americas of HRW, in May.
Kathleen Page, professor at the Johns Hopkins University School of Medicine and HRW collaborator, adds a defining aspect of the construction of epidemiological data in the country: the Government conditions the confirmation of death from covid on having been tested PCR to the affected person, something that happens on very few occasions due to the aforementioned lack of capacity. Consequently, it is practically impossible for the number of confirmed deaths to reflect the reality of the contagion.
3. Cases concentrated at the border
The map of cases confirmed by the Venezuelan authorities places the largest number of cases in border states
It is true that conditions probably play a role in this distribution: Zulia is the state that suffers the most from water and electricity cuts. THE COUNTRY visited the Las Pulgas de Maracaibo market a year ago, now closed, where rotten meat was sold and the lake water, with high levels of contamination, was used for cleaning. This place, the epicenter of the illegal sale of medicines and foreign currency trafficking, was identified as one of the first centers of the country. However, the biggest problem is probably not in the importation of cases (according to data from the Colombian Ministry of Health, the incidence among the Venezuelan migrant population in the country is not greater than 2.5% as of July 21), but in the management of migratory return by the Venezuelan authorities. There is an established protocol that, in theory, begins with doing a rapid antigen test which, as highlighted above, has a high probability of giving a false negative. The migrants then enter a “quarantine center”, known as Points of Integral Social Attention (PAIS), where the probability of overcrowding is considerable.
These are schools, public venues, hotels or sports centers where returnees often sleep on mats with hardly any security protocols. The NGO Provea received several complaints since May related to lack of care, food, hygiene and also some cases of escape. In the border state of Apure, migrants, for example, were confined "without complying with the minimum conditions for human beings."
That is, dozens, hundreds of people are entered into a space that does not respect minimal epidemiological or humanitarian conditions. “In crowded rooms there are people who have perhaps given a false negative”, Taraciuk points out. For example, a single unconfirmed asymptomatic carrier would suffice for, under the conditions described, the quarantine protocol to actually become a vector of contagion with an impact on the region.
Professor Page explains that we cannot be sure whether or not these numbers are due to test bias . It is possible that a majority of cases are actually concentrating on the border, but if so, the government's own epidemiologically counterproductive measures would be encouraging it. But it is equally possible that it is a pure bias of greater incidence of the test, aligned with the political discourse.
No water, no other basic means
The difficulties in dealing with the epidemic in Venezuela far exceed the government's own restrictions. Something as basic as access to a constant and reliable water service, which allows the most basic hygiene actions (starting with the constant hand washing recommended by the WHO), is no longer an element that the population can trust. Neither the urban, more exposed to contagion by conditions of density and overcrowding.
The incidence of the problem varies in Venezuelan territory, although it is still intense in any of the country's large cities.
The confrontation on account of the management of the pandemic that occurs between Chavismo on the one hand and the opposition and international organizations on the other has been inserted into the country's enormous political gap. In other words, the coronavirus has become another element of tension and that is what the Government clings to to try to refute the complaints about lack of data and transparency. However, the authorities have not offered arguments to prove otherwise and the precariousness even led them to agree a protocol with the National Assembly, controlled by Guaidó, to receive aid from the Pan American Health Organization and the United Nations. “Today happens what our Academy of Sciences and Mathematics said more than four months ago. Despite the manipulation of the 60% under-registration, of how Nicolás Maduro manipulates the numbers of deaths and cases, today a truth that the academy said four months ago explodes, and the response was persecution and jail and a threat to science and the academics, ”Olivares charged last week. In any case, the problem of origin remains intact: Venezuela is not in a position to face a health emergency of this magnitude.
Information about the coronavirus
- Here you can follow the last hour on the evolution of the pandemic
- This is how the coronavirus curve evolves in Spain and in each autonomy
- Search engine: The new normal by municipalities
- Questions and answers about the coronavirus
- Guide to action against the disease