Argentina, Bolivia, Colombia, Ecuador or Peru entered quarantine almost at the same time. They were immediately joined by Mexico with its “Healthy Distance Day”, which lasted more than two months. Even Brazil, with a reluctant central government, would end up establishing regionalized restrictions by decision of each state. It was the second half of March, and the entire world was facing its first pandemic in a hundred years. Health systems were overflowing in Spain and Italy, and the most unequal region of the globe did not want to suffer the same fate as southern Europe.

Five months later, if you ask the average citizen of almost any Latin American country where in the world is with the longest and most intense quarantines, it is very likely that they will respond with a convinced “here” (or “here”). It is normal for people to magnify their own experience. However, a comparison of the five basic aspects of restrictions (confinement at home, trips to work, to schools, to public events or internal displacement) shows considerable variation in the region. Honduras and El Salvador are the countries that have spent the most days with the most intense confinements. Uruguay, Brazil and the extreme case of Nicaragua - where the Government of Daniel Ortega decided not to impose any substantial limitation - are on the other side. What almost all countries do agree on is suspending face-to-face classes.

The most populous nations with early quarantines fall roughly in the middle of the table. From a strictly epidemiological point of view, the hypothesis that these quarantines reduced infections at the beginning, when they were general and abided by, is difficult to rule out. Let's take the Colombian case: the country hardened during March what began as a strong recommendation to telework. At that time, the approximate contagion rate (R or reproductive number: the average number of people who become infected for each person who already carries the virus) remained above 2. The entry into quarantine, in all probability coupled with the individual self-care decisions, contributed to reduce it to around 1.1. But it was short lived at that point. It was already rebounding when the norm went the opposite way, during April, including and expanding exceptions to be able to go out on the streets.

The director of the National Institute of Health and the country's highest epidemiological authority, Martha Ospina, has recently stated in several forums that these exceptions were included based on a finding: that Colombia does not have the “financial muscle” necessary to maintain strict quarantines and continually. This implies that the effect that the restrictions have on the economic transition of the most vulnerable households without another source of income than the day-to-day is too strong, and therefore the norm ends up not being respected. This limit is, in fact, something common to all of Latin America, and the main reason why confinement failed to suppress contagion at the levels that it did in Europe: regardless of what the norm said, deep confinement is less sustainable in societies with high levels of poverty and informality.

The limits of quarantines

Precisely looking for a balance in this kind of context, after trying several methods, Mexico decided on a traffic light system to define the degree of openness that each of the states that make up the federation could access. The higher the hospital occupancy and the number of cases, the closer to 'red' (with all associated restrictions) an entity fell. The capital officially went from 'red' to 'orange' on June 28. But the number of people on the street had been growing steadily before. In fact, the relaxation of the written norm did not imply any perceptible acceleration in the percentage of people who went out to work, but rather it came in tow of what people had already been doing. This is probably influenced by the fact that, unlike what happened in other countries, practically no security forces were called upon to control the population's exits.

The 'orange traffic light' did, however, bring a certain upswing in confirmed cases, probably due to a greater degree of closeness in interactions (work, but also family and social). The question for Mexico City now is whether this rebound is being sustained over time, and who is suffering it more intensely.

That the virus hits the popular classes with greater force is something that the region has verified day after day. One of the reasons is precisely that if the exceptions to the declared confinements are designed so that those who need income outside the home can leave, these “holes in the wall” (as Ospina herself has defined them at some time) will mainly affect certain kinds of work. If we compare the days of compulsory labor confinement to which different profiles have been subjected in three large cities of the continent, we will realize that while those professions that can be done from home (normally better paid) have effectively been teleworking for almost six months Others (such as home delivery of platforms, informal vendors or employees in factories of first necessity) have not seen a day of restriction; something that, logically, left them more exposed to contagion.

The virus against the economy

In this scheme of porous and variable quarantines, it is difficult to measure precisely what is the aggregate effect of the restrictions on the economy. The relationship between the forecast of the fall in GDP presented in June by the World Bank and the degree of restriction to work in each country exists, but it is tenuous.

Although right now the aggregate relationship is not clear, it will probably be more so as time passes and we have more accurate measures than a forecast on the evolution of the economy. When we go down to the level of daily consumption, measured in three Latin American countries with different times and levels of restriction, it is observed that the return to the confinement of Bogotá a month ago produced a relapse in the recovery of the rhythm of credit card transactions. At the same time, it is also clear that consumption begins to rise in Mexico or Peru before reopening, exactly as happened with mobility in Mexico City, indicating at the same time that portions of the population cannot wait, and that it is not only the norm that matters: also the degree of contagion.

Is there an alternative to quarantines?

One of the reasons that we are likely to see more and more intense relationships between the use of quarantines and economic decline is that, after all, massive restrictions are a sign that the use of epidemiological-based tools has failed. in conducting diagnostic tests on time, contact tracing and individualized isolations of suspected cases. In other words: when, after a long time dealing with the virus, a city or an entire country returns to a quarantine from which they had already left, it is because the contagion is so high that it exceeds its installed capacities. It is an emergency brake to avoid a greater tragedy. But, like any brake, from so much use it can wear out easily. It supposes an increasing cost (material, but also emotional) for the citizens who suffer them

That is why, as far as possible, the Latin American authorities are trying to reduce and size them. In Bogotá, for example, the city entered a biweekly quarantine cycle in mid-July by large sectors (called localities, each containing hundreds of thousands of inhabitants) from which it will barely leave this Thursday. The data suggest that indeed the average contagion rate has been reduced in these areas thanks to the confinements. But citizen exhaustion is increasingly noticeable in a city that has practically half of its population living in informality.

Thus, the sustainable solution for the region is probably to expand the epidemiological tracking capacity. If the firewall of each outbreak is established in each contagion, if the chain of transmission is broken at the beginning, using more severe but also rougher instruments will be less necessary.

There is at least one country in Latin America that, for now, has managed to avoid severe quarantines thanks to this approach: it is Uruguay. It plays with an advantage by being smaller, less unequal and having more economic resources than the continental average. But it is no less true that so far it has used its structural advantage to establish a reasonably effective defense based on a remarkable traceability, which starts from a number of diagnostic tests per outstanding positive case: 100 for each, thereby demonstrating that run enough tests to miss a comparatively fewer number of cases. The figure contrasts with Bolivia or Mexico: 2 tests per positive. The Mexican case, whose government opted from the beginning for a strategy that denied the usefulness of doing massive tests, despite having a long epidemiological tradition - which was reinforced after the influenza A episode in 2009-2010 -, it is particularly striking.

It is true that epidemiological work is more complicated when you have more, many more cases than Uruguay, as happens in Mexico: there are more potential positives to confirm, more tracking to do. But this is a two-way street: As detection and tracking capabilities expand, the number of infections is gradually reduced. Each new contagion that does not occur facilitates the mitigation work itself: not only does it make future quarantines more unlikely, it also reduces the stress on the teams themselves that have to isolate each suspected case, take care of it, study it and eventually confirm or discard it. It is a difficult circle to break, but a good point to do so is precisely to invest in these capacities, activating tracking processes with the mere suspicion of contagion. Countries that already have a structural base, such as Mexico, have a lot of ground to cover until reaching the point of Uruguay, but also the capacities to get there. Others have set to work to arrive in one way or another at the reference model (Costa Rica, Colombia, Paraguay). In this way, restriction policies could be adapted not only to the moment, but also to the needs of the countries of the region. With a new priority: avoid, as far as possible, the return to quarantines.