On March 21, 2020, Colombia confirmed its first official death from covid.
He was a 58-year-old man, a resident of Cartagena de Indias, and a taxi driver by profession.
He had, like so many other millions of Colombians, untreated hypertension and diabetes.
He entered the clinic on March 13, died on the 16th. It seems that, by then, the virus that causes the disease had already been circulating in Colombia for more than a month.
Genomic studies carried out later by the Universidad del Rosario even allow us to intuit a probable origin: France.
And its first visible destination: Caldas, coffee department.
But at that time it was not even clear that this first death was due to covid: there was speculation with the uncertainty surrounding some diagnostic tests that were initially inconclusive, and in fact the process of certification of the cause of death took five days.
In that period, a cacophony of political and media voices moved between fear, confusion and the management of expectations, launching forecasts about how long the epidemic was going to last and what impact it was going to have on the country.
A presidential decree even put into its explanatory statement the worst-case scenario: four million.
But few of them dared to foresee more than a year of living with SARS-CoV-2, with 50,187 deaths in just ten months, something that fits quite precisely with those four million probable cases according to the lethality that we assume to the virus .
Five thousand a month.
More than 150 a day.
About six an hour.
One every ten minutes, approximately.
But that is exactly the scenario in which Colombia has found itself today, along with the rest of Latin America, and the entire Western Hemisphere.
The rate of these deaths has not been far from constant, as the exercise of division by time might suggest.
Colombia went through a very pronounced peak between July and August 2020, and is now in the second, apparently similar in size and shape.
The impact varied not only in time, but also in space.
Some regions were saturated earlier.
In the first months, Barranquilla and Cartagena, the large cities of the Caribbean, were some of the worst hit metropolitan areas, as well as Leticia, in the Amazon.
The departments of Atlántico (capital: Barranquilla), Bolívar (capital: Cartagena), and to a lesser extent Magdalena (capital: Santa Marta) concentrated most of the excess mortality in the first half of 2020, according to the National Administrative Department of Statistics (DANE).
The second peak has resulted in a high level of ICU occupancy in several places, but it has been particularly worrying in the three main Colombian cities: Bogotá, Medellín and Cali, which together have more than 12 million inhabitants.
The three large cities have reported in recent days an ICU occupancy above 90%, and they have started this 2021 between confinement measures, quarantines and curfews - both at night and running.
"You cannot speak of a national peak, since the pandemic has behaved differently according to the regions," defended President Iván Duque last weekend.
"Logically, when we have peaks in cities with the highest number of inhabitants, it becomes much more noticeable and forces us to have to make more decisions."
⇲ ICUs almost overflowed
The reality is that these regionalized peaks would have exceeded local intensive care capacity if it were not for the fact that installed capacity grew, to more than double in many cases, in the capital and in many other areas of the country.
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A doctor who has been treating covid patients for nine months in a hospital in the north of Bogotá describes as “overwhelming” what the health personnel are experiencing.
You talk on the phone on your first day off after a week with hours of up to more than 12 hours.
"We are concerned about having to do prioritization committees to see who we give a ventilator to, who we send to the ICU," he says.
Although the disease was less known last year, they are now having to make more difficult decisions.
In recent weeks there have been frequent meetings with the ethics department of the medical center where he works to decide who to give a bed.
"We were not prepared for this, the relaxation of the measures in December is taking us to the limit," he acknowledges.
Juliana Mantilla, an internist who works in a private clinic in the south of Bogotá, says that this month has been the most difficult.
Unlike the first peak -counts- now in addition to covid patients, there is a high number of hospitalized for other diseases.
“In the first months of the pandemic, the emergency rooms were almost empty.
People feared being infected in a hospital, many stopped treating illnesses and today they need urgent attention ”, explains Karen Álvarez, who works in a hospital in the capital.
And if this happens in the nation's capital, with 1,400 more intensive care units than in March 2020 and about 30 per 100,000 inhabitants, the conditions in regions such as Chocó, on the Pacific coast, where ICUs have barely grown to reach 4 per 100,000, it can burst at any time.
Herd immunity?
Some voices within the country have been suggesting that there were regions that could be calmer than others after the first peak.
The preliminary results of the seroprevalence studies that the National Institute of Health (INS) revealed at the end of December indicate that in Leticia 6 out of 10 people have passed the contagion;
55% in Barranquilla;
50% in Cartagena.
In Medellín or Bogotá the amount is lower (27% -30% respectively), leaving a larger stock of people susceptible to contagion (as they do not have antibodies produced by past infection) in the face of this second peak.
And although this is technically true, it is also true that in the two capitals of the Caribbean coast, cases have begun to rise once again, underlining what several epidemiologists have pointed out in recent months, including the Colombian Zulma Cucunubá (Imperial College London): that herd immunity via massive contagion is not an option, nor is it advisable, nor is it viable.
This does not mean that the territorial incidence is differentiated, and with it regional solidarity emerges.
Up to 629 patients from different parts of Colombia have been transferred to an ICU in Bogotá.
Now, health authorities have requested support for cities such as Barranquilla, Cartagena and Santa Marta to receive covid-19 patients from the capital.
Although at the moment there are only thirty transfers, it is an illustrative action of the different moments.
The demographic weight of Bogotá, a city of more than seven million inhabitants, is enormous, and it has been one of the epicenters of the coronavirus since the first positive was confirmed on March 6, 2020. Practically from the first moment, the management The pandemic has faced the leadership of the mayor of the capital, Claudia López, and President Duque.
The country's two leading political figures exhibit notable ideological differences, and sticking points have abounded.
At various times the mayor, from the progressive Alianza Verde party, has set the pace of the response, but in this second wave she became the target of criticism for having taken vacations - which she interrupted to attend to the emergency - at the beginning of the new year, when the situation got worse.
The increase in the occupancy of intensive and intermediate care beds in the capital occurred from the first week of December.
Due to its high level of infections and its speed of transmission, from the first week of January a third of its inhabitants returned to a strict quarantine.
Since then, confinement measures and mobility restrictions have escalated, with night curfews for the entire city and localized quarantines that at the beginning of this week sheltered nine of the 20 towns in the city, in addition to general quarantines during weekends.
The critical moment has set off the alarms.
Both Mayor López and her Medellín counterpart, Daniel Quintero, have speculated in the search for explanations with the “possible presence” of the new variant of covid-19 reported in the United Kingdom.
The second peak, they have argued, is being much more drastic than estimated, not only due to the greater number of contacts and infections but also because of the greater viral load identified in the positives.
The INS has clarified that so far the presence of the new strain has not been detected in Colombia, and indeed there is no indication from genomic surveillance that allows validating the hypothesis.
Also economic impact
The costs of the epidemic are not only measured in cases, deaths and sequelae.
The economic crisis that the covid has brought has produced one of the largest world recessions in remembrance, especially affecting households that depend on daily wages to ensure their livelihood.
Taking this into account, the Secretary of Health of Bogotá, Alejandro Gómez, has said that the measures were relaxed at the end of the year because the number of infections made economic reactivation possible, after several months of closures and quarantines.
Now, when hospitals are at the limit, he recognizes that the result was not what they expected.
"Not only did the District and the Ministry of Health lack greater capacity for pedagogical conviction, but also the will of a part of the population that did not believe in the risk of the disease and its serious consequences," he said in an interview with the newspaper
El Tiempo
.
This cumulative impact is not only different by income level and ability to maintain a ceiling to weather the crisis: the gender gap, already deep in Colombia, has become even more pronounced during this crisis, which has disproportionately eroded employment of women.
Personal services and places in direct contact with the public, notably feminized, are inevitably the most damaged by a situation that mainly affects activities that involve social interaction.
Olga Rivera, 43, was unemployed during the pandemic.
The beauty salon where she worked for more than 15 years in the north of Bogotá closed overnight.
"Suddenly I had no money to pay the rent or to buy food," he says.
To receive some money, he cleans houses and does brickwork, but for a couple of weeks he has not been able to do it because his neighborhood is under strict quarantine.
"If we do not leave our houses we cannot work," claims this woman, a mother of three children.
⇲ Unequal risks
The data collected by the Bogotá Mayor's Office in its surveys during the first confinement (from March to June 2020) underline this thesis: when citizens who left during quarantines were asked why they did so, the proportion of responses related to work or basic necessities were notably higher among people living in areas of lower socioeconomic status.
In households belonging to the upper-middle and upper strata, purely social or recreational motivations gained weight.
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The unequal impact of the pandemic (both in its economic and directly epidemiological aspects) fits into the inequitable structure of the country.
The authorities, both national and local, have approved support measures, but their implementation is slow and insufficient.
At the same time, the fluctuation of decisions to stop or slow down the spread of the virus has produced a gradual erosion of trust in the rulers, which in turn responds to another Colombian structural feature: the lack of institutional trust accumulated after decades of disagreements between citizens and public authorities.
The most recent expression of this erosion is the constant demand to these authorities to learn more about what a growing part of the population reads as the only way out of the pandemic: immunization by vaccination.
The vaccine, last departure
The country navigates this second wave amid enormous anxiety over the arrival of vaccines.
The Duque Administration chose to combine a multilateral strategy and several bilateral ones, since it is part of the Covax mechanism and has reached agreements with several pharmaceutical companies.
In total, it has announced agreements to immunize 29 million people: 10 through Covax, 5 with Pfizer-BioNTech, 5 with Oxford-AstraZeneca and 9 with Janssen, from Johnson and Johnson - which, unlike the others, only requires a dose-.
The plan aims to immunize 34 of the roughly 50 million residents.
But the details have only transcended by dropper, and the lack of transparency has aroused suspicions both in various opposition sectors and in the control entities themselves.
"These acquisitions are true facts," said the Minister of Health, Fernando Ruiz, to stop the criticism and defend that all countries have had to submit to the confidentiality agreements established by the pharmaceutical companies.
Except for the United States, he argues, the other countries do not have a specific timetable for the arrival of vaccines, since production and distribution chains are being consolidated in an environment of scarcity.
According to projections, Colombia will have doses from Pfizer in February, from the Covax mechanism in March, and those from Jansenn and AstraZeneca between April and May.
"The objective of the Government is not to have a leading role with the first vaccine, but to execute a massive process with which the final goal of vaccinating more than 34 million Colombians is achieved, highlighting that 29 million immunizations are already guaranteed," he said. Ruiz emphasized.
The different phases prioritize health workers, those over 60 years of age and people with comorbidities.
Workers of the El Tunal Hospital in Bogotá, Colombia.
In video, Colombia reaches 50 thousand deaths from coronavirus.PHOTO: AP |
VIDEO: EPV
It is very difficult to compare negotiation processes because each country has a different portfolio of vaccines, but none has dared to fight for transparency, says Johnattan García Ruiz, researcher at the Dejusticia think tank and professor of Law and Global Health at the University of the Andes.
"It is very difficult for the Government to explain itself, to be able to give simple and clear information to citizens, and this generates a lot of confusion," he values.
"The fact that this uncertainty persists causes people to enter a situation of hopelessness, and even mistrust with public institutions," he warns.
It highlights that although Colombia has a structured plan and a serious offer, citizen criticism has served to reveal more information than was known.
The day and time of the first vaccination, however, remain a mystery.
Information about the coronavirus
- Here you can follow the last hour on the evolution of the pandemic
- The coronavirus map: this is how cases grow day by day and country by country
- Questions and answers about the coronavirus
- Guide to action against the disease
- In case of symptoms, these are the telephones that have been enabled in each Latin American country.