Brazil exceeds 1.5 million cases of coronavirus 0:49
(CNN) - In late April, a video from the main hospital in Manaus showed bodies lined up in corridors, victims of a sudden increase in the coronavirus. At the same time, that Brazilian population began to dig mass graves for hundreds of people who had not even had the opportunity to receive treatment.
Similar scenes have since been seen in Latin America, which has witnessed an explosive spread of the coronavirus. In Guayaquil, Ecuador's largest city, coffins were made from cardboard boxes while uncollected bodies were left on the street. In Santiago, the Chilean capital, public hospitals were overwhelmed as restrictions eased too soon.
In the last week of June, coronavirus deaths averaged more than 2,000 per day in Latin America and the Caribbean, half of all deaths recorded worldwide, according to a CNN count of WHO data. Most forecasts suggest the picture will get much bleaker, with nearly 440,000 deaths projected across the region by October, according to the University of Washington.
The head of the Pan American Health Organization (PAHO), Dr. Carissa Etienne, said this week: "The Americas region is clearly the current epicenter of the covid-19 pandemic."
Inequality and political will
There are many reasons for the great impact of the covid-19 in Latin America: high levels of inequality, the vast “gray” economy of informal workers, the lack of sanitation in crowded urban slums, as well as the slow and uneven response of the governments.
Alejandro Gaviria, a former Colombian health minister, told CNN: “Latin America is very heterogeneous. In some cities, the health infrastructure is similar to that found in developed countries; In rural areas, infrastructure is generally poor. It is like having Europe and Africa on the same continent. ”
Often, that disparity exists within a city, one reason why the virus spread so dramatically in Santiago.
Nurses transfer a patient with covid-19 to an intensive care unit at a hospital in Santiago, Chile, on June 24, 2020.
Latin American countries have had different experiences with covid-19. Uruguay, which has a well-funded public health system, embarked on an aggressive monitoring and testing program when the pandemic hit. Despite a change of government in the midst of the crisis, it has had a consistent policy on confinement. Almost 20% of the population downloaded a government application with guidance on the virus.
Paraguay, which is much poorer than Uruguay, appears to have benefited from an early closure. It also imposed quarantine measures for people entering the country from Brazil, the epicenter of infections on the continent.
Elsewhere, the story is much less optimistic, especially in countries with large informal economies. In Mexico, Colombia and Peru, almost two thirds of workers do not have a safety net underneath them. And their incomes have probably declined by 80% during the pandemic, according to the International Labor Organization, putting even basic medical care out of reach.
The coffins are taken to a funeral storage facility in Santiago, the capital of Chile, on June 19, 2020.
Crowded living conditions in the poorest urban areas, where basic hygiene and social distancing are almost impossible, threaten the region with a growing wave of infections. As Dr. Marcos Espinal, head of PAHO's Department of Communicable Diseases and Health Analysis, pointed out to CNN: "In the neighborhoods of Lima it will be very difficult to make social distancing."
Espinal pointed out that in some countries only a third of the population has a refrigerator, which means that people must buy on a daily basis.
Low investment
In the two decades to 2015, many Latin American countries invested in public health as their economies grew. There was success in reducing infant mortality and tuberculosis, for example. Colombia increased its intensive care beds tenfold.
Gaviria says there are many differences between countries, “but most people have access to some type of care. In Colombia, for example, coverage is close to 100% ”.
The coffins are brought to a funeral store in Santiago, Chile, on June 19, during the coronavirus pandemic.
However, quality is a different matter, he explains (a point Espinal also made at PAHO.) All but five or six governments are well below the WHO target of spending 6% of GDP on health, he says. Peru, for example, spends 3.3%.
Multiple studies have shown that the poor, and especially the rural poor, have less access to health care. Border areas are often poorly served.
Some Amazonian cities in Brazil are more than 500 kilometers from the nearest ICU bed. In 2016 there were less than three beds for every 100,000 inhabitants in some northern Brazilian states, but more than 20 beds for every 100,000 in the richest southeast. PAHO warned that the region will not overcome the virus unless care is provided to marginalized communities, such as indigenous peoples in the Amazon. CNN reported an increase in infections this week among Xavante communities in the northeast of the Brazilian state of Mato Grosso.
On the other hand, new studies suggest that ethnic minorities in urban areas of Brazil are also at higher risk. A survey by the University of Sao Paulo published this week found that the coronavirus had infected 2.5 times more black residents than whites.
Coronavirus is only one of the multiple health crises in Latin America. Studies showed that the poorest people in the region have higher levels of diabetes, obesity, hypertension, and heart disease, making them more vulnerable to covid-19. This is especially problematic in Mexico and Brazil.
Men in protective gear bury a coronavirus victim in a cemetery 14 km north of the Honduran capital, Tegucigalpa, on June 21, 2020.
Fabiana Ribeiro, a Brazilian researcher currently at the University of Luxembourg, told CNN that a recent study revealed that the lowest survival rates were for rural patients 68 years of age or older, and for black, illiterate, or previously ill patients, like heart disease and diabetes.
The winter months in the southern hemisphere bring other diseases, such as influenza and pneumonia. Francesco Rocca, president of the International Red Cross, assured this week that the health emergency in Latin America could worsen "with the arrival of winter in the south, the flu season in South America and especially the hurricane season in the Caribbean."
Some governments, for example Chile, have warned private providers that they can take up beds as public hospitals double over from tension. Gaviria points out that in Colombia the government now controls access to ICU beds in the public and private sectors, “and decides where each new patient should go. They want to avoid rationing based on the type of insurance or financial considerations. ”
The Pan American Health Organization has said that solid testing and tracing programs will be essential in the coming months. There are some promising signs, such as mobile teams in Costa Rica that check for infections and quarantine. And in much of the region there is already a large network of laboratories established to detect the flu that is being mobilized.
The grave of an evangelical pastor who reportedly died of covid-19, in a cemetery in Managua, Nicaragua, on June 5, 2020.
But the testing capacity is highly variable across the region. As of June 29, Chile had performed nearly 5,800 tests for every 100,000 inhabitants, according to PAHO. Panama had made just under 3,000. But Brazil had made 230, and Guatemala 45.
"In Nicaragua we don't even know how many tests are being done," says Espinal.
The impact of the coronavirus in Latin America is likely to leave deep scars. The World Bank believes that more than 50 million people will see their income fall below the poverty line of $ 5.50 a day. Some economists fear that the economic damage may be on par with the "lost decade" of the 1980s.
Amid a deep recession that may shrink the region's economy by one-tenth this year, the necessary investment in public health may not materialize. Espinal thinks it would be a big mistake. "There is no way," he told CNN, "countries can justify continuing to invest at the same level even if the economy suffers."
Without it, the social unrest that erupted in Chile and Ecuador last year may return as populations emerge from confinement. Political risk consultancy Verisk Maplecroft warns: "The riots are expected to escalate in the second half of 2020 because the cumulative problems that spread to the protests in late 2019 remain unresolved."
Alejandro Gaviria, former Minister of Health of Colombia and now rector of the Universidad de los Andes, is concerned about what the rest of 2020 will bring. "Three problems overlap," he says, "a growing pandemic, social devastation and increasing fatigue. with confinement. The new restrictions will only be possible with strict and repressive measures. "
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