COVID-19 in Latin America: what do the figures reveal?

It does not matter in which region or country of the world, whether it is one or two million. Every sick person, every death, every recovery counts. But the total figures of COVID-19 infections and deaths in Brazil (more than two million cases and 80,000 deaths), Mexico (more than 350,000 cases and 40,000 deaths) or Peru (more than 360,000 cases and 13,500 deaths) they alarm. It is followed by Chile (more than 330,000 cases and 8,600 deaths) and Colombia (more than 210,000 cases and 7,000 deaths).

However, if they are normalized by population, these figures are rearranged. Chile tops the lists of infections and deaths per million inhabitants (with more than 17 thousand cases and 451.61 deaths). Although it also leads the laboratory tests (PCR) carried out for every thousand inhabitants (75.6). And it is second in the proportion of recovered by total infected (92.40%).

They follow, in infections per million, Panama (with more than 12 thousand), Peru (almost 11 thousand), Brazil (almost 10 thousand), Bolivia (more than 5 thousand), Dominican Republic, Puerto Rico, Ecuador, Colombia (more 4,000), Honduras (more than 3,000), Argentina, Mexico, Costa Rica, Guatemala (more than 2,000), El Salvador, Suriname (almost 2,000), Haiti (more than 600), Paraguay (more than 500 ), Nicaragua, Venezuela, Guyana (more than 400), Uruguay (more than 300), Jamaica, Cuba (more than 200) and Belize (more than 100).

In deaths per million, Peru (405.95) and Brazil (376.93) also follow. Then Mexico (306.24), Ecuador (301.42), Panama (261.20), Bolivia (190.01), Colombia (136.18), Honduras (94.40), the Dominican Republic (91.54 ), Guatemala (83.84), Puerto Rico (62.92), El Salvador (54.27), Argentina (52.5), Suriname (35.80), Guyana (24.16), Nicaragua (14, 94), Costa Rica (12.96), Haiti (12.80), Uruguay (9.5), Cuba (7.68), Belize (5.03), Paraguay (4.63), Venezuela (4, 08), Jamaica (3.38).

In the matter of recovered by infected, everything is rearranged again: Cuba leads (94.48%). And, after Chile, Jamaica (87.53), Uruguay (84.76), Nicaragua (72.46), Peru (68.70), Brazil (67.62), Guatemala (66.33), Mexico (63) , 76), Suriname (62.33), Paraguay (60.44), Haiti (57.30), Panama (54.53), Venezuela (54.67), Guyana (48.08), Dominican Republic (47 , 40), Colombia (46.84), Argentina (44.47), Ecuador (42.94), Bolivia (30.93), Costa Rica (27.04), Honduras (11.72).

To more cases worse management?

These official figures processed by international statistical projects such as Johns Hopkins University, Our World in Data or Worldometers, change several times a day, although the trends they mark last somewhat longer. Thus, in Costa Rica, with just 5,486 cases until July 8, infections have doubled in the last two weeks, reaching 11,811 cases today. "The country that has the most cases does not mean that it is the country that is doing the worst," Dr. Marcos Espinal, director of the Department of Communicable Diseases of the Pan American Health Organization (PAHO), assures DW.

According to the figures, it would seem, for example, that the development of the pandemic in Haiti, Nicaragua or Venezuela can be compared to that of countries such as Costa Rica, Uruguay, Paraguay or Cuba. But all these figures must also be read through the prism of the reliability of the data and, especially, of the magnitude of the testing on which they are based.

Without enough evidence, "we cannot have a clear picture of how the epidemic behaves," and this is something that happens in Haiti, a country without resources, or even in Brazil, says Espinal. Haiti performs a test for every thousand inhabitants, for example, while Uruguay does 26, Cuba 20, Paraguay 15 and Costa Rica 13.

For its part, Brazil is doing 23, despite an extension of the epidemic comparable to that of Chile (which does more than three times more tests). That, without counting how many people with mild symptoms do not even report their case or are detected by the health systems of the different countries.

In the case of Nicaragua, PAHO recognizes difficulties with the continuity of the reports and the disaggregation of the data. And in Venezuela, the limited reliability of rapid tests, widely used in the country, compared to PCR tests. But, in general, most of the countries have responded "very committed" to the recommendations and maintain "very fluid communication" with PAHO, Dr. Espinal insists.

And it refers to the implementation of non-pharmaceutical measures (use of a mask, hand washing, social distancing). As well as the preparation of ports and airports, hospitals, availability of beds, personal protective equipment, intensive care areas (ICU), decentralization of laboratory tests (test), research capacity and patient assistance, prevention and control. from (other) infections, etc.

In addition to communication and educational programs, which serve and respect population groups in situations of vulnerability such as Amazon Indians, their literacy levels, their culture and language. All of these are essential functions of the international health regulations, with which the signatories committed in 2005, he specifies.

However, PAHO prefers to highlight the strengths of each country: the use of mobile primary care teams in Costa Rica, the massive Chilean testing program; or the advantage of federalism and the Brazilian primary care system (key to diagnosis today and prevention with an eventual vaccine in the future), despite the denialism of the country's president.

Does Chile have many cases because it tests a lot?

But "we have very populous cities, an excessive, unplanned urbanization in our region. Big cities like Rio, Sao Paulo, Mexico City, Lima, surrounded by belts of poverty, of overcrowding," recalls Espinal.

The SARS-CoV-2 coronavirus that causes the COVID-19 disease was introduced in countries such as Chile through the wealthiest social classes, but "it spread to neighborhoods, where there is less possibility of maintaining social distancing," explains the expert. from PAHO.

Just what happened in Chile, specifically in "the capital, which concentrates 40 percent of the country's population and is the pacemaker" of the pandemic, Dr. Christian García Calavaro, epidemiologist at the University of Santiago, confirms to DW. After five months of experience with the virus, the expert acknowledges that, although the country increased its diagnostic capacity by PCR from the beginning, it did not control the curve of spread of the disease in the first months.

So it is the high community circulation of the virus, the high rate of positivity that the PCR tests have produced, and not only the capacity of the country, that has determined the sustained extension of the testing. "Chile started the movement restriction measures, the quarantines, partially and late," says García Calavaro. And he remembers the strategy of "dynamic quarantines" implemented by the authorities in Santiago, despite the disapproval of the scientific community.

Municipalities or fragments of municipalities entered or left the quarantine, according to the evolution of the situation in short periods of less than two weeks, "which does not make any epidemiological sense," he says. "For the resources we have, we have not done so well," he regrets and points to the example of Argentina, "which has controlled quite well, with measures and early financial aid."

Peru: excessive urbanization and high informal economy rate

Countries like Peru, which took early containment and mitigation measures, for example, have also been affected by its high rate of informal economy, large groups of vulnerable populations, high rates of other diseases such as tuberculosis and malnutrition. In our region, "the most inequitable in the world", COVID-19 is not the only health challenge, Espinal insists: "We have tuberculosis, malaria, dengue. We are going to have influenza now that winter is coming in the south."

In other countries, the premature revival of economic activity, understandable by the economic and social challenge that accompanies this public health crisis, has also affected the control of the pandemic. In general, among the most mortally affected by the virus, as everywhere, in addition to the elderly, are the poorest and most vulnerable populations: Afro-descendants and indigenous people, for example.

In Chile, "mobility in vulnerable areas decreased considerably less than in the richest municipalities, due to the need to go out to work and eat," confirms the epidemiologist at the University of Santiago. Mortality rates in popular neighborhoods like La Quintana have been up to eight times higher than in affluent areas like Vitacura, Providencia or Las Condes, he says.

The lesson

But "this is a virus that mildly or moderately affects 80 percent of cases. So if we can avoid deaths, we are doing our job," says Dr. Espinal. "The recovered continue to increase in our countries, because every day we learn a little more about the virus," he adds. In this sense, Dr. García Calavaro insists on the need to improve information systems and incorporate diagnostic figures without virological confirmation (cases deduced by symptoms, without PCR test). Something that Chile is doing, but does not include, like most countries, in its reports to PAHO.

In the near future, hopefully for next year, PAHO bets on the WHO COVAX program to guarantee rapid, fair, and equitable access to COVID-19 vaccines in the region, as in the rest of the world; as well as its Revolving Fund for the purchase of vaccines.

But, at the national level, this pandemic leaves a clear lesson for politicians in our societies, Espinal concludes: "The need to increase public investment in health in all of our countries", gradually and steadily. And remember that most do not reach the minimum recommended by PAHO: 6 percent of GDP.

Source: Rosa Muñoz Lima for DW

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