Intended for healthcare professionals


Covid-19 hot spots appear across Latin America

BMJ 2020; 369 doi: (Published 01 June 2020) Cite this as: BMJ 2020;369:m2182

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  1. Owen Dyer
  1. Montreal

Central and South America are fast becoming major centres of the covid-19 pandemic as cases surge in Brazil, Peru, Mexico, Chile, and, to an unknown extent, Venezuela and Nicaragua.

With 514 849 reported cases, Brazil is now second in the world in case numbers, behind only the United States. This week it passed the landmark of 1000 deaths in a single day and on some days reported more new cases than the US.

Brazil’s far right populist president, Jair Bolsonaro, has drawn criticism at home and abroad for his dismissive attitude to the virus, which has echoed many of the claims made by US president Donald Trump.1 Like Trump, Bolsonaro has touted the unproved antimalarial drug hydroxychloroquine. He has also said that resistance to infection is a national characteristic of Brazilians, even after they “dive in sewage.”

Brazil’s early response, however, was guided by health minister Luiz Henrique Mandetta, who urged strong social distancing measures. He was often at odds with Bolsonaro, who fired him last month. His replacement, the oncologist Nelson Teich, quit the job on 15 May, after four weeks, without any clear explanation.

“Life is made up of choices, and today I chose to leave,” said Teich. He had only accepted the job, he said, “because I thought I could help the country and its people.”

Teich has been temporarily replaced by Eduardo Pazuello, an active army general. With deaths standing at 29 314 and climbing fast, some parts of the country are easing restrictions, while many big cities remain partly locked down. As in the US, state governors have a large say in local rules, creating an uneven national patchwork.

Some Brazilian cities show a large discrepancy between reported covid-19 deaths and overall excess mortality. Testing remains sparse, at about 4000 per million people, and patients who die without being tested are not being recorded as covid-19 deaths.

Strict lockdown in Peru

Unlike Brazil, Peru has won international praise for its pandemic response. President Martin Vizcarra took significant measures even before the World Health Organization formally declared covid-19 a pandemic. Peruvians have been theoretically under strict lockdown for 71 days, longer than any other South Americans, and testing has reached more than 28 000 people per million population, more than in several European countries.

But, experts say, Peru is the country that did everything right, only to be betrayed by its poverty. It is now second in Latin America for cases, with 164 476, and for deaths, with 4506. The government says that 85% of intensive care beds are now full.

Less than half of Peruvian households have a fridge, forcing people to shop for food every day in crowded markets. “We must endure [the crowds] because there is no other way,” one woman standing in line told TV Peru. “If not, we will not have food.”

Peru was one of the first countries to issue relief cheques to compensate for lost income, but because only 38% of Peruvians have bank accounts they had to crowd into banks to collect cash. The government has since acknowledged that this was a misstep.

Video of a well known lawmaker being turned away from a hospital as he complained he couldn’t breathe (he later died at a different hospital) alarmed Peruvians and persuaded some with symptoms to try to fight the disease at home. But many live in crowded homes, and this has helped the virus to spread.

Recent revisions to Peru’s lockdown rules place less emphasis on staying at home and more on safety at the food markets. Despite the death rate, the government enjoys high approval for its response and the honesty of its public briefings.

Limited response in Mexico

Mexico’s president, the left wing populist Andrés Manuel López Obrador, commonly known as AMLO, was almost as dismissive of the coronavirus threat as his Brazilian counterpart Bolsonaro. He spent much of April touring the country, hugging, and shaking hands with supporters, wearing no mask. But, as in Brazil, the Mexican president’s direct control over the pandemic response is limited, and lockdowns have been in place. Some are now being eased, even as case numbers climb fast.

Mexico has reported 87 512 cases, but with 463 deaths on 28 May alone this is likely to be a major undercount. Testing is minimal in Mexico, with fewer than 2000 tests per million population to date.

More than 11 000 Mexican health workers have been infected, one of the worst rates in the world. Some claimed that they were told to work without masks so as not to alarm the public. Illness and massive absenteeism has left some Mexican hospitals with just a quarter of their staff.

“We have had many of what we call ‘dumb deaths,’” Pablo Villaseñor, a doctor at the General Hospital in Tijuana, told the New York Times. “It’s not the virus that is killing them. It’s the lack of proper care.”

Many Mexicans with dual citizenship or work papers, and US retirees resident in Mexico, are pouring across the border and filling up hospitals in southern California.

Chile’s healthcare systems struggle

In Chile, with 99 688 cases, deaths remain comparatively low at 1054, but intensive care capacity is now being reached. “Our healthcare system, and especially that of Santiago, is very close to reaching its maximum capacity,” said President Sebastian Pinera on 28 May.

In Ecuador, pictures of coffins in the streets of Guayaquil shocked the world in March, but the country is now well past its peak, having had 3358 deaths and 39 098 reported cases, though the government acknowledges that the second figure is probably a significant undercount. Guayaquil is now cautiously reopening some businesses. “In the home there is hunger, outside there is the coronavirus,” mayor Cynthia Viteri told reporters.

Mystery still surrounds the situations in Nicaragua and Venezuela. Nicaragua’s president, Daniel Ortega, who recently disappeared for two weeks and was rumoured to have the disease, has played down its threat, even holding mass political rallies. But the country is rife with reports of “express burials” involving sealed caskets, with family members banned. These deaths are commonly listed on certificates as atypical pneumonia.

Venezuela claims a mere 1510 cases and 14 deaths from covid-19. Human Rights Watch called the numbers “absurd and not credible.” But Gerardo de Cosío, the Caracas based head of WHO’s Venezuela office, told Global News that it was unlikely that the government could hide a large outbreak. “We would have seen a lot coming out from social media—people talking about the increase of cases, hospitals being overrun.”

In recent days, however, the official numbers have begun to tick up faster, suggesting that the worst is ahead. Aid agencies warn that Venezuela is woefully unprepared for a large outbreak, with some hospitals lacking even running water.

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