Soon, a doctor and an administrator had also perished. In the end, 41 hospital workers tested positive for the virus.
It was the first in a series of hospital epidemics that shook Mexicans and raised questions about the Social Security Institute, the country’s largest public health network. Nurses and doctors organized protests across the country. Baja California Governor Jaime Bonilla denounced federal officials for the lack of protective equipment in his border state, saying the doctors “fell like flies.”
Medical staff at other pandemic hotspots, such as Italy and Spain, have also expressed outrage at the idea of working without proper equipment. But Mexico is particularly vulnerable because it has far fewer doctors and nurses per capita.
“European systems are better funded per capita and much larger as a percentage of GDP,” said Eduardo González-Pier, former Deputy Minister of Health. Mexico’s public health system has been underfunded in recent years, he said, leaving it “more fragile, less well equipped”.
According to authorities, six hundred people in Mexico have died of lust 19. About 9% of the country’s confirmed cases – 535 people – are employees of the Social Security Institute, known by its Spanish acronym IMSS. They represent about half of the Mexican health professionals infected, according to officials.
Unlike the United States, most Mexicans receive health care through the government. And no single supplier is more important than the IMSS, which serves about half the population. It manages more than 350 hospitals and thousands of clinics, the largest public health network in Latin America.
One such hospital is Monclova Hospital, less than three hours from Eagle Pass, Texas.
The truck driver, admitted in mid-March, was sent to a bed in the emergency department. He remained there for days until it was confirmed that he had coveted-19, said Roberto Bernal, the secretary of health for the state of Coahuila. At the time, few coronavirus tests were available in Mexico.
“There are three teams of people, morning, evening and night” in the emergency room, said Bernal. “Imagine what a contamination Petri dish was. “
Even before the driver died, doctors and nurses at the hospital began to organize protests to protest their lack of protective equipment.
“There is no material, no equipment – gloves, masks, there never is,” nurse Arturo Ramírez told the Televisa network.
According to the governor, almost half of the 230 confirmed cases in the state of Coahuila are medical personnel. The head of No. 7 Hospital has been replaced.
Monclova’s epidemic was followed by outbreaks in other hospitals. In the seaside resort of Cabo San Lucas, two employees at No. 26 hospital developed symptoms, so authorities tested all of the staff. Forty-two had the virus.
In Tlalnepantla, outside of Mexico City, 44 staff from No. 72 Hospital have tested positive, according to the IMSS. They included a group of resident physicians who had pressured their supervisors to give them protective equipment. Young doctors have learned that buying their own equipment is part of their “commitment” to medicine, they wrote in a letter to the Mexican media.
A senior IMSS official, Víctor Borja, said that some of the hospital epidemics were not surprising, since they were located in areas with high rates of contagion. And in several cases, he said, medical staff contracted the coronavirus outside the hospital – during trips or at social gatherings.
But he acknowledged that the staff were initially under-equipped for the pandemic. Authorities began ordering additional protective equipment in late February, he said.
“At first we had a problem because there were shortages both nationally and internationally,” said Borja, head of medical services at IMSS. “Each country was in competition” to buy the same items.
Another problem, he said, was that the initial definition used by medical authorities to determine what constituted a case of coronavirus was too restrictive. They focused on people they knew to have traveled abroad or been in contact with carriers, rather than all people with possible symptoms. The truck driver did not initially say he had recently been to the United States, said Borja, slowing the diagnosis.
“The important thing is what we have learned from these epidemics,” said Borja, as did the need to quickly disinfect the facilities. Mexican authorities have received tons of imported medical supplies in recent days, which should resolve the shortages, he said. They also announced 20% bonuses for IMSS employees who treat covid-19 patients.
The challenges of the Mexican public health system go far beyond the coronavirus.
IMSS, founded in 1943, was a pioneer among social welfare institutions in Latin America. His surgeons performed the first kidney transplant in Mexico in 1963 and his first heart transplant in 1988.
But in recent years, the Institute’s finances have been hit hard by an aging population, requiring more expensive health care, and medical personnel’s retirement expenses have increased.
“The IMSS has had thin financial margins for years,” said González-Pier. “You can see that reflected in the low investment in hospitals and equipment.”
The new policies introduced by President Andrés Manuel López Obrador after taking office in December 2018 have further complicated matters.
López Obrador has centralized government drug purchases to cut costs and deter corruption. But this has resulted in drug shortages. He launched an austerity campaign that angered the head of the IMSS, Germán Martínez, so much that he resigned last May. Martínez called the cuts in health spending “inhuman”.
López Obrador also revised Insabi, another large public health system, aimed at the poorest Mexicans. (The IMSS is primarily aimed at employees.) But its deployment has been bumpy.
The recent shortages in IMSS hospitals have caused such concern that state governments and business groups have donated masks and other equipment to the facilities.
Eugenio Derbez, a well-known actor here, called on Twitter for his subscribers to provide protective equipment at IMSS No. 20 Hospital in Tijuana. He had received a letter from a doctor telling him that the establishment was “overwhelmed.” His video, published last Sunday, went viral.
IMSS replied that the hospital had adequate equipment. But Bonilla, the governor of Baja California, supported the actor, saying that the medical staff was ill-equipped.
“They fall like flies,” said Bonilla, a member of the Morena de López Obrador party.
Borja said 24 staff from Tijuana hospital have tested positive for the coronavirus. He said the virus was apparently introduced by a nurse who could have been infected outside the facility.
He acknowledged that the IMSS had been lacking sufficient infrastructure for some time. She had plans to increase the number of beds for her clients. Then came the coronavirus.
“You cannot build a hospital overnight,” he said.
Gabriela Martínez contributed to this report.