Since then, similar scenes have taken place across Latin America, which has seen an explosive spread of the coronavirus. In Guayaquil, Ecuador’s largest city, the coffins were made from cardboard boxes while the bodies were not picked up. In the Chilean capital Santiago, public hospitals were overwhelmed because the lock-up was eased too early.
The head of the Pan American Health Organization (PAHO), Dr. Carissa Etienne, said this week: “The region of America is clearly the current epicenter of the Covid-19 pandemic. “
Often this disparity exists within a city – one of the reasons why the virus has spread so dramatically in Santiago.
Latin American states have had radically different experiences with Covid-19. Uruguay, which has a well-funded public health system, launched an aggressive screening and screening program when the pandemic arrived. Despite a change of government in the midst of the crisis, he had a consistent policy of foreclosure. Almost 20% of the population downloaded a government application containing advice on the virus.
Paraguay, much poorer than Uruguay, seems to have benefited from an early foreclosure. It also imposed quarantine measures on people entering the country from Brazil, the epicenter of infections in Latin America.
Elsewhere, the story is much less optimistic, especially in countries with large informal economies. In Mexico, Colombia and Peru, almost two-thirds of workers have no safety net under them. And their income likely fell by 80% during the pandemic, according to the International Labor Organization – even putting basic health care out of reach.
Overcrowded living conditions in poor 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 the Department of Communicable Diseases and Health Analysis at PAHO, told CNN: “In the barrios of Lima, it will be very difficult to distance yourself from society. ”
Espinal noted that in some countries, only a third of the population has a refrigerator, which means that people have to shop daily.
Over the two decades to 2015, many Latin American countries have invested in public health as their economies have grown. The reduction in infant mortality and tuberculosis has been successful, for example. Colombia has increased its intensive care beds tenfold.
Gaviria says there are many differences between countries, “but most people have access to certain types of care. In Colombia, for example, the coverage is close to 100% ”.
However, he says, quality is a different problem – a point taken up by Espinal at PAHO. All but five or six governments are far from reaching the WHO target of spending 6% of GDP on health, he said. Peru, for example, spends 3.3%.
Multiple studies have shown that the poor, and especially the rural poor, are less able to access health care. Border areas are often underserved.
Some Amazonian cities in Brazil are more than 500 kilometers from the nearest intensive care bed. In 2016, there were fewer than three beds per 100,000 population in some northern Brazilian states, but more than 20 beds per 100,000 in the wealthier southeast. PAHO has warned that the region will only defeat the virus if it improves care for marginalized communities, such as the indigenous peoples of the Amazon. CNN has reported an upsurge in infections this week among Xavantes in the northeast of the Brazilian state of Mato Grosso.
But new studies suggest that ethnic minorities in Brazil’s urban areas are also at greater risk. A University of Sao Paulo survey released this week found that the coronavirus infected 2.5 times more black residents than white residents.
The coronavirus is just one of the many health crises in Latin America. Studies have shown 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 particularly problematic in Mexico and Brazil.
Fabiana Ribeiro, a Brazilian researcher currently at the University of Luxembourg, told CNN that a recent study found that the lowest survival rates were among rural patients aged 68 and over, as well as black, illiterate patients or having previously suffered from heart disease and Diabetes.
The winter months in the southern hemisphere bring other illnesses, including influenza and pneumonia. Francesco Rocca, President of the International Red Cross, said this week that the health emergency in Latin America could worsen “with the arrival of the austral winter, the flu season in South America and especially the hurricane season in the Caribbean ”.
Some governments – Chile for example – have warned private providers that they could take over from beds while public hospitals are closing under pressure. Gaviria notes that in Colombia the government now controls access to intensive care beds in the private and public 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 said that in the coming months, strong screening and testing programs will be essential. There are some promising signs – like mobile teams in Costa Rica checking for infections and quarantine. And in a large part of the region, there is already a vast network of laboratories created to test the flu that are mobilized.
But testing capacity is extremely variable in the region. As of June 29, Chile had carried out nearly 5,800 tests per 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 done,” says Espinal.
The impact of the coronavirus in Latin America is expected to leave deep scars. The World Bank estimates 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 will be worth the “lost decade” of the 1980s.
In the midst of a deep recession that could reduce the region’s economy by a 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 could return as people emerge from isolation. Political risk consultant Verisk Maplecroft warns: “Expect unrest to increase in the second half of 2020 because the pent-up problems that spread through the protests at the end of 2019 are still unresolved. ”
Alejandro Gaviria, former Colombian Minister of Health and now rector of the University of the Andes, is worried about what the rest of 2020 will bring. “Three problems overlap,” he says, “a growing pandemic, social devastation and growing fatigue of closings. New closings will only be possible with strict and repressive enforcement measures. ”