Challenges to confront the COVID-19 in Latin America and the Caribbean

March 28, 2020

 

The new coronavirus landed in the Latin America and the Caribbean (LAC) region on February 26, in Brazil. Since then, governments across the region have taken an array of actions to protect their citizens against the pandemic. Soon, we will see whether infection trajectories mimic those in Asian and European countries.

The reports about the current pandemic show that the case fatality rates vary widely from country to country worldwide. These rates range from just 0.3% in Germany, 0.5% in South Korea, 0.9% (rest of China) to 7.7% in Italy (European CDC). This difference depends on several factors. These include age structure, underlying health conditions of those infected, national health system capacity, and the strategies adopted to reduce the transmission rate.

 

Age structure in LAC could be in favor

For many infectious diseases young children are most at risk. This is the case for malaria, endemic (regularly found among people in certain areas) in the LAC region, that causes most of deaths are in children under age 5. For COVID-19 cases, this is the opposite.

As of March 24, over 80% percent of the deaths in China, South Korea, Spain and Italy were among people 60+ years old (European CDC). This age group accounts for 15, 18, 24 and 28% of the population in those countries, respectively. In the LAC region, they make up 11% of the population (UN population division, 2015).

 

 

Challenges that threaten to exacerbate the health situation

Facing a low healthcare capacity

A nation’s healthcare capacity is of great importance to respond to the pandemic. South Korea and Germany well equipped with hospital beds (12 and 8.2 per 1,000 people, respectively), compared to China (3.8), Spain (3.1) and Italy (3.4). The outlook is not bright for the countries in the LAC region. Except for Argentina (4.7) and Cuba (5.3), most of the countries have less than 2 beds (per 1,000 people). Many of the rural areas have a number close to cero (World Bank, 2014).

A shortage of intensive care units in the LAC region is an aggravating point. About ¼ of severe and critical COVID-19 cases require treatment in intensive care units  (WHO). Colombia, with a population of 50 million and a usual hospital occupancy above 90%, holds only 5,300 intensive care beds. In this time of preventive isolation, non-vital surgeries were postponed and home care was expanded, allowing to reduce the occupation of intensive care units by 50%.

Colombia’s government and private corporates have developed a strategy to duplicate the capacity to confront the pandemic. According to this plan, (i) the current operating hospitals will receive most of the seriously ill patients, and (ii) adapted abandoned hospitals, hotels and tradeshow buildings into ‘field hospitals’ or mobile medical units will receive patients without complications. Only in the capital city, Bogota, the plan considers to increase 5-fold the intensive care capacity this month. This strategy could cost between 62 to 125 million US dollars.

Even if this plan of 10,000 intensive care beds is ready by April, it could also be insufficient if the virus spreads at accelerated rates. Since March 24, Colombia began a quarantine that will last through April 13, at least. Today, Colombia reported 608 cases, 327 imported and 6 deaths. Under a very optimistic scenario, if Colombians follow strict quarantine, one person could infect 1.5 other individuals. Thus the country could expect 50,000 confirmed infections and 700 deaths by the April 20. The scenario could be much more dramatic if transmission rates are higher. With a transmission rate of 2 or 3, the number of confirmed COVID-19 cases could scale to 200,000 or more. This scenario could be adverted if measures to sustain social distancing are truly effective.

 

Given the low capacity of healthcare systems in most parts of the LAC region and the prevalence of other serious illnesses, COVID-19 could quickly overwhelm these systems. 

 

Centralized diagnosis

Importantly, adequate testing allows infected people to receive the care they need and to take measures to reduce the probability of infecting others. Testing also helps healthcare workers identify and isolate the contacts of those infected, which is crucial for containment of the pandemic.

Perhaps most importantly, testing allows to understand the spread of the disease and the risk for those infected. Based on this evidence, the national leaders can take effective measures to slow down the spread of the disease. The best strategy to confront a disease that spreads easily, and does not kill many of those infected, is very different to the best strategy to confront a disease that spreads more slowly and is more deadly.

The capacity for COVID-19 testing is still low in many countries around the world (WHO). For this reason, we still do not have a good understanding of the spread of the pandemic (European CDC). The standard testing method is time-consuming, demands specialized laboratories and trained personnel. Due to the high demand, innovators released new serological rapid diagnostic tests. But the short period of time since the beginning of the epidemic has not allowed accuracy assessments of the rapid tests under different settings.

Most of the countries of the LAC region rely on specialized laboratories for diagnosis of COVID-19 in its capital cities. This is not the best choice. The transport of the samples takes very long time in large countries. Some people needs to be tested multiple times. There might be poor handling and shipping of samples.

For example, in Colombia the National Health Institute has the capacity to process 3,000 tests daily but they receive only 500 samples. They expect a massive arrival of samples for case confirmation so they have trained a total of 22 facilities in the country to support the diagnosis. These labs include universities, clinical labs and research centers that routinely perform molecular biology protocols, complied with the regulatory requirements, and hold personnel with the required training. However, most of them are located in the main cities. Solutions including accurate rapid screening tests should be evaluated, especially in isolated rural areas.

 

Since the number of confirmed cases is only a subset of the real total number of cases. Without massive testing, we are either underestimating the real scenario of infected people or overestimating risks. 

 

Social distancing

Although, people are relatively dispersed in rural areas in the LAC region. It is not simple keeping people apart in many dense Latin American cities. Actions were taken to communicate information about the need of social distancing in order to change behavior, but it is challenging in tightly packed public transportation systems. Besides people might refuse to comply with government instructions. This underlines the big differences between East and Latin American cultures, discipline and abiding the specifications of the state.

 

Economy

Aside from the health risks, there will be an economic impact as well. Although the scale of the setback is uncertain, the global GDP growth expectation for the year sinked from 2.9 to 2.4% (OCDE, March 2). In a perfect storm for economies, dropping oil prices have resulted in plunging Latin American markets and currencies. The regional GDP could contract -1.8% which could lead to unemployment in the LAC region rising by 10% (ECLAC).

Countries are starting to take policy initiatives in this direction. For example, some countries secured additional funds for health spending, including Argentina, Brazil, Colombia, Peru, Mexico, Paraguay, Uruguay, Costa Rica and Guatemala. Moreover, Uruguay, Brazil, Argentina, Peru, Colombia, Guatemala and El Salvador announced economic packages for supporting the socially vulnerable population. While Brazil, Chile and Dominican Republic deployed funds for maintenance of employment.

Countries must protect their companies so that they, in turn, support employment. The government can relax regulations, for example to authorize vacations and suspend labor tax contributions.

 

Informal economic sector

Many people in the LAC region rely on daily wages to survive, making it impossible for them to stay home during quarantine. Aggravated by the closing of school that disrupt school-based nutrition programs. Many local governments advocate for implementing curfews. This might impose restrictions on citizens liberties that could become quite severe.

 

Existing socioeconomic inequity

The spread of the disease could also increase social inequity, in the same way that HIV, tuberculosis, dengue, and chronic diseases have a major impact on specific vulnerable and marginalized populations.

 

Final comments

 

  • It is time for the international community to support the collapsing medical system in Venezuela, which cannot handle a COVID-19 outbreak on its own and is a potential danger for the region.
  • The capacity of the healthcare system could erode further if large numbers of healthcare workers fall ill. LAC countries have to guarantee that these professionals have enough safety materials and adequate salaries to face this crisis.
  • Solutions such as rapid screening tests are necessary. However, regulatory authorities must encourage accuracy studies of these rapid tests under different settings and regions.
  • Strengthening the healthcare and diagnosis capacity is expensive. Besides, every country in the world struggles for existing equipment and lab reagents to combat COVID-19. Local governments must encourage in site innovators and manufacturers, or create global alliances with international suppliers to guarantee the production and supplies of the items required.
  • In general, national governments are injecting a large part of subsidies to the low-income population. However, it might not suffice for a long period of time. Thus, it is necessary to coordinate a cohesive response with global groups including UN agencies, governments, donors, NGOs and companies.
  • It is essential to involve community leaders from marginalised populations to ensure that the communities understand and adopt the measures.

 


 

 

Government response and economic measures

As of March 27, this the situation in the countries of LAC region

Source: The Center for Systems Science and Engineering at Johns Hopkins University. European CDC – latest situation update worldwide.

Daily new confirmed cases are higher in Panama (19.9, per million people), Ecuador (10.8), Bahamas (10.1), Barbados (20.8) and Antigua and Barbuda (40.8) than the rest of the LAC region (between 0 and 8). While the USA presents the highest rate in the Americas with 50.7.

In terms of new confirmed daily deaths due to COVID-19, is higher in Panama, Ecuador and Honduras than in the rest of the region, with 0.7 – 0.28 and 0.1 (deaths per million people), respectively.

The collapsing medical system in Venezuela cannot handle a COVID-19 outbreak on its own and is a potential danger for the region. 

 

Brazil

A total of 3,417 confirmed cases. The country reported the first case on February 26. Quarantine started on March 25. The government announced 5,000 vacancies for doctors and the creation of 2,000 new intensive care beds. The COVID-19 test is an obligatory procedure in health insurance plans.

On March 27, the federal government announced the payment of two monthly salaries for workers employed by small- and medium-sized businesses.

 

Chile

A total of 1,909 confirmed cases. The country confirmed its first case on March 3. Since March 19, the government established a national quarantine and curfew, prohibits gatherings in public spaces, controls the distribution of basic necessities, during 90 days. Since March 25, health checkpoints secure quarantine rules in Santiago and 7 municipalities.

In addition, the government established a maximum cost of 30 dollars for the COVID-19 test in private healthcare facilities; and announced 8.7 billion in 2020 to help finance the emergency package to protect jobs. The president announced an economic aid plan of 11.7 billion, roughly 4.7% of annual GDP.

 

Ecuador

A total of 1,627 confirmed cases. The country reported the first case on February 29. Since March 15, foreigners are no longer able to enter the country and a nightly curfew was imposed. The government is providing free diagnostic tests for anyone with symptoms and increased internet and phone data service as well as.

On March 17, the president announced that social security payments will be postponed for 90 days. Also, taxes will be deferred for the tourism, export sectors and small businesses.

 

Panama

A total of 786 confirmed cases. On March 9, the first case was confirmed. On March 24, the national quarantine was declared. The national armed forces closed down all unofficial entry points at the border with Costa Rica. The banks are postponing mortgage and loan payments until December 31. People who have lost their jobs will not pay utilities for the next 3 months. Each of the 23 community councils will get 25,000 dollars in emergency funds. Panama will feel the impact as the pandemic continues to impact trade, since 5% of global trade passes through the Canal.

 

Dominican Republic

A total of 719 confirmed cases. First confirmed case was reported on March 1. On March 19, the country closed its borders for the next 15 days and called for the suspension of most commercial activities and cultural activities. On March 26, the government announced a nationwide curfew expansion until April 3.

The Central Bank approved 1.5 billion in credit for banks and 622.4 million for export industries. The government announced an economic package of 591,200 to alleviate salary losses and food insecurity.

 

Mexico

A total of 717 confirmed cases. The country confirmed the first case on February 28. From March 20 the schools are closed through April 20, the nonessential travel across the border with US is restricted. On March 23, the WHO predicted that the country will confront 600,000 life-threatening COVID-19 cases. On March 24, the government suspended gatherings of more than 100 people for 1 month, and work activities that require people to travel.

The government provided 180 million dollars for expanding hospitalization capacity and deploying thousands of health professionals. The government announced a fund of 1 million dollars for low-interest loans to small businesses and that senior citizens would get an advance on their next 2 pension deposits.

 

Argentina

A total of 690 confirmed cases. The country reported its first case on March 3. The government closed the borders and imposed obligatory quarantine from March 20 until March 31. It was implemented the family emergency income of 157 dollars in April. The salaries were raised by 470 dollars for medical workers at public and private hospitals.

 

Peru

A total of 635 confirmed cases. On March 6, the first case was reported. The government declared a nationwide quarantine from March 15 to April 12, and a nightly curfew from March 19. 2 days later 8,000 people were arrested for violating the curfew and the movement restrictions.

The government purchased 1.4 million coronavirus rapid tests. 3 million low-income households will receive payments of about 100 dollars. There will be large economic losses due to closure of touristic attractions. Only keeping Machu Picchu closed two weeks represents a loss of 100 million dollars.

 

Colombia

A total of 539 confirmed COVID-19 cases. The country confirmed the first case on March 6. Disease spread and government response was discussed above. The economic measures consider subsidies of 40 dollars to 3 million low income families, a public investment of 1.5 million in healthcare, the deployment of 2,500 health professionals, the distribution of 23 tons of food and 96 million gallons of water to vulnerable populations and reduction for student loan payments.

In conjunction with the national quarantine from March 24 till April 13, the government announced accelerated tax refunds, the elimination of import taxes on medical supplies and technology, reinstatement of water services, a grace period on mortgage and loan payments for small- and medium-sized companies, and special lines of credit for the agriculture, tourism, and aviation sectors. Furthermore, the national regulatory authority, INVIMA, has simplified the process for importing medical devices, reagents, medicaments and hygiene products.

A concerning factor is migration. It is estimated that 35,000 people cross the border with Venezuela daily. Many Venezuelans seek basic supplies and medical treatment due to the prolonged economic crisis.

 

Costa Rica

A total of 263 confirmed cases. Costa Rica was the first Central American country to confirm a case on March 6. Since March 18, citizens undergo a two-week quarantine. A state of emergency was declared, closing its borders till April 12. The national authorities closed all beaches and religious centers, imposed a nightly car restriction, and if foreign residents leave the country automatically loose the immigration status.

The tax relief legislation considers the Value-Added Tax, profit taxes, selective consumption taxes, and tariffs on imported merchandise (April – June). Costa Rica received a 1 million aid package from the Central American Bank for Economic Integration to combat the virus. The pandemic will have a significant impact, since tourism accounts for 8% of the GDP.

Migration is also a big concern. During the evening of March 24, authorities from Costa Rica transferred 2,600 US-bound migrants – mainly African and Haitian – from Panama to Nicaragua border. Health checks showed that by then none of them showed coronavirus symptoms. Nicaragua subsequently closed unauthorized entry points on the shared border.

 

Cuba

A total of 119 confirmed cases. The country reported the first three cases on March 11.  On March 21, Cuba sent 52 doctors and nurses to Italy to help, as this country continues its battle against the pandemic. On March 23, the government announced the closure of schools until April 20. The government also suspended cross-island travel and touristic activities indefinitely. Cuban residents returning must be quarantined for two weeks.

On March 26, the government announced the temporary suspension of more than 16,000 work licenses for entrepreneurs, landlords, contract workers, restaurant workers and craftsmen. The Cuban government enlisted the local textile industry to fabricate cloth masks.

 

Honduras

A total of 95 confirmed cases. The country confirmed its first two cases on March 11. On March 15, the government closed the borders, and imposed a curfew for 7 days. Starting on March 23, all markets across the country were closed to the public. The government announced a program aimed at giving 800,000 families foodstuff and hygiene products every two weeks for the next 30 days.

 

Bolivia

A total of 74 confirmed cases. The country reported the first two cases on March 10. The borders are closed until April 15. The national quarantine started March 22 and end April 4.

 

Paraguay

A total of 56 confirmed cases. The country confirmed the first case on March 7. The public events were suspended on March 10. From March 24 until April 12, the incoming flights are suspended. The government spent 800,000 dollars to build two new hospitals with 200 beds and 81 million for health measures.

 

Guatemala 

A total of 32 confirmed cases. The country reported the first case on March 13. Starting March 17, the government closed the borders, suspended all forms of work, prohibited events and stopped all public transport. On March 21, a nightly curfew was imposed until March 29.

The government announced a fund of 30 million dollars for containment of COVID-19, plus a 480 million loan to cover elderly, health, employment and security programs during the emergency.

 

El Salvador

A total of 19 confirmed cases. The country reported the first case on March 18. The country is under quarantine since March 11 during 51 days. The president suggested that final year medical students could start supporting medical efforts. The government is converting hotels to hospitals to take care of 12,800 infected people. It was announced a subsidy of 300 dollars per house for about 75% of Salvadoran households. The prices of basic goods were frozen.

 

Nicaragua

A total of 4 confirmed cases. The country reported the first case on March 18. The government banned funerals for those who die of the virus. So far, the government has not implemented quarantines, school suspensions, or travel restrictions. A number of local businesses decided to close down to protect their staff and clients.

 

Uruguay

A total of 274 confirmed cases. The country reported its first four cases on March 13. The same day the government announced a health emergency, closed the borders and schools, suspended incoming flights from USA and Europe, banned the stops for cruises and major public events. After 4 days the government closed completely the borders with Argentina and 5 days later with Brazil, at least 30 days.

The government announced the extension of tax payment deadlines, the injection of 22 million to social programs, plus 55,000 for workers 65+ years old. The government created a fund to cover the expenses caused by the pandemic, cutting a part of the public spending and pensions of public workers, ministers and legislators for two months, at least.

 

Venezuela

A total of 113 confirmed cases. The country reported the first two cases on March 13, 5 days later closed the schools, suspended flights from Europe and Colombia for a month. On March 16, the social quarantine is imposed nationwide.

The health system is in crisis. They country closed hospitals or kept a few operating partially without regular access to electricity or water.

Whereas China is the biggest supporter of the president regime. The International Monetary Fund denied a loan requested by the president for 5 billion to confront the emergency. The interim government, supported by the Inter-American Development Bank and USA, executed first line of action by delivering 3,500 protection kits to the health sector. Later the president regime activated permanent airlift with China to combat COVID-19. The country received 4,000 test diagnostics kits, medicaments and safety suits.

 


Other nations and territories

Cases have been confirmed in Antigua and Barbuda, Aruba, the Bahamas, Barbados, Belize, Cayman Islands, Curacao, Dominica, French Guiana, Grenada, Guadeloupe, Guyana, Jamaica, Martinique, Montserrat, Saint Barthelemy, Saint Vincent and Grenadines, St. George’s, St. Lucia, St. Martin, Suriname, Trinidad & Tobago, and Virgin Islands.

 

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