COVID-19: Perspective from the Americas
Even as the coronavirus has come under some measure of control in other parts of the globe, Latin America has become a burgeoning hotspot. As the pandemic has battered the region, it has jeopardized public health, devastated commerce, and exacerbated longstanding inequalities that threaten to derail years of social progress. Countries such as Mexico and Brazil are facing overwhelming caseloads, high death rates, and double-digit economic contractions. Latin America’s worsening COVID-19 plight will have ripple effects on the world stage for years to come, and it can also offer important lessons about global health policy as we re-evaluate our own preparedness for future disasters.
We chatted about the response in the Americas with Dr. Edwin Asturias, Professor of Pediatrics-Infectious Disease at the CU School of Medicine, Professor of Epidemiology and Director of Latin American Projects for the Center for Global Health at the Colorado School of Public Health and Dr. Mauricio Hernández Ávila, Director of Economic and Social Benefits at the Mexican Institute of Social Security (IMSS).
Key Takeaways So Far:
Dr. Mauricio Hernández Ávila, Director of Economic and Social Benefits at the Mexican Institute of Social Security (IMSS):
Countries were forced to launch the response to the pandemic as it unfolded. Despite warning from the scientific community, we were not prepared to respond to an epidemic of this magnitude. Leadership from respected institutions was weak or too late. We are reassured when we hear authorities are “following the science.” However, scientific knowledge seldom leads to a specific course of political action. How can we design cooperation mechanisms that allow science and evidence to better guide our decisions?
COVID-19 has exposed the lack of preparedness (limited stockpiling of PPE), healthcare system weakness (segmentation and fragmentation), social distancing has its limitations, and the new normal might not be working for most of society.
We need to analyze our personal, institutional, and political responses. We urgently need to learn from our success and failures, and we must conduct a critical evaluation of our response so far. It’s okay to allow ourselves to change. It is not okay to be comfortable with what is going on.
Dr. Edwin Asturias, Professor of Pediatrics-Infectious Disease at the CU School of Medicine, Professor of Epidemiology and Director of Latin American Projects for the Center for Global Health at the Colorado School of Public Health:
Latin America is the 2nd largest epicenter of COVID-19 in the world. Countries that took early consistent actions based on science have done better. Countries with robust universal health systems based on primary care have lower mortality. Upscaling testing for COVID-19 is critical. The boxing-in strategy is simple and clear for the population. Gradual reopening of the economy is better while maintaining closure of schools, bars, and large gatherings.
KRISTAN UHLENBROCK: What are some preventative strategies that have been implemented across your regions or your countries that you've been focused on?
EA: One factor that delayed our outbreak - that didn't come until late May, beginning of June - was the implementation of a mandate for universal masks. That was implemented in Guatemala a month after the first case, even when the World Health Organization and many countries were not recommending that as a as a strategy.
Masks are one of the most important strategies that we can have, even if it isn't as good as a complete lockdown of a country. In many of these countries, the economy really cannot survive that lockdown for that long. Universal use of masks can be crucial. Back in May, 90% of the population in our [vendor markets] was wearing a mask, but only 60% were wearing it correctly. Most recently, about a week or week and a half ago, 98% of the people in those markets are wearing a mask and 90% have been using that correctly. So I think that really has helped tremendously in that process.
MH: We had a difficult start with universal masking. And that was because we have a very short supply of PPE for medical doctors and we were struggling to keep our hospitals and clinics with a full supply. So I think that's why we did not recommend universal masking.
Further on in the epidemic we have been supporting it. One thing that we think is very efficient in Mexico has been to speed up contact tracing. Contact tracing needs resources, needs a lot of testing. And as I mentioned, our testing system experienced really severe bottlenecks with the restrictions. So those two issues were not really, I think, well put in place in Mexico. However, we were very successful in helping people to stay at home and to quarantine without needing to go to the doctor, without needing to go to the bank to collect your payment.
KU: In Mexico, there's a high number of people with diabetes or other pre existing health conditions. If there was one strategy that you could change right now that you are not doing - based on lessons from other countries or lessons yourself that you've learned since the start of this - what would that change be?
MH: This is a very relevant question because when you are a worker that has diabetes, then you might stay at home, and we have recommended this, so many workers with chronic disease are staying at home. Now, this also has a cost, because they have to stay with full salary and is the employer would base this the salary. So we ask these workers to come to our health facilities to get control of the disease. It's been shown that if you are in control of your disease, if your glucose levels are the good level, then you are not at a higher risk of having a severe manifestation of COVID. I think we struggle with how to reach these people, to help them to comply. The strategy that I will bring in will be telemedicine. We fell very short of access for these people living with this condition. So, I will implement telemedicine really heavily.
EA: Perhaps from my end, if I had to sort of restart the response to this pandemic, I will use two important things that I think we knew worked before, but we forgot as we were rushing to get the hospitals ready. We forgot that primary healthcare and population health were crucial for this. And I think what we have learned recently is that yeah, hospitals are tremendously important, holding down the consequences of this infection. But if we were able to tackle several causes early on, you know, the right treatments, and the right care early on, closer to their home, it was much better than actually waiting for them to show up at the hospitals. Once again, I think COVID-19 is telling us that primary health care and population health are crucial for any response.
MH: Mexico has a very high level of chronic disease so if you decide to make a recommendation of staying at home for hypertension and diabetes, you will send home 30% of the workforce. If you include obesity, then you increase that by 40%. So it's also has been in terms of protection and economic dilemmas that we face here.
KU: We’ve talked about some of the tradeoffs. Edwin, what are some of those fine balancing acts that are being talked about right now between public health, safety, and keeping the economy going?
EA: I think in Latin America, those balances are different depending on the country. There are countries which had very robust health systems and also at the same time, had a more organized economy in a way to be able to lock down completely. I think Mexico and most of the Central American countries, as well as some of the South American countries are similar to Guatemala in the sense that, for example, our reliance on agriculture is very high, and therefore, agricultural workers were able to continue to work because distancing was much easier there. However, the cities and urban areas really got hit very hard by this. There, we had to make a decision on which were essential industries and commerce that needed to continue, versus those that we needed to wait for in order to reactivate.
We are learning through those lockdowns that the ability for the population to resist those lockdowns is very low, and so we needed to come up with a partial strategy of sort of decreasing activity and mobility without really hurting people. I think so far, it has proven that the balance is in there. We haven't been hit by the second wave, so still more to come, but I think for the most part, it has worked well.
MH: In Mexico, to reopen certain industries, you can simply say they are essential for maintaining the living and the work of government. We opened, for example, all the automobile industry that is linked with the United States production chains. So, we open the factories that are feeding parts or vehicles to the US - large trucks and automobiles. I think this is good because then we work in the North America agreement, and that's when you see economy is being protected. Because things not being open in Mexico has huge repercussions for the industry in the U.S.
KU: There's close coordination of course between the U.S. and Mexico and our other Latin American neighbors. What are you seeing, where could we be doing better, and what should our audience know about traveling?
MH: The North American collaboration for pandemics and influenza has been working pretty well. We have had meetings, very helpful meetings, for example, when we had our crisis for personal protective equipment. We saw alternatives on how to recycle safely. This is because we were all facing similar problems in the U.S. and Mexico, so we've been working, I think, pretty closely together meeting every 15 days or so and sharing lessons and information.
Now, in terms of traveling. I hope that we are going to develop a safe, traveling industry because as many Mexicans visit the U.S., many U.S. citizens also visit Mexico. So we need to work out the security protocols to make this activity safe again and to empower our economy.
EA: I think from my end, I will say that the first day reaction of any government is to protect their own population. That really has been something that we have seen in other pandemics, where countries look to themselves first before they look into coordination. Now, it has been incredible the amount of coordination and help that has come from other countries, especially for Latin America.
The U.S. has been the traditional and natural partner of Latin America. In this case, the response to their outbreak has a really hampered our ability to sort of coordinate and cooperate on the amount of PPE that you have, the amount of testing that you need. Everything else has diverted away. So Latin America is now benefiting from partnerships with Europe, as well as Asia. So there will be a tremendous amount of help for example, to Central America from China and Taiwan, really because they have large amounts of PPE, masks, and testing. I think what we are seeing here is when a country as large as the United States is having trouble due to the epidemic, their ability to really coordinate with others is relatively low.
And I will say for the industry of travel, certainly Mexico as well as Guatemala and Costa Rica and other places which have hopes for tourism, are gonna need to look into that industry as a crucial one for restarting the economy because it’s going to be quite important. How can we have the traveler feel like they can come to the country and not necessarily get infected, and also that they can come to this country and not bring in more infections of cases.
The Institute for Science & Policy is committed to publishing diverse perspectives in order to advance civil discourse and productive dialogue. Views expressed by contributors do not necessarily reflect those of the Institute, the Denver Museum of Nature & Science, or its affiliates.