Mikhael G. Iglesias L. – MA Candidate at NYU CLACS
In the sixth month of the current health crisis caused by COVID-19, in which much of the world was caught off guard, Latin America and the Caribbean have become a focal point for infections. Historic inequality in access to healthcare services, high poverty rates and informal economies, marginalization of indigenous and afro-descendant communities, the new rise of populism, and lagging infrastructures are some of the biggest challenges for the region in facing the pandemic. In countries such as Haiti with precarious healthcare conditions or in Peru which is now the country in the region with the highest death toll per million inhabitants, this pandemic is critical. In Uruguay and Costa Rica responses seem to be having a positive effect. In this series of articles for the CLACS Blog, we will focus on the implications of COVID-19 in the region.
What is known?
COVID-19 continues to generate more questions than answers that challenge societies and their contingency strategies. So far, the scientific community has determined that COVID-19 is caused by a coronavirus called SARS-CoV-2. There have been other types of coronavirus before such as SARS in 2002 with the outbreak epicenter in China or MERS in 2012 with an outbreak epicenter in the Middle East. COVID-19 is thought to be transmitted mainly from person to person through respiratory droplets when an infected person coughs or sneezes. Older adults have a major risk of developing more serious complications from COVID-19; as of July 18, around 80% of the deaths in the US due to Covid-19 have been 65 years or older. As the virus is spreading easily between people, measures such as social distancing and quarantines have been the main tools for preventing virus transmission while the world waits for a vaccine.
Putting the lens on Latin America and the Caribbean
As of July 18th, Latin America and the Caribbean have become an epicenter of the pandemic representing 46% of worldwide deaths (Table 1 reports confirmed cases and deaths by country in the region).
Table 1.- Total confirmed cases and deaths by country in Latin America and the Caribbean. Data was extracted from World Health Organization Situation Report 189 on July 27th, 2020.
This global crisis has exposed the persistent health inequities in most countries of Latin America and the Caribbean, which are rooted in structural and systemic problems regarding healthcare access, inequality, and governance models. Beyond the quality of healthcare services, politics have become an obstacle in some cases. Countries such as Brazil and Mexico have shown political unwillingness to take the current pandemic seriously, even when the health system and infrastructure is not capable of providing proper services for the entire population.
Guidelines for prevention and containment of the pandemic, such as social distancing, quarantine, tests, and taking care of at-risk populations, seem effective when applied in a timely manner. However, these guidelines are more complicated to implement when a significant portion of the region’s population survives economically on a day-to-day basis and relies on informal jobs (53.1% regionwide), and around 20% of the population in the region lives in informal settlements—mostly high density with poor access to basic services such as power, water, and sanitation.
Peru has reported the highest deaths per million inhabitants in the Americas, having a total death toll of over 18,000 deaths. Additionally, it is estimated that more than half of the non-agricultural workers are informally employed, which leaves them without any legal protection or safety net if they maintain quarantine and stop working. Those in Peru with formal jobs have been more resilient and have been able to maintain quarantine. The gap is not only about access to medical care, but the ability to comply with the pandemic contingency measures.
In the case of Haiti, the situation is worse. It took nine years, from 2010 to 2019, to address the cholera outbreak that was imported from the United Nations peacekeepers battalion, and that killed close to 10,000 people. This outbreak exposed that 35% of the population does not have basic drinking water services and that two thirds have limited or no sanitation services. Now with COVID-19 the country is facing a pandemic with inadequate medical equipment and low funding. On average, the country spends $13 on public health care per capita per year, which is below the average for low income countries, which is 15 US dollars. Furthermore, the country has gradually reduced its national health budget from 16.6 to 4.4% since 2004.
Mexico, an upper-middle income country, is dealing with challenges brought by COVID-19. Nearly 30% of workers are informally employed, and 17% of the population is not affiliated to any healthcare services, neither private nor public. Those who do have access often deal with a mismanaged system, high rate contagion among healthcare workers, and with lack of equipment adding to a complex situation to address the pandemic.
The challenge ahead
As confirmed cases continue to increase in most of the countries in Latin America, early easing of social distancing and quarantine measures could lead to more new contagions, such as is the case of Peru or Brazil that have seen a contagion rise as they ease lockdown restrictions. Even countries that have been managing to control the virus adequately, such as Costa Rica and Uruguay, could also be at risk if their neighboring countries cannot manage the virus. In the case of Uruguay, they took early measures of social distancing relying on the responsibility of its citizens to comply with contingency measures, coupled with almost 100% of the population having access to potable water. In Costa Rica they have a robust universal healthcare system that covers almost 95% of the population with all the equipment and supplies necessary to address the pandemic. This puts both countries with low death rates in Latin America and the Caribbean. Additionally, as quarantines are prolonged in some countries, the inequality gap widens and those who rely on daily income or informal economy jobs become more vulnerable.
Center for Disease Control and Prevention
World Health Organization
Pan American Health Organization
Dominican Republic: https://www.msp.gob.do/web/?page_id=6948
El Salvador: https://covid19.gob.sv/
Puerto Rico: http://www.salud.gov.pr/Pages/coronavirus.aspx
Trinidad and Tobago: http://www.health.gov.tt/sitepages/default.aspx?id=292