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."
There are many reasons for the Covid-19s major impact on Latin America: high levels of inequality, the huge "gray" economy of informal workers, lack of sanitation in the crowded urban slum. , as well as slow and uneven responses from governments.
Alejandro Gaviria, a former Colombian health minister, told CNN: "Latin America is very heterogeneous. In some cities, health infrastructure is similar to that found in developed countries; in rural areas, infrastructure is generally poor. have Europe and Africa on the same continent. "
Latin American states have had dramatically different experiences with Covid-19. Uruguay, which has a well-funded public health system, embarked on an aggressive tracking and testing program when the pandemic arrived. Despite a change of government in the midst of the crisis, it has had a steady policy of lockdown. Nearly 20% of the population downloaded a government app with guidance on the virus.
Paraguay, which is much poorer than Uruguay, seems to have benefited from an early lockdown. It also enforced the quarantine of people entering the country from Brazil, the epicenter of infections in Latin America.
Crowded living conditions in poorer urban areas, where basic hygiene and social distancing are virtually impossible, threaten the region with a growing flood of infections. As Dr. Marcos Espinal, head of the Department of Infectious Diseases and Health Analysis at PAHO, told CNN: "Social barriers will be very difficult to do in Lima."
Espinal noted that in some countries only one third of the population has refrigerators, which means that people have to shop daily.
Gaviria says there are many differences between countries, "but most have access to some kind of care. In Colombia, for example, coverage is close to 100%."
Quality is another matter, but he says – a point repeated by Espinal at PAHO. All but five or six governments fall well below WHO's goal of spending 6% of GDP on health, he says. For example, Peru uses 3.3%.
Some Amazonas cities in Brazil are more than 500 kilometers from the nearest ICU bed. In 2016, there were fewer than three beds per 100,000 population in some northern states of Brazil, but more than 20 beds per 100,000 in the richer south-east. PAHO has warned that the region will not overcome the virus unless it improves the care of marginalized communities, such as indigenous people of the Amazon. CNN reported an increase in infections this week among the Xavante people in the northeast of the Brazilian state of Mato Grosso.
Coronavirus is just one of several health crises in Latin America. Studies have shown that poor people in the region have higher levels of diabetes, obesity, hypertension and heart disease, all of which make them more susceptible to Covid-19. This is particularly problematic in Mexico and Brazil.
Fabiana Ribeiro, a Brazilian scientist currently at the University of Luxembourg, told CNN that a recent study showed that the lowest survival rates was for rural patients aged 68 years and older, and for patients who were black, illiterate or had previous conditions such as heart disease and diabetes.
The winter months in the southern hemisphere bring other diseases, including influenza and pneumonia. Francesco Rocca, president of the International Red Cross, said this week that Latin America's health emergency could worsen "with the arrival of the southern winter, the flu season in South America, and especially the hurricane season in the Caribbean."
Some governments – such as Chile – have warned private providers that they can take over beds when public hospitals are under strain. Gaviria notes that the authorities in Colombia now control access to ICU beds in both the private and public sectors – "and decide where each new patient should go. They will avoid rationing based on the type of insurance or financial considerations."
The Pan American Health Organization has said that robust testing and tracking programs over the coming months will be critical. There are a few promising signs – for example, that Costa Rica mobile teams are checking infections and quarantine. And in large parts of the region, a large network of laboratories has already been established to test for influenza being mobilized.
But the test capacity varies tremendously throughout the region. As of June 29, Chile had conducted nearly 4,800 tests per 100,000 population, according to PAHO. Panama had done just under 3000. But Brazil had done 230 – and Guatemala 45.
"In Nicaragua, we don't even know how many tests are being performed," says Espinal.
The consequence of coronavirus in Latin America is likely to leave deep scars. The World Bank believes more than 50 million people will see their earnings fall below the $ 5.50 per day poverty line. Some economists fear the economic damage may be on par with the "lost decade" in the 1980s.
In the midst of a deep recession that could shrink the region's economy by a tenth this year, the necessary investment in public health may not have materialized. 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 is suffering."
Alejandro Gaviria, Colombia's former health minister and now rector of the University of the Andes, is worried about what the rest of 2020 will bring. "Three problems overlap," he says, "an increasing pandemic, a social devastation and a growing fatigue with lockdowns. New lockdowns will only be possible with strict and repressive enforcement measures."