Latin America’s poor bear the brunt of a disease they blame on the rich
Covid-19 is spreading fast as leaders under pressure to protect their economies call halt to lockdowns
Hospitals usually smell of bleach – but not this one. Instead there is a stale stench of stagnant water. The cream walls carry deep scars, inflicted by years of passing trolleys. Flakes of paint decorate the floor, uneven from so much traffic of feet and wheels. But the obvious years of chronic underfunding cannot conceal the compassion of the doctors, nurses and technicians who control these corridors.
El Tunal hospital is in Bogotá’s sprawling southern suburbs, and it is filling up. At the start of the pandemic in Colombia, it had just 15 beds in the intensive care unit, but by the end of this week that will have increased to a maximum capacity of 104, as each of the wards is converted into a highdependency unit.
“For every patient that leaves ICU, a new one arrives. It’s a conveyor belt,” says Dr Jhon Edinson Parra Mancipe, the head of intensive care. “If a 105th patient is wheeled through those doors, that’s when we need to worry.”
With more than five million infections and 247,000 deaths, Latin America has reported more cases of Covid-19 than any other region of the world.
Lockdowns on the continent have been some of the longest on the planet, but even as infections and deaths continue to rise, quarantine measures are now being relaxed amid a debate on lives versus livelihoods.
In Colombia, epidemiologists warn the country will not reach the peak of the virus until August, yet ICU occupancy is at 73 per cent in Bogotá and increasing daily. Nevertheless, President Iván Duque is gradually easing the lockdown. Shopping centres are open and hairdressers are taking appointments, although bars and restaurants remain closed for now.
Last week, the president said the country cannot afford to shut down while it waits for a vaccine. Instead he pledged to expand ICU capacity and purchase extra ventilators.
“Latin America has to open up because we cannot afford to maintain the economy in an induced coma,” Luis Felipe López Calva, the UN Development Programme Latin America director, says. “But we have to do it in an evidence-based manner to be able to protect people.”
The first recorded case of coronavirus in Latin America was in Brazil at the end of February. On March 6, patient zero arrived in Colombia from Milan.
As the WHO declared the continent the new epicentre of the global pandemic in late May, Brazil became the second country in the world to reach a million cases. Along with Mexico, Chile and Peru, it continues to report some of the highest infection rates globally.
Colombia is not far behind. The official death toll is 3,000 but experts say the real figure is likely to be much higher. According to the country’s health ministry, more than 41,000 are expected to die as a result of the pandemic by the end of the year.
Outside Tunjal hospital’s emergency department, ambulances line up packed with coronavirus patients. The hospital has become a nerve centre for Bogotá’s response to the pandemic. Staff here are anxious, but steeling themselves for the peak of the crisis.
A young woman stands alone. Marcela González is desperately trying to maintain her composure, but as her father Jorge, 50, is wheeled off into the hospital, emotion gets the better of her. “It’s just the two of us,” she says. “He’s all I have.”
Mr González had been ill for two weeks before testing positive for Covid-19. He had been in self-isolation at their home to prevent Marcela, who tested negative, from becoming infected. “He stopped being able to breathe. I had to call for help,” she says. Marcela isn’t allowed into the building. She is left outside to wait.
“He’s never been ill before,” she says. “I don’t know what I would do without him.”
Latin American healthcare systems were overstretched even before the pandemic began, facing epidemics of measles and dengue fever, as well as a rise in non-communicable diseases, including cancer and diabetes.
Although healthcare spending has increased across the region, it remains much lower than in other parts of the world. Germany spends £4,432 per capita, while the figure for the UK is £2,989. In comparison, in 2017 Brazil spent £755, Colombia £373 and Haiti just £30 per person.
In Ecuador, the health system collapsed in the country’s second city of Guayaquil as it was overwhelmed by the number of deaths. Emergency services began to ignore calls, hospital emergency departments closed their doors and the dead were left on the streets. Similar scenes were witnessed in Iquitos, Peru, as the city’s hospitals and morgues simply could not cope with the sheer volume of dead.
Marcela sits on a bench outside the hospital, awaiting news of her father.
“We’re both taxi drivers. We had to keep working because we had no money. But it was risky and now my dad is seriously ill,” she says.
Marcela and her father had taken precautions. They washed their hands regularly and wore masks – but they had to continue driving their taxi, and in the end, their efforts were not enough to keep her father safe.
Latin American governments are not just struggling to contain the virus in the continent’s hospitals, but also in the inner cities, where social distancing is basically impossible and infection rates are skyrocketing.
Marcela and her father live in Kennedy, the Bogotá district with the highest infection rate of Covid-19 in Colombia. In these poor communities, 52 per cent of people rely on the informal sector for employment. They work cash in hand, surviving from day to day with basic necessities.
The mantra has been that this virus does not discriminate, but that’s only partially true. A recent study from the Inter-american Development Bank concluded that the pandemic is exacerbating inequality in the region.
Brazilian researchers say the poorest are three times more likely to die than the wealthiest.
“Anyone can contract the virus,” says Dr López-calva of the UNDP. “But relatively well-off people are more able to protect themselves.”
Across the continent, cash-strapped governments have done what they can to support the worst-off during lockdowns. In Colombia, 2.5million of the country’s poorest families received financial support, while in Argentina the government introduced handouts for low income workers. Chile is also organising emergency cash transfers and Brazil extended its welfare programme for the most vulnerable families. In Peru, the country’s poorest also received financial aid, but in a country where only 38 per cent of the population has a bank account, the cash had to be handed over in person. It created large queues at banks, which many believe contributed to Peru’s high infection rate.
Marcela stands suddenly. A doctor is tapping on a window, trying to get her attention. “We have to take your father to ICU,” he mumbles from behind PPE glasses. “We’ll have to intubate him and sedate him. He’ll be unconscious.”
Marcela sinks to the floor. The doctor stoops to her level and puts his hand against the window. “I’m so sorry. We’ll do what he can,” he says.
Inequality has always defined Latin America. Newspaper archives from 1918 show Bogotá’s slums littered with bodies, as the city’s poor succumbed to a “strange fever and snotty cough”. This was, of course, the Spanish flu.
Before it belonged to the poor, the influenza of 1918 was perceived as an illness of foreigners in Latin America. Today, Covid-19 is seen by the poor as a disease of the rich.
“They are the ones that brought it here,” says Rosa Hernández, who lives in a poor neighbourhood near the hospital. “But we, the poor, are the ones who suffer more.”
The global pandemic is defining presidencies and premierships the world over.
In Latin America, the leaders of Nicaragua, Brazil and Mexico have engaged in a theatrical show of idiocy and self-destruction.
As the virus started claiming its first victims in Central America, President Daniel Ortega of Nicaragua, a former Marxist guerrilla, called for a popular march against the virus. Thousands took to the streets, forming the kind of mass gathering that public health officials had warned should be banned.
The response of Jair Bolsonaro in Brazil has been equally absurd. After flouting the advice of healthcare professionals, and endangering the lives of countless Brazilians, Mr Bolsonaro this week revealed that he, too, had tested positive for the virus. He claimed his symptoms were mild and that he is treating them with hydroxychloroquine, an anti-malaria drug that has not been proven effective against Covid-19.
In 1918, the Spanish flu became known in Bogotá as the “Suárez embrace”, referring to then President Marco Fidel Suárez, who was criticised for a slow and inept response. Today, President Duque is on the verge of a similar legacy, accused of putting the country’s economy before its health.
Last month, Mr Duque declared a 24-hour moratorium on VAT. Undeterred by what one comedian called the president’s “buy now, die two months later” strategy, shoppers poured into stores, fighting each other for bargains in the aisles. Many were horrified by the crowds.
At El Tunal hospital, Marcela has visited every day since her father was intubated. On the 17th day, she smiles again. Her father has been discharged from ICU to a specialist ward. The hospital psychologist arranges a video call.
“Dad, you look so much better,” she says. “I’m so happy. So relieved.”
But his recovery will be slow and the hospital staff know that not everyone will be so lucky, as Mr Duque opens the country amid steeply climbing infection rates.
“This is an aggressive virus,” says Fernanda Castaneda, the head nurse in the ICU. “I know people are desperate, but it’s offensive to us as health workers to see people back on the streets as if nothing is happening.”
‘Latin America has to open up. We cannot afford to maintain the economy in an induced coma. But we have to do it in a manner to protect people’