New COVID surge overwhelms hospitals in Venezuela
A spike in the number of coronavirus cases is leaving Venezuelan hospitals without beds as hundreds of patients desperately seek medical attention.
The messages fill a WhatsApp chat for doctors at private clinics each day in Venezuela’s capital: Pleas for help in finding intensive care unit beds for COVID-19 patients.
As the troubled South American country grapples with a new surge in virus cases, patients and doctors have been scrambling to find enough beds to treat the sick. The vast majority can’t afford a private clinic, instead turning to a public
health system where testing is limited, doctors have scarce protective gear and beds are in short supply. Now even the privileged are finding their options limited as hospitals that charge up to $3,000 a night run out of space.
In the WhatsApp chat, Dr. Herman Scholtz, president of La Trinidad Teaching Medical Center in Caracas, and other doctors share information every 12 hours on how many ICU beds they have available. They created the chat after ambulances began showing up with patients they had to turn away.
“It is truly very painful to refer a patient to another place when you know they won’t be able to receive them,” he said.
At the Poliedro in Caracas, a giant entertainment center where Queen and Metallica once commanded the stage, makeshift hospital rooms in tents separated by a thin blue cloth are now filled with patients after being mostly empty last year. At a large public hospital, a doctor said all of the COVID-19 beds are full. At Scholtz’s clinic, the number of patients arriving at the emergency room, many with symptoms of the virus, is on track to potentially triple the numbers seen in February.
The uptick comes as Venezuelan authorities confirm they have identified cases of a more contagious COVID-19 strain first found in Brazil. President Nicolás Maduro recently ordered a “radical quarantine” confining Venezuelans to their homes for 14 days in response. Opposition leader Juan Guaidó announced Saturday he had tested positive for the virus.
Meanwhile, Venezuela’s vaccine campaign has barely begun. The country has received 700,000 doses thus far, most of which were donated by China’s Sinopharm, far short of the amount needed to vaccinate the population of 25 million. Political infighting between the government and opposition has delayed access to vaccines through the COVAX Facility, the World Health Organizationbacked initiative to provide shots to poor countries.
The slow vaccine rollout, along with the emergence of a potentially more dangerous variant, has put the country’s medical system on edge.
“We have a health system that is very ill, that is very weak, and then we are caught in this pandemic. It is obvious that we are going to be in crisis,” said Dr. German Cortez, president of the Santa Sofía Clinic and president of the nonprofit Capital Association of Clinics and Hospitals.
Recalling the coastal Ecuador city where bodies piled up in homes last year during the first months of the pandemic, he added: “Those images we saw in Guayaquil, I don’t want to see them in Caracas. But if we don’t take drastic measures, if we don’t execute a massive vaccination campaign, we’ll be headed in that direction.”
VENEZUELA’S SLOW SPIRAL
Since the pandemic’s start, Venezuela was considered one of the world’s least prepared to confront a surge in virus cases. A study released in early 2020 found that 78% of the country’s hospitals suffered from chronic water shortages and that 49% of emergency rooms lacked basic supplies to treat patients, including face masks. Many hospitals don’t have supplies to clean inside operating rooms, much less waiting rooms and hallways.
Faced with the flight of an estimated 30,000 doctors, many hospitals closed specialized wings or
even entire buildings. The nation’s economy shrunk by more than 63% between 2013, when Maduro took office, and 2019, according to the International Monetary Fund, a collapse fueled by economic mismanagement, corruption and a drastic fall in oil prices. Skyrocketing hyperinflation made even many doctor salaries nearly worthless.
“Most of the Venezuelan hospitals are only operating at 20 or 25 percent of their capacity, with the rest basically closed,” said Douglas León Natera, president of the Venezuelan Medical Federation. “Most of the beds are not in working order. So instead of the more than 46,000 beds that should be functioning in the hospitals, there are only 12,000 or 13,000 being used.”
While few healthcare professionals doubt that Venezuela has so far been spared the brunt of the COVID-19 crisis in comparison with neighbors such as Brazil, Peru and Colombia, many believe that the official numbers may underrepresent the real dimension of the pandemic inside the country because of limited testing.
Venezuela’s official figures report 28.83 cases per million people, according to Our World in Data, a collaboration between the University of Oxford and Global Change Data Lab, a nonprofit group. Those figures indicate an increase in recent weeks, following a first peak in August and September of last year. But they are still much lower than neighboring countries like Colombia, which reports 109.65 cases per million residents.
Maduro himself has acknowledged the recent surge, saying on national television recently that the country is facing “a new wave of contagion” that he attributed to the arrival of the Brazilian strain.
“Venezuela is underdetecting the virus, it is under-registering what is going on,” said Miguel Pizarro, a lawmaker appointed by Guaidó as the point person for the coronavirus crisis. “When you look at the occupancy rates inside the intensive care rooms, when you look at the number of people that are dying because of
an acute respiratory infection, then it becomes obvious that there is not a real report on the pandemic in the country.”
Dr. Julio Castro, one of the leaders of the nonprofit Doctors for Health, said at a recent forum that the official numbers don’t reflect “all the cases or all the deaths.”
“But we are clearly in a second wave of the pandemic and we don’t know where it will take us,” he said.
VIRUS PUTS INEQUALITY INTO SHARP RELIEF
The late socialist President Hugo Chávez rose to power in part by promising to deliver free health care to all. He opened new medical centers in slums, brought in thousands of Cuban doctors and succeeded in adding two full years to life expectancy and reducing infant mortality from 26.7 to 14.6 deaths per 1,000 live births between 1998 and 2013.
But in recent years, those gains have steadily eroded. There have been outbreaks of vaccinepreventable diseases like measles, a significant rise in infant and maternal mortality and widespread hunger and malnutrition. Inequality in the healthcare system never went away and now during the pandemic, has been put back into sharp relief.
At the University Hospital of Caracas, one of the largest in the capital, doctors and patients walk up a dirty ramp where the smell of urine permeates the air and hundreds of cigarette butts, condoms and even feces litter the ground.
The ramp is the main way patients get from one floor to another in the 10-story hospital. The elevator has been out of order for several years.
One of the employees working with COVID-19 patients on a recent week wasn’t using gloves or a face shield, protected only by a face mask and a worn disposable gown. A health specialist at the hospital, who asked not to be identified, for fear of retribution, said all 50 of the COVID-19 beds were occupied, and that they had been forced to turn away many patients.
Marva Barrios, a 32year-old occupational therapist, arrived hoping
to get a free COVID-19 test, convinced she had contracted the virus. She recently lost a friend to COVID-19, she said, and in the last few days had come down with the symptoms herself, including loss of sense of taste and smell. Her job as a social media accounts manager required a positive test in order to work from home. But getting one proved to be an odyssey.
Private clinics were offering at-home testing for $100, a price far out of reach. She went to two hospitals, one private, one public, and was told they had no tests. A friend suggested she go to the National Hygiene Institute, but they were only offering tests to those who needed them in order to travel. She ended up at the University Hospital, waiting in line with other patients.
“They always say, ‘Go to these health centers and get tested.’ But they don’t have the tests,” she said.
“If you don’t have health insurance here, you die [waiting] at a public hospital, because they can’t receive you.”
Yusmary Pino, a 42-yearold mother, and her husband, were also among those hoping to get tested. They’d both had virus symptoms for four days but had been too afraid to go to the hospital. Her daughter works at a private clinic that offers a test for $80, money that the family doesn’t have. So they decided to try their luck at a public hospital.
Two hours later, a doctor came out and announced they didn’t have any tests.
“Everything they say on TV is a lie,” a frustrated Pino said, sitting on the ledge of a small wall, gasping for air. “Everything is collapsed. Last night on national television, everything looked beautiful. They showed hospitals with all the supplies needed, and here, they don’t even have the means to test us.”
EVEN PRIVATE HOSPITALS ARE STRETCHED
While much better supplied, private hospitals are facing their own challenges as a growing number of patients contact them each day seeking beds. The clinics coordinating efforts through WhatsApp, some of which are among the country’s largest private institutions, are operating
at full capacity, the crisis filling up almost all of the nearly 500 beds they have jointly available, said Cortez, the leader of the nonprofit trade association.
Like elsewhere, the private hospitals are dividing their services in two in order to ensure that regular patients are not in close proximity to those with the virus. In effect, it means running two separate hospitals, an added expense. Most private hospitals have their own water well and generators to stay up and running during the city’s habitual power outages.
But oxygen tanks are growing scarcer.
At the current moment, there is only one company providing clinics with oxygen, said Scholtz, the clinic leader who helped launch the WhatsApp group.
“They just came in and provided us with 7,000 kilograms and oxygen but at the current rate that only will last until Saturday,” he said. “Half our patients need that oxygen and running out would be a severe problem.”
To deal with the limited space, his clinic is monitoring COVID-19 patients with less severe symptoms outside the hospital through a digital system that measures temperature and blood oxygen levels. If these fluctuate to alarming levels, a medical professional contacts them and guides them on what to do, he said.
Cortez said that the pandemic has stretched the budgets of private clinics as they stock up on protective gear.
“Every time you see a patient, you have to wear a disposable gown,” he said. “You have to wear gloves and a cap that you must replace. Not only for the doctors, but also for the nurses and the personnel that brings food to the patient, as well as the stretcher that has to transport the patient from one point to another to get an X-ray.”
NEW VARIANT BEGINS TO SPREAD
The uptick comes at a particularly weak moment for Venezuela: Progress in reaching an agreement with the Pan American Health Organization, the Americas branch of the World Health Organization, to secure COVID-19 vaccines, has been slow. And PAHO health officials warn the strain detected in Brazil has begun to spread.
Venezuela failed to make an $18 million payment to secure vaccine doses through COVAX as the opposition and Maduro regime sparred over how to come up with the money. Guaidó recently said he would ask U.S. officials to release Venezuelan assets that have been frozen by U.S. sanctions against Maduro, potentially bringing the country one step closer to getting shots.
But even if both sides reach an agreement, there are still a number of issues that must be resolved, said Dr. Ciro Ugarte, director of health emergencies at PAHO.
“After that payment, comes the need to ratify that there are sufficient funds, amounting to around $100 million, to acquire the rest of the vaccines, which amount to around 2.4 million vaccines, which would arrive when that payment arrives,” Ugarte said in a recent conference call with reporters.
He added that the country’s small-scale rollout of the Russian and Chinese vaccines has already shown that Venezuela needs to strengthen the country’s cold chain, though he provided no details. As part of that, he said Venezuela also needs to improve access to essential services like transportation, electricity and water. In recent weeks, shortages of diesel have become more acute, putting at risk the ability to transport everything from food to shots.
Maduro has said that his government has administered around 60% of the 100,000 doses of the Russian Sputnik V vaccines it received in February, prioritizing medical personnel and officials. Reuters reported that the South American country has invested $200 million to buy 10 million doses of the Russian vaccine.
Potentially adding to the delay, Maduro’s team recently announced that Venezuela will not allow use of the AstraZeneca vaccine, the inoculation being offered through COVAX.
“Taking into account the technical difficulties, President Nicolás Maduro had decided … not to approve and not to license this vaccine in Venezuelan territory,” said Vice President Delcy Rodríguez after several European nations announced they would be suspending use of the vaccine over concerns about blood clots. The World Health Organization has said data don’t suggest the shot caused clots and that it should still be used.
Maduro, meanwhile, has been criticized for promoting Carvativir drops as a miracle cure. The oral solution is derived from the herb thyme and has long been used in traditional medications. Venezuela’s Academy of Medicine has urged the Maduro regime to stop spreading false information, while Facebook late last week suspended Maduro’s account for one month for displaying a video where he praised the drops.
The new P1 Brazilian variant, which first became dominant in the Amazonian city Manaus, is also causing alarm. The country’s recent surge has overwhelmed its healthcare system, with daily deaths accounting for one-quarter of all worldwide. Few details have been made public on how many Venezuelans have been infected by the new strain, but officials at PAHO said there are signs that it has begun to spread in the southern states of Bolivar and Amazonas.
“Unfortunately, the terrible situation in Brazil is also affecting its neighboring countries,” said Sylvain Aldighieri, PAHO’s incident manager, during a recent briefing. “Cases have increased in Venezuela.”
The shortage of hospital beds in Venezuela has brought back an old practice, which had disappeared in many large cities with the passage of time: house calls. When the WhatsApp list for private clinic beds shows none available, doctors are referring patients to services that offer such visits.
Scholtz, for his part, said there’s another factor complicating the response: panic.
“This disease generates a lot of fear,” he said. “For many, it is almost worst to find out that you have COVID than to find out you have cancer, because they see the risk of death as more immediate.”