Latin America, unable to flatten its curve, struggles to cope with pandemic

Customers sit outside at a bar in the San Telmo neighborhood of Buenos Aires on Sept. 5. (Alejandro Pagni/AFP/Getty Images)

By Sebastián Lacunza, Anthony Faiola and Terrence McCoy

September 12, 2020 at 2:48 a.m. GMT+3

BUENOS AIRES — When ICU doctor Arnaldo Dubin left the sick and the dying at the end of another harrowing workday last week, the scene outside made him shudder.

Clusters of people, many without masks, were strolling and chatting under the Belle Epoque-style balconies of the capital’s fashionable Recoleta district.

Argentina is trying to return to “normal life” — the phrase President Alberto Fernández used when he announced new steps to ease one of the world’s strictest coronavirus lockdowns in July. Within days, long-cooped-up porteños were returning to hair salons, workplaces and psychiatrists’ couches. This month, the capital’s cafes and bars won permission to serve outside tables, bringing the sound of clinking wine glasses and beer bottles back to the city’s grand avenues.

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But as Argentines emerge from their shells, they’re getting sick, undoing what had been one of the globe’s strongest performances against the novel coronavirus. In less than two months, new cases have grown threefold, to top 12,000 a day.

“If there are more infections, we will not be able to handle them,” said Dubin, head of intensive care at Otamendi Hospital. “We are at our limit, and losing more and more of our colleagues to this fight.”

Seven months after Latin America diagnosed its first case of covid-19, the region continues to rack up some of the worst numbers in the world — failing to flatten its curve as it reels from persistently high infection levels and devastating mortality rates.

Brazil, Peru, Mexico, Colombia and now Argentina make up half the global top 10 in total coronavirus cases. Add Chile, Bolivia and Ecuador, and Latin America accounts for eight of the 12 countries suffering the most deaths per capita. (The United States leads the world in coronavirus cases and deaths.)

Latin America had time to prepare for the coronavirus. It couldn’t stop the inevitable.

The region suffers from a range of preexisting conditions. The population is more urbanized than in Europe, Oceania, Asia or Africa. Covid-19 has scythed its way through the urban slums of Sao Paulo in Brazil, Lima in Peru, Buenos Aires and Mexico City.

Close quarters and multigenerational households have undermined attempts at social distancing. Inequality is high, health care uneven and safety nets limited. The region’s many poor people must work to live, and they have routinely violated lockdowns to eat. Porous borders have made it difficult to quarantine infected travelers.

A Red Cross volunteer stands at Tecnopolis Park in Buenos Aires, which has been repurposed as a shelter to quarantine coronavirus patients who are asymptomatic or have light symptoms. (Natacha Pisarenko/AP)

As in the United States, erratic leadership has also played a role, particularly in hard-hit Brazil under coronavirus skeptic Jair Bolsonaro and in Mexico under Andrés Manuel López Obrador. Some countries haven’t even tried contact tracing, which health experts say is key to containing the virus.

“Here, in the area where I live, there are huge families living all together, some in houses, and others just share rooms,” said Daniela Fonseca, 21, a public administration student in Colombia.

Fonseca, her mother, brother, sister and 2-year-old son all were infected in the rundown colonial-era home they share near downtown Bogota. They lost her 44-year-old father to the virus in July.

But despite rampant infections in the neighborhood, she said, “there’s still people walking around without face masks, people on the street corners drinking, having parties. . . . There really is a big lack of awareness.”

Indeed, analysts say, Latin American countries have suffered from the same divisive individualism that has hampered a unified coronavirus response in the United States.

In Colombia, people attended thousands of fiestas clandestinas — secret parties — as cases exploded in July. In Peru, a mayor undermined quarantine by going out, getting drunk, then playing dead in a failed attempt to avoid detection.

Peru took early, aggressive measures against the coronavirus. It’s still suffering one of Latin America’s largest outbreaks.

And in Brazil, where the virus has infected 4.2 million and killed more than 129,000, people have packed beaches, jammed into bars and flouted pleas to wear masks. A survey released this week found that a plurality of respondents blamed not Bolsonaro’s chaotic leadership nor local leaders for the country’s crippling outbreak, but other Brazilians. National leaders who have long criticized health guidelines as governmental overreach, meanwhile, have cheered the rule-breakers on.

“Crowded beaches don’t just show people’s willingness to have fun, but are also a message to aspiring dictators,” tweeted Eduardo Bolsonaro, the president’s son. “People know what’s best for themselves, not hypocritical government leaders and authoritarians.”

Authorities in Mexico blame the country’s size for an outbreak that has infected more than 652,000 and killed more than 69,000. They hired more than 45,000 doctors, nurses and other health professionals in the early days of the crisis, and they boast that no coronavirus victims have been denied a bed.

But critics say Mexico’s epidemic has been more deadly than it would have been if authorities had conducted mass testing. And while the country locked down for 70 days starting in late March, it began reopening businesses while case numbers were still rising — in part because of pressure on the economy.

“Economic conditions forced a reopening that was too early,” said Malaquías López Cervantes, a public health expert at the National Autonomous University of Mexico.

Peru now has the highest coronavirus mortality rate per capita of any major country in the world. But because of limited testing, even its official tally of more than 700,000 cases might be a gross underestimate. Infections, analysts say, might be as high as 7 million.

Peru’s disastrous performance might appear perplexing, given President Martín Vizcarra’s initially decisive response: an early and strict lockdown that put the economy into deep freeze. Restrictions including a national 10 p.m. curfew remain in force. Yet poverty, decades of underinvestment in health care and what critics say are strategic errors by the government — repressive policies enforced by the police and military, a complete lack of contact tracing, the failure to use targeted lockdowns for local outbreaks, and the lack of a communication strategy — have undermined the response.

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Even as Peru struggles to control its virulent outbreak, it is facing a constitutional crisis. Congress on Friday voted to open impeachment proceedings against Vizcarra amid allegations, denied by the president, of his involvement in an influence-peddling scandal.

Only 20 percent of the nearly 3.3 million coronavirus tests administered so far in Peru have been the molecular tests that require a swab from the nose or throat, considered the best way to diagnose patients before they become contagious.

A worker places flower arrangements during the funeral of a person who died of covid-19 at Cementerio General in Santiago, Chile. (Claudio Santana/Getty Images)

“We are missing too many asymptomatic people, never mind the people they have been in contact with,” said Dionicia Gamboa, a tropical-diseases expert at Cayetano Heredia University, Peru’s top medical school.

Argentina’s Fernández, who took office in December, imposed a strict national lockdown in March, halting international and domestic flights and buses, closing borders, and requiring people to isolate themselves even in the remote cities and towns of sparsely populated Patagonia.

At first, it seemed to work. Cases spread in the poor, densely populated villas miserias, or misery villages, of Buenos Aires, where residents did not have the luxury of following the rules.

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“More than half of the residents in our villa have already got the virus,” said the Rev. Guillermo Torres, who lives in Villa 31, a slum beside a railway in the capital. The infected have included Torres and two fellow priests. “We knew it was going to happen.”

But national numbers remained relatively low compared with those of nearby Brazil, Chile and Peru — a development that boosted Fernández’s approval ratings. In one sense, the lockdown might have been too successful: The president soon faced mounting pressure from the opposition, and part of the public and the media, to ease the restrictions.

By May, children in Buenos Aires were allowed to leave their homes for one hour per weekend for “recreative walking.” In June, Fernández shifted from a policy of “mandatory isolation” to “mandatory social distancing.” Isolation remained in place for Buenos Aires and its suburbs, but local authorities allowed more stores to open and some sports to resume.

As infections edged upward, Fernández reimposed some restrictions. “They wanted to go out and run, and they went out and ran,” he said. “Now we see the consequences.”

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But as the economic toll of locking down mounted, he allowed a phased easing of restrictions in July. Specifics have been left to local officials, subject to the approval of the national government. In Buenos Aires, for example, hairdressers, takeout service from bars and restaurants, and other professional services were allowed to reopen.

By late July, infections began to skyrocket in middle-class neighborhoods of the capital and expand more deeply into the provinces. Still, diners in Buenos Aires this month were allowed to eat at sidewalk tables at bars and restaurants. Masks remain mandatory in public, but the rule is routinely flouted.

Other restrictions remain. Domestic flights and long-distance buses are still idle, and malls, cinemas, schools and universities remain closed.

Argentine officials point to the country’s still relatively low mortality rate and say they have managed the curve, giving the country time to respond to a crunch period now, in part by expanding ICU beds by 41 percent since March.

The strict, early quarantine and phased reopening “allowed the number of cases and deaths to increase more slowly than in other countries, and thus prevented the health care system from collapsing,” Health Minister Ginés González García told The Washington Post in a statement.

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But doctors are alarmed by the massive surge in cases.

On June 7, the country had recorded 22,794 infections.

Today, it has counted more than 524,000.

At Otamendi Hospital, the ICU ward is now at 100 percent capacity. Nationwide, ICU wards are 62 percent full — compared with 45 percent in late June.

 “We know that one in two patients will never wake up again,” Dubin said.

Faiola reported from Miami. McCoy reported from Rio de Janeiro. Mary Beth Sheridan in Mexico City, Ana Vanessa Herrero in Caracas, Simeon Tegel in Lima, Steven Grattan in Bogota and Lula Gonzalez in Buenos Aires contributed to this report.