Latin America facing the shock of the pandemic

In the course of March 2020, all Latin American countries began to register cases of Covid-19. That is, two months after China’s notification and one month after the first cases were registered in European countries.

A reference to the speed at which the pandemic has spread can be had by comparing the variation in some countries according to the Johns Hopkins University database. For example, the first two cases of Covid-19 were diagnosed in Italy on January 31. By February 29, there were 1,128 cases. As of March 30, the number of cases had increased to 101,739. At this moment Italy is the country with the highest number of deaths (11,591). In Spain, the first case was diagnosed on 1 February. By February 29, the number of cases had increased to 45. By March 30, the total number of reported cases was 87,956. In four weeks, the number of cases increased 100-fold in Italy and 2,000-fold in Spain.

The different rates of spread are related to the capacities of health systems to detect and isolate cases, as well as to identify contacts and implement quarantine and follow-up routines. As these interventions become more effective, the progression of the epidemic can be reduced. This is why it is necessary to know the different expressions of the spread, specifically in Latin American countries. The objective is to determine the response capacity of health systems to the pandemic. For this purpose, it is useful to examine the trend of the pandemic in each country and compare it with that experienced in reference countries, for example, those that have reported cases previously.

The first country to report cases of Covid-19 in Latin America was Brazil (27 February). To date, in most countries in the region (17 of 20), more than 15 days have passed since they began to report cases. In all of these countries, with the exception of Paraguay, the number of cases is higher than the number of reference countries (Italy, Spain, South Korea, Japan, Singapore) on the comparable day of the epidemic. For example, the 4,579 cases reported by Brazil on day 34 of the epidemic (March 30), are higher than the 3,089 cases that Italy had on March 4 (also day 34 of the epidemic in that country). The other reference countries had far fewer cases than Italy on that day.

A similar situation is observed with Ecuador. By 30 March, the 30th day of the epidemic in that country, the number of cases was 1,962, up from 1,128 in Italy on the 30th day of the epidemic. Only Paraguay, with 64 cases on day 23 of the epidemic, had fewer cases than Singapore (67 cases), which was the country with the most cases in the reference group at that time. As a result, in absolute numbers, 14 countries in the region have more cases than those experienced by comparison countries in similar lengths of national epidemics.

Clearly, the magnitude of the epidemic must be based on the total population of each country. It is not the same 1,000 cases of Covid-19 in a country of 10 million people as in one of 100 million. When we incorporate this adjustment, for example, in Argentina we find that the cumulative incidence rate of Covid-19 (number of cases per 100,000 inhabitants), as of 30 March is almost double that of Italy in a similar period. In Chile the cumulative incidence rate is 12 times higher, in Ecuador 11 times, and in the Dominican Republic 8 times.

According to the above, the health systems in Latin America did not contain the increase in cases in the first weeks of the epidemic, as was possible in the reference health systems, although in this group Italy and Spain experienced increases in cases that were much higher than those of Japan, South Korea and Singapore. The fact that the cumulative incidence rate is higher than that experienced by the reference countries indicates that, if this trend continues, the affected population will also be larger. The implementation of quarantine measures is intended to prevent further increases in the number of cases. However, as has been the experience of Italy and Spain, the results are not immediately apparent.

In the coming weeks, given these conditions, health systems in the region will experience greater pressure to attend to patients, whether complicated or not, but they should also strengthen epidemiological monitoring teams. This measure is key to reducing the number of cases in the shortest time possible. Managing the immense shock of the pandemic is probably the most significant challenge that the region’s health systems have faced in the last century.

Published in Spanish on April 1, 2020 in TalCualDigital.com. See the article in: https://marinojgonzalez.blogspot.com/2020/04/america-latina-ante-el-shock-de-la.html