On May 23, the World Health Organization (WHO) announced that the epicenter of COVID-19 had moved to Latin America, particularly South America. The region now has the highest number of new cases and deaths in the world. Brazil, Mexico, Peru and Chile, in this order, have the highest number of deaths in the region.
The pandemic arrived later to Latin America, giving it a chance to prepare by observing as COVID-19 swept through Wuhan and the surrounding Chinese cities and collapsed hospitals in Spain and Italy. South American governments adopted varying strategies to confront the pandemic, which can be grouped in three basic categories: the denial strategy in Brazil, strict quarantines such as those implemented in Argentina and Peru, and the intermediate policies characteristic of Chile and Uruguay. While Brazil’s approach had predictable catastrophic results, in other countries similar strategies did not lead to similar results, such as in Argentina and Peru. The strength of pre-existing health systems, rates of informality in the labor force and the capacity of the political leadership to clearly transmit messages regarding pandemic control measures, among other factors, have played an important role in determining results.
The denial strategy
On Feb. 26, Brazil became the first Latin American country to present a confirmed case of COVID-19. As in the rest of the countries in the region, the first cases were imported from Europe, most of them from Italy or Spain, by people from high socioeconomic levels.
The virus spread rapidly throughout the country and infected the population of the large cities: São Paulo, Rio de Janeiro, Minas Gerais and Espiritu Santo. It spread to the Manaus region, where hospitals were soon overwhelmed and to the native communities of the Amazon jungle. However, President Jair Bolsonaro, like his idol Donald Trump, continued to minimize the pandemic.
In the third week of March, cases grew exponentially. The 1,924 cases on March 23 doubled in just three days. When most of the countries in the region had already decreed social isolation measures, almost all mandatory, the governors of the main states urged Brazilians to stay at home unless they worked in critical sectors and called on non-essential businesses to shut down their operations. Educational, cultural and sports activities were suspended, but public administration at all levels – federal, state and municipal – was not interrupted. Social isolation was not mandatory.
Bolsonaro lashed out at the governors for succumbing to “hysteria”, as he put it, and claimed without evidence that they were inflating coronavirus figures for political gain. [I] He also attacked journalists and accused them of causing panic in an effort to undermine his government. Like Trump, Bolsonaro threatened to withdraw from the WHO, accusing the international body of acting with ideological bias. [Ii]
Meanwhile, much of Brazilian society demanded quarantine measures and that the federal and state governments unify criteria to confront the pandemic as a nation rather than leaving states to their own devices. In a message to the country in late March, far from passing strict quarantine rules, Bolsonaro said that “the side effects of measures to combat the coronavirus must not be worse than the disease itself” and proposed that businesses and schools reopen their doors and that mandatory social isolation should be only for groups considered high risk, such as older adults.
Twenty-six of the twenty-seven governors refused to abide by the president’s mandate and announced that they would continue with WHO recommendations. The Supreme Federal Court recognized the autonomy of the states in adopting public policies to confront the pandemic, which in practice involved telling Brazilians to ignore their president. The population in the main cities of the country, including people who voted for Bolsonaro in the Oct. 2018 elections, repeatedly carried out cacerolazos (protests banging on pots), demanding he be removed from office and that the nation adopt effective and coordinated measures with the governors to confront the pandemic.
A week before that message, the president stated at a press conference that COVID-19 was “just a little cold”, and that Brazilians had immunity. His handling of the crisis generated dismay across the country’s political spectrum. In late April, the mayor of Manaus, Arthur Virgílio Neto, noted that the city’s hospitals were saturated and affirmed that “with an irresponsible, almost criminal discourse, President Bolsonaro is encouraging people to go out into the streets, pushing them toward death.” [iii]
The president’s irresponsible attitude towards the pandemic led to the exit of two health ministers in less than a month. On April 16, Bolsonaro fired Luiz Henrique Mandetta due mainly to his views in favor of the mandatory total quarantine measures. The Presidents of the Chamber of Deputies and the Senate released a joint communication in support of Mandetta.
Less than a month later, the deputy health minister, oncologist Nelson Teich, resigned over disagreements with the president’s inappropriate promotion of the curative and preventive properties of hydroxychloroquine. Teich noted the president’s declarations led the population to think that there was a cure or a way to prevent the disease, and this had a negative impact on social isolation. He had also repeatedly confronted Bolsonaro due to discrepancies regarding plans to reopen the economy.
Bolsonaro, meanwhile, was participating actively in anti-confinement protests outside the Planalto presidential palace in Brasilia, where he appeared without a mask and shaking hands with the crowd. Some people carried banners calling for military intervention and the closure of Congress and the Supreme Court. The president’s behavior gave rise to rumors that Bolsonaro was preparing a military self-coup to stop the attempts of the Judicial and Legislative Powers to rein him in [iv].
Bolsonaro’s aim is to reduce the negative impact the economic crisis will have on his government’s popularity ratings. Instead, the spread of the pandemic has highlighted his lack of leadership and his approval ratings have dropped to 30%. Brazil’s management of the pandemic was not clear to citizens and was permeated by differences between the president, governors and mayors. The differences are so serious, and the messages so confusing, that on June 23, a federal judge had to order the president to wear a mask when he is in public places [v].
With nearly 60,000 deaths, Brazil has overtaken European countries for second place in the world, behind the United States. The toll in Brazil could have been worse except that Brazil has a single health system to which all citizens are entitled. Private health services must follow the protocols established by the Ministry of Health. In the event of an emergency, the law obliges them to place themselves at the service of public health.
Despite the WHO’s warnings about the risks of rapid opening, most of the Brazilian states have begun to relax confinement rules and gradually reopen the economy. Experts believe that the country is not yet ready to open it in safe terms, since the testing capacity is low and a contact tracking system has not been established.
Since the departure of the two health ministers, the pandemic is managed locally. The re-opening criteria are defined based on the number of deaths, infections and ICU beds for patients with COVID-19. Thus, for example, the Governor of Sao Paulo announced the relaxation of the quarantine in some regions of the state as of June 1, while maintaining voluntary social isolation until July 14. At the end of June, except for essential activities, bars, restaurants, sports, social and religious activities, among others, continue to be prohibited in the city of Sao Paulo. However, the Governor of the State of Sao Paulo announced on June 26 a plan to reopen classroom classes in schools in September, a proposal that has been rejected by teachers who have threatened to strike.
In the State of Rio de Janeiro, shopping malls re-opened June 10 and the governor has announced that, starting on July 10, stadiums can host a crowd equivalent to up to a third of their capacity. Soccer returned to Rio de Janeiro on June 16, without the presence of the public. In some cities that reopened their economies, such as Porto Alegre, infections increased and they had to back down.
Nationally, new cases and the number of deaths have not decreased. What has happened is an “internalization” of the pandemic, which has moved from the large cities, which have registered a slight decrease, to the small and medium cities in the interior of the country. This presents new challenges for the health system, since its resources are concentrated in the large cities.
The advance of the pandemic has set off alarms in some of its neighboring countries, such as Uruguay, and its main ally, the United States, which on a May 25 prohibited the entry of foreigners who had been in Brazil within 14 days prior to their expected arrival in the United States [vi].
Bolsonaro is immersed in a serious political crisis. In addition to the disastrous handling of the pandemic, the resignation of his Minister of Justice, Sergio Moro on April 24, after he dismissed the head of the Federal Police, dealt a blow to his approval. This office was carrying out an investigation into a criminal organization dedicated to the elaboration and dissemination of false news to threaten and defame authorities, in which Bolsonaro’s two sons were allegedly involved.
Strict and mandatory quarantines
The first case of COVID-19 was confirmed in Peru on March 6. Ten days later, with just 76 cases and no deaths, Peru was the first Latin American country to adopt a nation-wide quarantine, one of the strictest in the world. This included closing borders, prohibition of driving in private vehicles, suspension of all educational, cultural and sports activities and public administration, and all kinds of activities considered non-essential. The government of Martin Vizcarra imposed a curfew, which was initially applied from 6 in the afternoon until 5 in the morning.
The measures were accompanied by a plan of more than 26 billion dollars (approximately 12 GDP points), one of the largest in the region, with a component focused on containing the virus and another on stimulating the economy. Priority spending went to trying to increase the country’s weak health capacity to handle the emergency.
An example shows the degree of precariousness: when the health emergency was decreed, Peru had just one hundred intensive care units (ICU) with mechanical ventilators to attend to COVID-19 patients. As of June 25, these had increased to 1,314, but they had an occupancy rate of 87%. This national aggregate does not reflect the situation in Lima and other regions, where the public health system was saturated.
The private sector, which serves only 9% of the population, finally reached an agreement with the government by accepting its rates 101 days after the quarantine began. This, despite the fact that the General Health Law allows the government to establish cap rates and mandatory fees for the care of COVID-19 patients in private clinics. In the first months, private-sector healthcare facilities had been charging exorbitant figures for treating COVID patients. The agreement took place on June 25, a day after the president threatened to expropriate private clinics while the health emergency lasted, under Article 70 of the Constitution [vii].
The plan’s component to stimulate the economy combined aid bonds for the most vulnerable families with measures to support private-sector companies through tax relief, subsidies to the payrolls of micro and small companies, and two programs aimed at guaranteeing the payment chain with cheap financing lines from the Central Reserve Bank with a Treasury guarantee, Reactiva Peru, and the Business Support Fund, the latter destined for small businesses. [viii] In addition, the government called for a perfect suspension of labors for three months for those companies that could not sustain themselves due to the economic impact of the crisis. This means the temporary cessation of the obligation of the worker to provide the service and that of the employer to pay the remuneration, without termination of the employment relationship. [ix]
The measures were well received by society as a whole. President Vizcarra had an approval level of 80%. The quarantine was extended five times, the last of which occurred on May 23 and lasted until June 30. However, new cases and deaths continued to increase.
In the midst of this health crisis, the images of streets full of poor people engaged in informal trade and unable to comply with the quarantine, and the fall of the GDP in April by 40% provided a favorable backdrop for pressure from many economic sectors to make the quarantine more flexible. The strict compliance observed during the first month began to unravel.
Beginning in early May, in the midst of the pandemic, the government authorized the opening of certain mining, electricity, transport, construction, agriculture and professional services activities, among others. The first week of June, it expanded the number of manufacturing activities, shopping centers and online sales services through delivery.
On June 27, the government announced the lifting of compulsory social isolation starting July 1, with the exception of seven departments [x] showing increases in coronavirus cases. The curfew has not been eliminated and it will be maintained between 10 p.m. and 4 a.m., and from 8 p.m. for the departments that remain in quarantine.
Social, political and cultural events will continue to be prohibited, as will international passenger transport, and the borders will remain closed until July 31. However, in the first days of July restaurants reopened at 40% of capacity. The department of Lima, which concentrates a third of the population of Peru and 55% of infections, has slightly reduced the rate of contagion, but remains at high levels, in a scenario in which hospital capacity is collapsed.
Management errors on the part of the government during the first month of strict quarantine, such as having caused huge queues around banks to collect the bonds for families, prevented the curb of contagions. Added to this was a phenomenon that no one foresaw: the return of some 200,000 people from the provinces who lost their jobs in the cities and chose to return to their places of origin. Once ground and air transportation were suspended, many families traveled hundreds of kilometers on foot. Others waited in crowds, sleeping on the streets, for the government to organize a way to move them and coordinate quarantine rules with the authorities of their respective places of origin, so as not to spread the disease. The government also did not design a protection program for native communities.
The cumbersome process of State purchases, and the closure of international markets for the sale of these products, generated delays in acquiring virus detection tests and special protection equipment (PPE). This explains the high number of police and members of the Armed Forces who contracted the virus and died. The same has happened with doctors and nurses in proportions that exceed other countries in the region. According to the Medical College, Peru records 45 deaths of COVID-19 doctors nationwide, the highest number in Latin America [xi].
These deficiencies occurred in a context where more than 70% of economic activity in Peru is informal and excluded from the social security and banking systems. The State does not have adequate records of people belonging to that sector, nor of the most vulnerable, which is why not everyone who needed them has been able to receive social aid bonds. Added to this, is the high level of overcrowding in poor households and the fact that a quarter of Peru’s population does not have running water.
The Peruvian State is characterized by its operational weakness and small size, a product of the neoliberal reforms of the 1990s. According to the economist Efraín Gonzales de Olarte, its size is incompatible with resolving social inequalities and poverty that today exceeds 30% in the country. He considers that Peru has a State with a 21st century macroeconomy, but 19th century infrastructure and public management systems. It also notes that the privatization of social services has been functional for the higher income sectors. [Xii]
The economic boom, applauded by risk rating agencies, has not been able to compensate for the lack of investment in health and education in the last three decades. Public investment in health continues to be one of the lowest in the region and the level of primary health care is very poor. This has resulted in the high number of deaths from COVID-19 in Peru. Many have died in their homes or in the corridors and on hospital doors due to lack of oxygen.
This situation contrasted with the strength of public finances. The country has net international reserves close to 74 billion dollars, as of June 10, a public debt of 27% of GDP, low inflation, one of the least volatile currencies in the region and a fiscal surplus. However, the latter is the result of a low level of current and infrastructure spending, including in the health sector.
The elimination of compulsory social isolation in Lima and other departments as of July 1, marks Peru’s transition to a phase with high risks. With limited hospital capacity and no bed availabilty in ICU units, Perú holds second place in number of cases and thrid in deaths in the region. The econmy faces a drop of 14% according to IMF estimates in 2020—one of the affected in the region and the world.
The first confirmed contagion took place on March 3. More than two weeks later, on March 20, and five days after Peru decreed it, the Argentine authorities launched a mandatory quarantine (“social, preventive and mandatory isolation”) as it is officially called. At that time, Argentina registered 97 cases and two deaths.
Days before, the country had canceled educational activities, closed the borders, prohibited local flights, as well as interprovincial sea and land transport for passengers, blocked circulation in private vehicles, and closed banks and the public administration services. Initially, the quarantine, established at the national level, was as strict as the Peruvian one. The concern was also the same: the economic and social impact that this would have, in the scenario of an economy with large imbalances, high levels of inflation and a default on foreign debt.
Argentina has just over 35% of workers employed in the informal sector. The paralysis of economic life and the suspension of school classes implied the suspension of food assistance in a country where millions of schoolchildren eat daily in school food service. As in most countries, the government implemented a social assistance program and reinforced food delivery to school canteens, which began to deliver food in portions for children to take home, and created a new program Aid the Family Income Emergency, aimed at the wide universe of informal workers (more than eight million people).
In addition, on March 31, President Alberto Fernández signed a decree that prohibited the dismissal or suspension of workers without pay, “for the sake of preserving social peace.” The measure, which was to last two months, has been extended for two more months, to the end of July. To support compliance with said law, the Emergency Work and Production Assistance Program was created for employers and workers affected by the health emergency, through which the State transfers resources so that employees continue to receive their wages, or a percentage of them, depending on the amount.
Preventive and compulsory social isolation continues, but its scope has been changing. The restrictions, initially adopted throughout the country, are basically concentrated in the metropolitan area of Buenos Aires, where about 40% of the country’s population lives and where more than 90% of infections are registered. Even in this area, since May 23, the government relaxed some measures and allowed the operation of local shops, the departure of athletes to run at night, among others. In the regions of the country with low or no transmission level, restrictions have been relaxed and almost all activities are carried out normally.
Despite the serious financial and economic situation facing the country, the strategy has allowed it to manage the pandemic. Time Magazine highlighted the good management of Argentina in a list of exemplary countries that include Taiwan, Singapore, South Korea, New Zealand, Australia, Canada, Germany, Iceland, the United Arab Emirates and Greece. [Xiii]
Several factors explain the control of the pandemic. First, despite the lack of investment in the health, education, science and technology sectors in the last government of Mauricio Macri (who eliminated the Ministry of Health to make it a Secretariat of the Ministry of Social Development), the country has a reasonably efficient hospital system compared to the rest of the region. In addition, although it has not been necessary, the beds of the private sector are at the service of the Ministry of Health due to the contingency.
Another factor to highlight is the clear and unique direction of the authorities, including those of the opposition parties. Although it is a federal republic, the governors of the different provinces have followed the directives issued by the president, who has reached 90% approval in handling the pandemic.
However, in the last two weeks of June there was a sharp increase in the number of infections, hospitalizations and deaths in the metropolitan area of Buenos Aires, and in the province of Chaco. There is growing questioning of the obligatory lengthy quarantine, especially in the upper middle sectors, which reject the curtailment of their liberties.
The majority of epidemiologists and government authorities recommended a return to Phase 1 that was in effect in March. The penultimate time that the president extended it, he stated that “it would last as long as necessary for the Argentines to be healthy and for the Argentines not to die.” [Xiv] In these circumstances, on June 26, the president announced a new extension of the quarantine, until at least July 17, as well as the tightening of the measures in the metropolitan area of Buenos Aires (AMBA), and in the province of Chaco, due to the rapid increase in infections. In the rest of the country, the opening process will continue.
On July 1, Buenos Aires went back and only establishments considered essential could open: health services, food and pharmacies. Likewise, permission for sports authorized in the last extension of the quarantine were eliminated and only authorized basic services workers may use public transport.
Although the numbers are not critical –in the Buenos Aires metropolitan area, intensive care beds are at 54% occupancy– the authorities of all political stripes and epidemiologists considered that if quarantine measures had not been tightened, the health system could reach the point of collapse. The president pointed out in his speech that «if Argentina had followed the rhythm of Brazil, today it would have 10,000 deaths. (…) Look at Chile, it has a third of the inhabitants of Argentina, look at the difference, 10 times more deaths for every million inhabitants »[xv]. Brazil has 271 deaths per million inhabitants, while Chile and Argentina have 288 and 28, respectively.
The government is preparing the implementation of a universal income for informal workers, who are coming off of several years of suffering falling incomes and who have now lost their livelihoods due to the pandemic. This income should be valid for years. The Minister of Social Development, Daniel Arroyo, has pointed out that universal income must work together with the Empower Work program, through which productive activity is promoted in five sectors. [Xvi]
Given the fall in tax collection, the government is evaluating the establishment of a “solidarity and extraordinary contribution to help mitigate the effects of the pandemic”. It would be a one-time tax, aimed at the great fortunes of Argentina held by individuals, not companies, and that would affect 12,000 people. [Xvii]
The health crisis hit while the country was in the process of renegotiating its foreign debt of $ 66 billion, which has it on the brink of default. Despite the increase in monetary issue for social programs, it is estimated that inflation, which last year registered 54%, will fall to 43%. This is due to the contraction in demand that will imply a drop of almost 10% of GDP, according to the latest estimates by the IMF. The Argentine government has prioritized health over the economy, and everything seems to indicate that it will start opening its economy on safer bases, when the curve flattens.
Quarantines with voluntary aspects
On March 13, when the first four cases of COVID-19 were confirmed in the country, Uruguayan authorities immediately launched drastic containment measures similar to those of other countries in the region such as Argentina and Peru: They closed borders and suspended flights and cruises, classes, religious services, shopping centers, social, cultural and sporting events, and public administration. Work in the construction sector was banned for three weeks to prevent the spread of COVID-19 and unemployment insurance was paid to the 100,000 workers in the sector with State resources. Although small businesses could continue open, the vast majority remained closed due to the fact that the population complied with the government’s recommendations to stay home for fear of contagion. Unlike other countries in the region, the ruling Liberal Party imposed a voluntary quarantine, in the sense that there was no impediment to citizens going outside.
Wilson Benia, representative of Health Systems and Services of the Pan American Health Organization (PAHO) in Uruguay, considers that “the development of the first level of care, having an epidemiological surveillance system, with an integrated national health system with strong leadership of the health authority, in addition to having electronic medical records, a wide internet network and a law on audiovisual communication services, have been key aspects in responding to the healthcare demand for COVID-19 ”. [ xviii]
Uruguay is the only country in Latin America in which the State has not detached itself from its companies in the electricity, oil and telecommunications sectors. The population reject privatization during the 1990s through a referendum, a mechanism that other countries in the region do not have for these purposes. Thus, the state telephone companies, Antel, and the mobile telephony company, Ancel, made large investments in the extension of the fiber optic network throughout the country, allowing the nation to successfully carry out distance education and access to medical records in the health sector. [xix]
With a unique integrated first-rate health system, and comfortable hospital capacity, Uruguay has begun to reopen its economy. Its great threat is currently the border area with Brazil. The respective neighboring cities make up a single unit and so the Single Sanitary Epidemiological Unit has been created with joint measures to contain the spread. Currently, this area is on red alert due to new infections on the Brazilian side. This level of alert implies the closure of businesses and self-isolation measures, which has forced the Uruguayan government to shield the Rivera border department from the rest of the country through sanitary barriers and military control on the roads.
Only a country with the demographic, socioeconomic and institutional quality characteristics of Uruguay can have controlled the pandemic with a strategy that combines mandatory elements with permitted activities and the free movement of its citizens. It received the support of the health unions and the opposition political forces acted as a single force on this front.
The country has a population density of 20 inhabitants per square kilometer and lacks large cities. Its territory is 15 times less than that of Argentina and 50 times less than that of Brazil. Almost the entire population has access to drinking water and informal work is only 24%, the lowest in the region. It is a more homogeneous country, without the diversity and cultural complexities of Brazil or Peru, and it has the highest social indicators in the region. In addition, during the fifteen years of government of the Broad Front, significant investments were made in the health sector, as well as in the education sector.
In its latest report, the Chamber of Commerce and Services of Uruguay (CCSU) reflected the harsh reality that companies are going through, with a drop in sales of more than 75% after the appearance of coronavirus. In addition, it mentions that 60% consider that the government’s support measures are insufficient.
Uruguay has not been able to escape the storm and is facing an economic recession, which according to the IMF will be expressed in a drop of about 4% for 2020. The strategy they put in place allowed them to control the pandemic and managed to keep deaths at barely 8 per million inhabitants, one of the lowest in the world. These figures have allowed the country to gradually reopen its economy on a secure basis. The shopping malls opened on June 9 and on June 27 it was announced that it will be the first Latin American country authorized to enter the European Union.
Chile reveals the failure of a strategy for rich countries applied in a poor country Unlike the success of the strategy followed by Uruguay, in Chile it was a resounding failure, despite the fact that it was one of the first countries in Latin America to enact a health alert on February 7. This allowed the country to buy supplies such as tests, respirators and intensive care beds and coordinate the centralization of the health system.
Chile presented the first coronavirus case on March 3. Two weeks later, the government decreed a state of emergency and imposed a curfew from 10 p.m. to 5 a.m. throughout the national territory. Colleges and universities, land borders and public administration were closed. In addition, severe fines and prison terms were imposed for those patients diagnosed with COVID-19 who did not comply with their quarantines. However, unlike its neighbors Argentina and Peru, which decreed mandatory national confinement, social isolation was only mandatory for older adults and for some parts of the country. The rest of the population, not subject to a mandatory quarantine regime except for the curfew at night, observed social distancing voluntarily.
The government opted for a dynamic and focused quarantine in some communes, which was transferred to others depending on the evolution of infections. National mandatory quarantines were considered to bring many problems, especially for the most vulnerable sectors. The initial results were successful due to the effect of the closure of activities at the national level. These were highlighted internationally and were shown as an example. Associated with this good initial performance, the approval of President Piñera rose from 11% at the beginning of March to 21%, a level close to the 29% it had at the beginning of the explosion of social protests on October 18, 2019. The protests ended with an agreement to hold a plebiscite on April 25 that would determine if the citizenry chose to call a Constituent Congress to write a new Constitution. [Xx] This date had to be postponed to October 25 due to the pandemic.
In late April, Sebastián Piñera’s government celebrated reaching a “contagion plateau” and planned the gradual reopening of productive activities, including shopping malls, and a gradual plan for a return to school and public administration. These announcements led to a loosening of social behavior, with more meetings and parties that spread the virus. The applause lasted only a few days. Contagions and deaths from COVID-19 began to skyrocket and, on May 8, the government announced that the new normal strategy had to be shelved. The pandemic had spread to the poorest districts of Santiago that soon concentrated most of the country’s cases. The dynamic, focused quarantine strategy had failed.
A week later, on May 15, the government decreed mandatory total quarantine for the 32 communes that make up Greater Santiago, other neighboring communes, and two in the Tarapacá Region, affecting a total of 8 million people–42% of the total population of Chile. Sanitary rules were established around the localities of the areas to be quarantined to limit traffic and reduce the risk of the infection spreading to other places.
On May 28, Piñera admitted errors in the strategy to deal with the coronavirus and pointed out that the country’s hospital capacity was on the verge of collapse. [Xxi] The previous day, the former Minister of Health, Jaime Mañalich, carried out a self-criticism of the models used and noted that “what we have learned the hard way in this pandemic is that all the epidemiological exercises, the projection formulas I found convincing in January, have collapsed like a house of cards (…) Reality has overcome any model that one can simulate. It must be said frankly, we are sailing in a kind of darkness. “[Xxii]
The Minister of Health apparently did not know much about the reality of his country either. That same day he discovered that “in a sector of Santiago there is a level of poverty and overcrowding that, I’m sorry to say, I was unaware of in terms of its magnitude. That is the truth. ”[Xxiii] His inability to control the virus and political weakening caused Malanich to be replaced on June 13 by Enrique Paris, former president of the Medical College of Chile.
Two fundamental factors explain the failure of the dynamic and focused quarantine strategy launched in Chile, which is based on the widespread testing model used in Singapore or South Korea. Chile did not have the capacity to carry out sufficient tests, nor does it have a solid health system like the one in force in those countries. On the other hand, since it was not a compulsory quarantine in all the communes, many asymptomatic infected people went out to work. There was a lot of movement between communes with different regimes, permits to move between them were abused and not adequately controlled. The primary health system did not have the capacity in supplies or staff to attend to the sick. Most experts agree that without adequate primary health care, the possibility of tracing cases, isolating them and quarantining them, this strategy does not work and the virus continues to circulate. According to the American news service Bloomberg, “Initial evaluations suggest that Chile followed the example of rich nations only to realize, once again, that a large percentage of its citizens are poor.” [Xxiv]
After the first month of total and mandatory quarantine, the country has been unable to control the pandemic. Contagions and deaths continue to increase and the hospital system is collapsed. The government extended measures until July 3, and has included the entire Santiago Metropolitan Region, in addition to adding other communes in the Tarapacá Antofagasta and Valparaíso regions.
Likewise, the state of constitutional emergency due to catastrophe was extended for 90 days, an umbrella under which it is possible to limit traffic, prohibit meetings in public spaces and establish mandatory quarantines or curfews. These measures will be in force until September 16, assuming that quarantine and the curfew will be extended as necessary.
The state of national catastrophe allows the State to use beds, pavilions and the personnel of private facilities, and place their management at the hands of a public agency. The coordination was carried out by the former Minister of Health in late March, without much success. [Xxv] On April 12, President Piñera announced that, given the national health emergency, the State has “centralized control of all capacity of health, both public and private, in order to have it available for those who need it. “[xxvi]
On May 20, the government issued a new regulation that required the private health service to expand its number of beds to treat critical cases of coronavirus. The former minister pointed out that it was not a request, but rather an order emanating from the health alert and that it was going to be audited. With this measure, the authorities sought to gain a total of 720 beds equipped with mechanical respirators, after 95 percent of the capacity of health centers in the Santiago Metropolitan Region was occupied. But such requirements have not been fully met. [Xxvii] Chile has a fractured public health service, efficient for the insured, but with poor coverage for those who cannot afford it.
Currently, Chile has the highest death rate per million inhabitants on the continent, only exceeded by the United States. Politically, this has weakened the government that had already been hit hard following the social protests. The president does not have the support of social and political forces and his initial strategy to control the pandemic failed, and the current one is also questioned.
Representatives of the health unions, parliamentarians from the Health committees of Congress and presidents of political parties, demanded a change in strategy in the face of the pandemic, and called for discussion. In a letter to the Minister of Health on June 27, unions and representatives of the political forces pointed out that «contempt for participation has been a constant in the handling of this pandemic and that (…) it is perhaps the most important mistake that has been made during this crisis. The government’s response has been to fragment and exclude dissident voices »
The different strategies applied by the countries analyzed allow us to conclude that these have been successful in countries with relatively strong public health systems and efficient primary care services. Weak health systems, with high levels of the population excluded from social safety nets, access to drinking water, low levels of education, reduced access to digital technology and high levels of overcrowding have failed to control the pandemic.
The most visible case of success is Uruguay, a country that has a unique first-rate health system and a fiber optic network –installed with investments from its state-owned telecommunications companies– that have made it possible to have electronic medical records and lead to conduct distance education efficiently. The voluntary social isolation strategy, although with the closure of public and border activities, has managed to flatten the contagion curve. Their demographic characteristics and social development indicators, the best in the region, have also contributed to these results. Controlling the pandemic allowed Uruguay to start the process of opening its economy safely, which in turn will likely make it the country with the lowest economic decline in the region.
To a lesser degree than Uruguay, Argentina traditionally has a unique efficient health and primary care system, despite its recent deterioration as a result of having been systematically neglected during the last government chaired by Mauricio Macri, as well as by other neoliberal governments. Due to this deterioration, as well as the size of its territory, a strict system of compulsory social isolation was chosen at the national level that allowed controlling the pandemic. Argentina has 28 deaths from COVID-19 per million inhabitants, a much lower number than Chile (292) and Peru (288). The good results led to the relaxation, after a month, of some measures that determined the increase in infections. The government did not hesitate to prolong and toughen the quarantine as it aspires to carry out an opening process based on a flattening of the contagion curve.
Like Argentina, Peru was the first Latin American country to adopt a strict and mandatory quarantine at the national level. But unlike the first, which has better social indicators, the Peruvian government has not been able to control the pandemic. The precariousness of the health system and its primary care, in addition to the high levels of poverty, overcrowding, informality, and access to drinking water, played against it. The quarantine began to be disregarded by the population that needed to go out to work to survive, to which was added the pressure of the economic power groups. The government’s commitment to eliminate compulsory quarantine and deepen the reopening of the economy is very risky, in a scenario in which infections and deaths remain at very high levels and hospital capacity is collapsed.
Brazil is a special case. Despite its enormous inequalities, cultural complexities, enormous pockets of poverty and high levels of informality, it has a unified health system (SUS) enshrined in the 1988 Constitution, which is accessible to the entire population. President Jair Bolsonaro chose not to lead the fight against the pandemic and favored, like no other in the world with the exception of Donald Trump, the economy over health. Both the period of confinement, which was not mandatory, and the current reopening of the economy have been carried out without guidelines at the national level. The authorities have resigned themselves to coexisting with the infection and with the risk of rising numbers, but unlike Peru, Brazil has a better hospital capacity. Bolsonaro is responsible for having converted Brazil with the highest number of deaths (59,000) and infections (1.37 million) in South America.
Chile has also failed to control the pandemic. It registers the highest death rate per million inhabitants in Latin America, even more than Brazil (275). These results are explained because its strategy of dynamic and focused quarantines in some communes was too much for the nation to apply, not having the capacity to carry out tests and follow up on cases. Also, the country has a fractured, first-world health system for the upper sectors, but very weak system for the majority of the population. All the democratic governments since the end of the military dictatorship, without exception, have preserved and deepened the neoliberal model that General Pinochet implemented. Behind the stable statistics and the high averages of growth per capita that the international establishment applauded, an enormous inequality and concentration of wealth was incubating, which has dramatically shown its deep cracks in the inability to control the pandemic and, previously, in the extraordinary demonstrations started in October last year.
The COVID-19 pandemic has called into question neoliberal models and has shown the structural weaknesses of countries that were considered successful in the region. It has also highlighted the need to build more inclusive societies. Several economists, including Ricardo Ffrench-Davis and José Antonio Ocampo consider this to be an opportunity to rethink the role of the State and make structural changes that include the people.
Societies with high degrees of inequality are unable to cope with a pandemic like the current one, which draws out and makes more difficult the path to economic recovery. The appearance of this coronavirus has shown that social investment, in addition to being fair, improves the quality of life for everyone, including the wealthier, since it allows them to live without the potential instability that could be unleashed by widespread hunger in the weakest sectors in extremely unequal societies.
Ariela Ruiz Caro is an economist from the University of Humboldt in Berlín, with a masters in processes of economic integration from the Universidad de Buenos Aires. She is the analyst for the Americas Program in the region Andes/Southern Cone.
[iv] See: https://www.americas.org/is-brazils-bolsonaro-plotting-a-self-coup/
[vii]“No-one can be deprived of their property except, exclusively, due to national security or public necessity, declared by law and previously payed in cash the indeminization at a fair price that includes compensation for eventual damage.”
[viii]The channeling of resources from the Programa Reactiva has been questioned since an important part has benefited banks and large companies, some linked to the Lava Jato corrruption case.
[ix]The rule establishes that the Suspensión Perfecta de Labores is applicble to employeres and employees and workers in the private sector (micro, small, medium and large companies), under any labor regime in three cases: 1) when there is the impossibility of working remotely due to the nature of the activities, 2) when it is impossble for leave with pay due to the nature of the activities and 3) when remote work cannot be applied to leave with pay, due to the level of economic impact.
[x]Arequipa, Ica, Junín, Huánuco, San Martín, Madre de Dios y Áncash. These departments have a curfew from 8 pm to 4 am. In these 7 departments the curfew extends to Sundays.
[xvi]One area is small construction projects, houses or infrastucture. The textile industrial and food production are other activities that continue and require intensive labor. Then there is the area of care work and the recollection and recycling of urban waste.
[xvii]Not applicable to businesses, only to individuals who declare personal assets of more than 200 million pesos (around 3 million dollars) on 31 Dic. It is estimated that this will reach about 12,000 people. https://www.france24.com/es/20200530-COVID19-impuesto-riqueza-congreso-argentina
[xix]In 2007 the Plan de Conectividad Educativa de Informática Básica para el Aprendizaje en Línea (Plan Ceibal) was created, which according to the World Bank “is one of the examples worldwide of how a program can use technology in the classroom and be a vehicle for bringing in teachers and professors for innovative solutions, with the objective of influencing learning potentials.”
[xxvi]“All this is coordinated, because it wouldn’t make sense, for example, that a private clinic have respirators not being used when there is need in the public hospital. Here there is no distinction between public and private, or between regions.·”