Corruption, Confusion and Commerce – The Case of South America

Introduction

In this installment of our series analyzing how global healthcare systems handled the COVID-19 pandemic, we look at the continent of South America. With a staggering population of 422.5 million people, nearly 50% of which is concentrated in Brazil, the populous continent took a rather interesting – especially considering that it was preventable – hit during the pandemic.

What happened and why?

Let's zone in on Argentina, which had its first case on the 3rd of March and its first death barely four days later, on the 7th. By the 19th of March 2020, a lockdown was imposed throughout the nation, which experienced intermittent restrictions until November and witnessed another lockdown during the second wave. This quick and timely response, which included trade and movement restrictions, border closing, and the shutdown of schools and institutions, was further heightened by the population's eager reception. However, the same cannot be said for Peru, another country on the continent.

Peru, enshrouded in political turmoil and civilian mutiny, was particularly vulnerable to the pandemic's effects due to the country's imploding government. Despite imposing lockdowns within ten days of the first reported case, Peru racked up the world's highest COVID-19 death rate due to the crumbling economy and ill-prepared privatized healthcare system. This was partly because of the public's poor response to government initiatives, including a fatal stampede in Los Olivos during a police raid to break up an illegal nightclub gathering. A similar story plays in Venezuela.

Another country in crisis due to failing socioeconomics and politics, Venezuela was bound to fall prey to the pandemic. There were pre-existing high rates of crime, starvation, and lack of necessities, along with chronic staff shortages in hospitals. Within a week of the first case, 21st March saw Venezuela record 70 cases, which was no surprise to many citizens who were lackluster about the government restrictions. Authorities, including the President of Venezuela, Nicolas Maduro, propagated misinformation, calling COVID-19 a biological weapon on national broadcast, and also cited and supported herbal antidotes and infusions against COVID-19 on his social media – in fact, it got so bad that his Facebook page was frozen. Sadly, this was not the first time that the continent of South America had seen something like this.

Brazilian President Jair Bolsonaro was a crucial player in the worsening landscape of COVID-19 misinformation. He perpetuated multiple conspiracy theories regarding the treatment and origins of the virus, downplayed effective mitigations, and was even recommended criminal charges for his horrendous handling of the pandemic. Brazil took the first hit of the continent, confirming a COVID-19 case in late February. An interrupted response took place on 13th March, which was scaled back by the President within a day. In less than a month, the number of cases was nearing 3000. However, instead of taking necessary action, the President adamantly clashed with the Ministry of Health, leading to two Health Ministers handing in their resignations back-to-back. The President had reportedly clashed with the Health Ministers over the use of hydroxychloroquine, a drug used in the early days of COVID-19, social distancing guidelines and being overruled in their jurisdictions.

In an alarming trend, Guatemala also reported a string of corruption and fraud within the ministry. However, the citizens held protests wherever possible and stood up for more PPE for frontline workers, pandemic-related rights violations, and corruption.

Costa Rica and Panama had fairly transparent systems throughout the continent of extremes until June 2020. Panama declared a state of emergency within four days of its first case. It established a gender-based quarantine system to help the police quickly identify when someone violated quarantine. However, this was not without drawbacks, as it led to the harassment of transgender and non-binary people. Costa Rica managed to come up with a better alert system, using four color codes to denote containment of the pandemic, namely: green (signaling no reported cases within the canton but neighboring cantons exposed), yellow (high hospital occupancy within the canton, and low control of cases, along with increasing canton risk by attack rate, an epidemiological variable developed by the government), orange (increasing canton risk by attack rate, medium hospital occupancy and acceptable control of cases), and lastly, red (extreme hospital occupancy).

Chile was, on all accounts, disastrous. Within three weeks of the first reported case, the World Health Organization placed the country in the 4th phase of the pandemic, and a significant contributing factor was the distinct lack of a national lockdown. While other countries on the continent set up restrictions within ten days, Chile simply implemented a night curfew and called it a day – literally. The government finally established quarantines in May 2020, but by then, it was far too late because, in the following month, Chile had earned itself a top spot among the worst outbreaks in the world. However, it managed to quickly revert the damage, becoming one of the fastest countries in the world to immunize its population. This does not take away from the fact that Chile's economy took a massive hit, facing the most significant recession in 40 years in 2020, along with the highest rates of unemployment in 10 years.

Despite all the above vignettes, nothing beats Ecuador. Within one month of its first case, Ecuador was described as an epicenter of the pandemic. The streets were covered with bodies in the city of Guayaquil, and the government had to build emergency cemeteries and distribute cardboard coffins. A lack of testing and severe underreporting led to newspapers uncovering excessive deaths, over three times the official number of deaths reported in the country. Naturally, due to the 6.5% fatality rate and jarring imagery of corpses crowding the streets, civilians held a peaceful protest criticizing the improper and unjust handling of the bodies. However, the government retaliated by sending police forces charging towards the demonstrators, injuring many.

Looking forward: How do we prevent this in the future?

If we analyze the complexities of South America's handling of the pandemic, we find three common patterns: funding, information, and governance. When we look at the WHO frameworks for healthcare systems, there is a clear lack of robust leadership, a decidedly unresilient health information system, and poor financing.

A lot of this has to do with the already uncertain territory that countries in South America find themselves in, particularly regarding socioeconomic development and political hierarchy. Rampant, deep-rooted corruption combined with economies highly dependent on more extensive, high-income countries led to extreme situations that these countries faced.

Therefore, fiscal policies must focus on handling the containment and mitigation of the pandemic, particularly health measures that reliably reduce risks of infection, thereby reducing the hindrance to economic activity. Secondly, policies must be able to provide liquidity in terms of assets and only cause a temporary increase in expenditures, and then later reallocate budgets to focus on improving the health and economy of the country, reversing the massive losses to GDP and household incomes.

Stricter confinements should have been applied, as well as gradual mass testing to transition to partial confinements with minimal loss of life and income. However, the movement towards mobility of citizens would result in mass testing, detection of asymptomatic patients, identification of clusters, and tracking down chains of contact – all at the lowest cost possible. This can only be made a reality if the continent improves the capacity of its hospitals – beds, ICUs, technologies, and workforce. This will include more investment in strengthening the quality and quantity of healthcare workers, as well as infrastructure, which all tie back to the resilience of the country's socioeconomic status. A few sporadic, last-ditch efforts include postponement of elective care, alternative spaces for hospital use (such as converting hotels into hospitals), bringing back doctors and nurses who have recently retired and integrating them into the pandemic response, and lastly, eliminating all barriers (tariffs, taxes, import costs, etc.) for medical technology, testing kits, and protective gear.

Another crucial step to quickly disseminate misinformation regardless of government corruption is access to public health information, either over the Internet, social media, or by authorities, wherever possible. Such campaigns can elicit positive responses from civilians, furthering the probability of public cooperation.