Inside the longest lockdown in the world Poverty and inadequate healthcare in South America makes shutting down society unworkable

Brazil, with its football stadiums converted into makeshift hospitals and its mass graves hastily dug in the Amazon, has suffered the hardest. The country’s president, Jair Bolsonaro, will be remembered as the region’s pantomime villain for playing down the virus as it ripped through the country. Over 5.5 million cases of the coronavirus — the third highest tally in the world — and 165,000 deaths have been recorded there.

But Brazil is not such an exception in South America. From Argentina to Colombia, despite most countries locking down swiftly and strictly, success stories are few. Of countries populated by more than 25 million people, five of the world’s ten highest Covid-19 death rates per capita are in South America.

More than six months of lockdowns have destroyed livelihoods and businesses and caused a spike in domestic violence and depression. The economic fallout threatens to reverse a decade of fighting poverty and widen the chasm between the haves and have-nots in the world’s most unequal region.

But the lockdowns have also failed to contain the virus’ spread.

Cases and deaths remain persistently high across South America and are now appearing in many previously unaffected regions.

Argentina, which has endured the longest lockdown in the world, became the smallest country to record over a million cases of the coronavirus on October 20. It has since recorded another 300,000 cases. Colombia joined the undesirable club five days later, and Peru is likely to follow soon.

While proponents and critics of lockdowns alike cherry pick figures from Sweden and across Europe to craft their arguments, Latin America offers perhaps the starkest lesson: lockdowns are not only devastating to economies and lives, but used alone, they are an ineffective tool.

On March 20, three days after the UK entered a national lockdown — and two weeks after Colombia diagnosed its first case of the coronavirus — Colombia’s president, Ivan Duque, ordered all residents to stay at home except for essential activities such as grocery shopping and medical attention. Schools, borders and public events had already been closed.

As Italy’s ICU units began collapsing under the strain of Covid-19 patients, the decision to enforce lockdowns swiftly and strictly was mirrored across most of South America. Fears — later borne out — were that if Europe’s healthcare systems could not cope with the influx, South America’s frail, underfunded hospitals stood little chance.

The region’s population is the world’s most urban (around 80% of people live in cities) and the most unequal. Around a third of people live in poverty — many of whom reside in sprawling slums where regular running water and soap are lacking. Healthcare systems are typical of developing economies, while people have the health profile of a developed one: heart disease, obesity and other comorbidities which make Covid-19 particularly deadly, are rife.

Swift action bought the region the vital time it needed to ramp up its hospitals. Overnight Colombia’s capital, Bogotá, was emptied of its usual chaos. Roads full of buses recklessly vying for precious tarmac suddenly became orderly and pavements fought over by food vendors, street hawkers, pedestrians, and cyclists became vacant.

“It was like one of those films in the Wild West with the balls of tumbleweed rolling through the streets,” says Gloria Zuluaga, a 52-year-old restaurant owner. Zuluaga was concerned by the closure of her restaurant but relieved by the trickle of daily Covid-19 cases as Colombians retreated to their homes, rather than the flood in Europe. But alarm bells were soon ringing elsewhere.

In neighbouring Peru, the number of Covid-19 cases were rising steadily despite similar measures being implemented. By May daily deaths had reached triple figures. As less than half of households own a refrigerator, many Peruvians had to shop daily in markets which quickly became breeding grounds for the virus.

In April, South America looked on in horror as families in Ecuador’s largest city, Guayaquil, laid the bodies of their loved ones in the streets. The city’s morgues, hospitals and large refrigerators had already been filled. The surge in cases was an early warning that the continent’s poverty and large informal economies would undermine lockdowns.

“It was the best evidence-based thing to do at the moment,” says Diego Rosselli, an epidemiologist at Bogota’s Javeriana University who has consulted the Colombian government on managing the pandemic. “But I think we would have been thinking differently if we had known what we know right now.”

Rosselli now advocates enforcing the use of facemasks in all public places and a nightly curfew rather than trying to prevent people from working in the day. Unlike in Europe, the majority of South Americans work in informal jobs such as cleaning houses or selling snacks on the street. They had to make a tough choice: go out and risk contracting the disease, or go hungry.

“We’ve been inside for three months. We’re all terrified of going outside and catching the virus but eventually I had to go back to work”, said Luis Carlos Diaz, a 35-year-old taxi driver and father of two young girls. Diaz was forced to resume driving for Uber in early June despite a surge in cases. He had handled the onset of alcoholism under house confinement but could not stop his savings being burnt up.

Governments did offer economic support but it came too late or not at all.

“They said they are helping people but I don’t know who, because they aren’t helping around here,” says Diana Rodriguez, a 47-year-old mother of two who broke quarantine after two months to resume cleaning houses for £10 a day.

The Panamerican Health Organisation (PAHO), the WHO’s branch for the Americas, believes a lack of financial security was central to lockdowns being broken. “PAHO has urged governments to ensure that public health measures are accompanied by social protection measures so that people do not have to choose between their lives and their livelihoods,” says Dr Jarbas Barbossa, the organisation’s assistant director.

As early as March, the economic pain caused by the pandemic sparked protests and looting protests and looting in Bogotá. But the biggest failure was misusing lockdowns indefinitely as a tool to fight the virus rather than to buy time to draw up a wider, more sustainable strategy, say experts.

“A lockdown is only meant to buy time for the health system to ramp up testing and tracing efforts. Certainly to clear out space in hospitals for intensive care units in particular, and to prepare public health guidelines and information campaigns or mask mandates, distancing suggestions, if not requirements,” says Michael Touchton at the University of Miami’s Covid-19 Policy Observatory for Latin America.

Lockdowns did allow South American countries to ramp up their intensive care capacity. Colombia’s ICU capacity was up 40% on March by August.

President Duque and PAHO have pointed to the country’s relatively low Covid-19 mortality rate of 3% to illustrate the success of lockdowns. It is less than half of Bolivia’s 6.1% and Ecuador’s 7.8%, where healthcare systems collapsed.

There was no plan, however, to come out the other side once hospitals had weathered the initial storm, say observers. “Lockdowns have been wasted because they haven’t been accompanied with sensible reopening measures,” Touchton says.

Colombia eventually relaxed restrictions such as restaurant and airport closures in September because of economic pressure. There was a brief respite from August’s peak of 13,000 daily cases but they did not drop below 5,000 and are rising steadily once again.

Across the continent, Argentina, hailed not long ago a regional benchmark for keeping infection rates low into the summer, is a grim example of why lockdown-reliance is dangerous.

“We were lecturing the whole world: ‘Argentina is doing great, Argentina is better than Sweden, it’s better than Uruguay, it’s better than Chile, it’s better than any other country in the world’ …. And now we are paying the price because we are the worst in the class,” says Adolfo Rubinstein, the country’s former Health Minister.

Argentina has recorded 1.3 million coronavirus cases and is reporting around 12,000 a day, more per million people than anywhere else in the Americas.

Like Colombia, mobility data illustrates why lockdowns failed to stem the virus’ propagation there. Activity plummeted in March when lockdowns began but slowly crept up and accelerated quickly around the two-month mark as people ran out of money and fatigue set in.

“It’s out of control; nobody is respecting the restrictions,” Rubinstein says.

Argentina’s government began relaxing lockdown in July when shops reopened and adults were permitted to exercise outside.

“Considering the final results and the situation we are facing now I would say that lockdown didn’t work,” says Rubinstein. The government’s “sin” was not that they implemented lockdowns but that they then “fell in love with them” and did not pursue a wider strategy, like tracing and isolating cases.

Argentina is stuggling to test at the same rate as the virus spreads. The country’s testing fell behind in March when global supplies bottlenecked, Rubinstein says, leaving it stuck in a perpetual loop where it cannot test sufficiently and therefore cannot localise and manage cases regionally, leaving national lockdowns the only option.

The only South American country that has proven capable of keeping the virus under control is Uruguay, where 4,000 cases have been recorded in its three million population. Though Uruguay is wealthier and better-equipped, scientists attribute the success to quickly breaking transmission chains through swift and widespread testing while keeping the public well-informed. Though borders and places where large numbers of people could gather were closed the public were not ordered to stay at home.

Argentina and the rest of South America have not been as successful. With the virus’ spread seemingly out of control there is no obvious remedy.

The economic and psychological damage from the first wave of cases was high: The World Bank predicts a contraction of 7.2% this year, more than any other region. Now the second wave is coming governments may have played all of their lockdown cards too early, leaving little recourse. “There’s no appetite for another lockdown, for economic reasons, for psychological reasons, and for political reasons,” says Touchton. “Unfortunately, I think we’re going to see a rise in cases until there’s a vaccine.”

Though Argentina, Brazil, Chile and Colombia have secured access to a potential vaccine  under an international agreement it will arrive next year at the earliest. Administering it to diverse populations spread across vast areas will be challenging. Rubinstein fears things may get much worse in Argentina, with nightmarish scenes like those seen in Brazil, before they can get better.

“If there is an increase in deaths or the collapse of the healthcare system then people will probably make themselves more aware and shelter at home, but otherwise nobody’s complying,” he says.

If there is some cause for optimism, it’s not in ordering people to stay at home again, but in the weather, and lessons learnt elsewhere, Touchton says.

Summer arrives in time for Christmas in South America and should entice Argentinians, Brazilians and Peruvians outside, reducing the risk of virus transmission.

Informing the public clearly on how to make the most of the weather safely with face masks and social distancing while preventing “super-spreader” events could be the type of sustainable middle ground that has reaped success elsewhere. And it may save lives.

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