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

A woman wears a mask reading 'Never Again' in Buenos Aires (Photo by JUAN MABROMATA/AFP via Getty Images)

A woman wears a mask reading 'Never Again' in Buenos Aires (Photo by JUAN MABROMATA/AFP via Getty Images)


November 18, 2020   7 mins

Jubilant crowds waving flags and lighting flares on the streets of Santiago, record numbers of beachgoers crowding Rio de Janeiro’s iconic beaches and bars, and Colombia’s city-dwellers crawling along sooty highways in their SUVs seeking a countryside escape.

These recent scenes in South America, so reminiscent of pre-pandemic times, will be reassuring for some — but will send a shudder down the spines of many in the region hardest hit by Covid-19.

Latin America became the pandemic’s epicentre this summer, when it recorded over a quarter of the world’s confirmed coronavirus cases, despite being home to only 8% of its population. The region accounts for over 415,000 Covid-19 related deaths — that’s around one in every three of the global total.

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 Bogotå. 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.


Luke Taylor is a freelance journalist covering Latin America from BogotĂĄ, Colombia.

LukeStTaylor

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Fran Martinez
Fran Martinez
3 years ago

What kind of genius could have foreseen this?

Lockdowns are tools for rich people to feel well about themselves and their “social awareness” at the expense of sacrificing the livelihoos of the poor.

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Fran Martinez

congratulations. best job of turning reality upside down on any of these threads so far, and you are up against some stiff competition.

LUKE LOZE
LUKE LOZE
3 years ago
Reply to  Fran Martinez

In the West it’s not just the livilhoods of the poor, the lives of the poor and their quality of lives have all been sacrificed.

The deaths by occupation read pretty much like a class diagram. The relatively wealthy middle class have sat wfh in their nice large house, with nice gardens. Ordering shopping online and occasionally visiting the supermartkets. Meanwhile the poor have kept working in factories and essential retail, deliveries etc – massively increasing their risk.

Virtue signalling whilst gaining is always the best.

Alex Lekas
Alex Lekas
3 years ago

Shutting down society is unworkable no matter the location. It’s not a strategy; it’s the govt maxim of “do something” to give the appearance of having a plan without bothering with one.

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.
The northern hemisphere is coming out of summer, during which there was a drop off in infections, and now rates are going up again. It’s almost as if respiratory infections become more prevalent in colder weather. In other words, this anticipated respite will last until the weather changes again. What then?

You cannot lock people up indefinitely and you cannot insist on making masks and distancing the new norms. It’s not how people are wired. I’m sure there are govts who will try their best, much like removing shoes at airports has become standard nearly 20 years after one guy one time tried using sneakers as a bomb. That’s a policy without a purpose, and it’s not unreasonable to think that the people who came up with that one might come up with things that are even more useless.

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Alex Lekas

“Shutting down society is unworkable no matter the location. It’s not a strategy…”

and your alternative is to do what…expedited mass burials and point out the upside of eliminating an entire segment of the population who are just drags on the economy anyway as detailed in the 2008 World Economic Forum’s paper “The Future of Pensions and Healthcare in a Rapidly Ageing World: Scenarios to 2030”

the opening sentences read…

“One of the most eminent challenges facing the world today is the ageing of our societies. The United Nations (2007) predicts that by 2050 the number of people aged 60 and older in developed countries will have increased from 21% today to 32%, and in the less-developed countries from 8% today to 20%.

“This will have profound implications for labour markets, aggregate demand, politics and societal structures. In addition, ageing societies will significantly challenge the affordability of traditional pension and healthcare systems.

New approaches and new solutions from both governments and the private sector are required.”

hey I know, lets unleash a virus that targets our elders…upwards of 80 percent of all deaths from the SARS-CoV-2 virus are comprised of those 65 and older.

Alex Lekas
Alex Lekas
3 years ago
Reply to  Nun Yerbizness

So the only options, beyond the massive straw man you built, are wholesale lockdowns and mass deaths? Your own post points to the reality that people were aware of from the beginning – the old and the sick were always at highest risk. Please explain how shuttering businesses and schools does anything to change that.

and your alternative is to do what.
Focus on areas where the problem is most acute perhaps? That’s not schools. It’s not bars and restaurants, either. It starts with elder care facilities, then moves to hospitals, and it entails a fair amount of stressing that individuals need to be pro-active in managing their own risks.

By your reckoning, the increase in overdoses, abuse cases, bankruptcies, divorces, deaths, and unemployment is worth it if grandpa gets to live six more weeks. In the US, 94% of the deaths were people who died with Covid, not because of it.

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Alex Lekas

the straw man you reference is a document created by the World Economic Forum conveners of the four day orgy in Davos.

the wholesale lockdowns and increasing fatalities are result of you and your science deniers who have argued since February the SARS-CoV-2 pandemic is a fraud.

and you save the best for last”your self identification as a willfully ignorant science denier.

“In the US, 94% of the deaths were people who died with Covid, not because of it.”

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Alex Lekas

By your reckoning your solution is for our elders to hurry up and die already.

Mark Corby
Mark Corby
3 years ago
Reply to  Nun Yerbizness

Well spotted from Mt Hood.

Andrew Harvey
Andrew Harvey
3 years ago

It would be interesting to know what has happened in Nicaragua. Back in March and April, their strategy for limiting Covid-19 was to hold street parties rather than lockdowns (as the rest of the world scoffed). According to official statistics, however, they’ve actually come out quite well with very few deaths. Why is that? Why is the media so incurious?

Fiona Cordy
Fiona Cordy
3 years ago
Reply to  Andrew Harvey

You’re right about the media being incurious. I have been disturbed by the inability to look more deeply. I hadn’t heard about Nicaragua. Do you have any information you could point me to?

Malcolm Ripley
Malcolm Ripley
3 years ago
Reply to  Fiona Cordy

Worldometers

Mark Corby
Mark Corby
3 years ago
Reply to  Fiona Cordy

Nicaragua, population 6.5m, C-19 deaths 158.
Average age in Nicaragua 24, in UK 40.
Therefore fewer Coffin Dodgers perhaps.

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Andrew Harvey

Hurricane Iota roars onto Nicaragua as 2nd blow in 2 weeks
MARLON GONZÁLEZ,
Associated Press
Nov. 17, 2020

eat drink and be merry for tomorrow we die.

C Arros
C Arros
3 years ago
Reply to  Andrew Harvey

Not that I can’t sympathize with the Nicaraguan approach, i.e.
avoiding a lockdown, but I suspect that the low figures have a rather simple explanation: not to be hypnotized by the pandemic, let live go on and not looking for a case under every stone. Life there is already difficult enough without adding on top all these destructive measures being imposed on the population in most countries worldwide, irrespective of the cost and the damage it is causing.

Admittedly I am not in Nicaragua, and maybe there is something miraculous going on there. I would certainly feel happy for them.

Having said this, I have been working in projects throughout Central America, and to my knowledge there is no difference between the countries, at least not the poorer ones, that could explain such different figures. Nicaragua does have a lower population density and is less urbanized than neighbouring countries, but that is valid as well for Belize, which does not have as optimistic figures. I could not really imagine other
reasons.

stephensjpriest
stephensjpriest
3 years ago

Dear Unherd

Pfizer’s former Chief Scientific Advisor Dr Mike Yeadon believes 50% of the population was already immune to Covid-19 by the time infection rates reduced in June.

Speaking with talkRADIO’s Ian Collins, he said: “Our bodies have experience of common cold-causing coronavirus which of course the BBC didn’t bother to tell you about.”

It comes after the goal of securing a Covid-19 vaccine moved a step closer with early data showing a new jab to be almost 95% effective in protecting against the virus.

YOu Tube watch?v=DZjtiqujql8

adifone2
adifone2
3 years ago

really?

david bewick
david bewick
3 years ago
Reply to  adifone2

A quick and dirty calculation is to use the IFR and number of deaths. It suggests between 25-33 million infections and therefore using the higher number 50% of the population have been infected and therefore have some immunity.
That’s without considering natural and cross immunity

Nun Yerbizness
Nun Yerbizness
3 years ago

thanks for explains why Dr Mike Yeado is Pfizer’s former Chief Scientific Advisor

Frederik van Beek
Frederik van Beek
3 years ago

The only problem in Latin America are the lockdowns, the virus is peanuts. Belgium has more death per capita than Peru, Spain has more death per capita than Brazil, so what’s the perspective of this article?

Nun Yerbizness
Nun Yerbizness
3 years ago

and yet another QAnon’s spokesperson weighs in.

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Nun Yerbizness

and thanks to you down voters for self identifying as QAnon whack jobs.

Martin Price
Martin Price
3 years ago
Reply to  Nun Yerbizness

Nun I can only identify one whack job on this thread. Are you drinking too much coffee again?

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Martin Price

said a member of an echo chamber turning up the reverb.

Daryl Jones
Daryl Jones
3 years ago

Real lockdowns work if you do them for a month straight and shoot anyone who leaves their house for any reason.

Any measure that is not 100%, such as pseudo-lockdown, masks, test and trace, simply delays the spread, and prolongs the pandemic. The longer the pandemic, the more total will die from the virus, as the vulnerable have more potential exposure. They can’t hide forever.

The current strategy is to prolong the pandemic, and expose the vulnerable in equal proportion to those who are less vulnerable. We are told everyone is at equal risk.

Ideally, you would first expose the less vulnerable, so they can no longer spread to the vulnerable, but then you are told you want to kill people. We tell college kids they are selfishly spreading the virus among themselves, when actually they are becoming immune so they can’t infect the elderly.

Rulers like to rule, and issue orders, and tell us how they saved us. Followers like to follow and feel afraid, then feel warm and fuzzy when told how their rulers saved them.

Of course, lockdowns can only happen when someone prints money to pay people to not work. The money printers love to print money, and exert their power.

And the media makes money off fear and more ratings.

Public health officials like to wage war on the virus, without considering collateral damage or unintended consequences, just like military leaders like war – it is what they do, and they want to be heroes.

The authors of the Great Barrington Declaration are seen as a threat, because their strategy would shorten the pandemic.

So expect this whole thing to continue as long as possible, and many more to die. By the time the vaccine is effective, won’t be many left that need protection.

Andy Whiteman
Andy Whiteman
3 years ago

I live in Costa Rica. So far we have had 1134 deaths and 91780 cases.

Costa Rica has the 13th-most new cases per 100,000 residents over the past seven days, according to data compiled by The New York Times.

About 1.2% of people who tested positive for the coronavirus in Costa
Rica have died. The deaths comprise 380 adults and 754 elderly adults.

The average age of Costa Rica’s coronavirus-related deaths is 70 years.

Our population is roughly 5M. If you compare us with say, the UK population of 60M our number of deaths would be 13608.

So we are doing OK so far. We have not had a lock down. We did close our borders for 6months to tourists. They opened again on November 1st. We have had a driving curfew and restricted driving on the weekend. The beaches were sort of closed for 6 months.

We shall have to see what happens over the next months with the arrival of Tourists. I run a small hospitality business. I’m going to be super careful as I’m 72.

Pura Vida.

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  Andy Whiteman

and, despite what the headline suggests, Costa Rica as well as a number of other nations in South and Central America has a robust health care system.

marcellofpe
marcellofpe
3 years ago

No, not true. The majority of us Brazilians have all kinds of jobs and not “informal jobs such as cleaning houses or selling snacks on the street” . Just google Sao Paulo to know a bit about my city.
Also, Bolsonaro is a great president and his popularity is rising. Finally, the economic impact was huge, but we are recovering and it is expected positive GDP by the end of 2020.

Fran Martinez
Fran Martinez
3 years ago

And Brazil is not the one hit the hardest, Peru and Argentina have more deaths per capita.

Laura Pritchard
Laura Pritchard
3 years ago

What a tragic story. One thing however, you mention the weather at the end of the article but your references to second waves etc utilise a Northern Hemisphere understanding of the rhythm of infectious diseases. I’d actually be interested to know
1) did South America get hit hard because it was going into winter
2) who is actually getting sick? It might not be those getting out of the house, staying healthy and maybe staying away from heavily air conditioned or heated environments. Whilst the effects of lock downs on the poor are pretty clear and your point about third world health systems and first world health problems is stark, communities that are used to building immunity and coping with hardship might not be the Covid statistics or at least not the death rates.
Some detail without assumption would be interesting.

Phil Bolton
Phil Bolton
3 years ago

Another issue in South America is that there is far more suspicion of the hospitals and health systems there. There are many rumours of people dying in hospitals unnecessarily which makes the general public avoid hospitals and try to manage the virus from home and consequently not getting proper treatment. Healthcare workers are frequently attacked as they are seen as promoting the spread rather than preventing. All very sad.

Ethniciodo Rodenydo
Ethniciodo Rodenydo
3 years ago
Reply to  Phil Bolton

In the UK we are very good at keeping news of unnecessary deaths in hospital quiet

kennedys7
kennedys7
3 years ago

What role does natural immunity play in state plans to reduce overall health and economic impacts to countries ravaged from foolish and evil policies?

Nun Yerbizness
Nun Yerbizness
3 years ago
Reply to  kennedys7

“…health and economic impacts to countries ravaged from foolish and evil policies?”

more right wing extremist provocation or have you specifics in mind?

Nun Yerbizness
Nun Yerbizness
3 years ago

the consensus of those commenting on this thread is clearly a message to our elders””Hurry up and die already!”

mark48
mark48
3 years ago
Reply to  Nun Yerbizness

I’m fairly sure the UK government’s policy of clearing the hospitals and sending CV19+ patients into care homes took care of the “hurry up and die already” strategy. It also helpfully created a mortality spike that can forever be pointed to as justification for more lockdowns.

A quick glance at the mortality from countries who instead protected people in care homes from the outset tells it’s own story; much, much lower mortality.

And of course, in the UK, the average age of CV19+ deaths is around 82.

Which should take us back to the matter of lockdowns; lockdowns alone do not protect the elderly. As has been seen in Scotland, England, Northern Ireland and Wales.

Michael Cowling
Michael Cowling
3 years ago

Lockdowns do work, but only if they are short and people who need financial help get it so that they can stay at home without starving. China is an example; so are Vietnam and Victoria. Taking South American lockdowns as examples and drawing general conclusions from them is not very sound.

Nun Yerbizness
Nun Yerbizness
3 years ago

Again with the eye candy click bait from the publishers of Unherd.

Nun Yerbizness
Nun Yerbizness
3 years ago

so the author would have us believe the problem is “the lockdown” not mind numbing poverty and a complete absence of healthcare in much of South America.