When São Paulo, Brazil, reported Latin America’s first case of the new coronavirus last month, South Florida had reason to worry.
São Paulo is Latin America’s most populous city. Its population has strong ties to Italy – where coronavirus is so rampant its northern provinces have been locked down – and Paulistas travel there frequently. And each day scores of flights leave São Paulo’s airports destined for Miami.
But a severe coronavirus outbreak hasn’t happened in Brazil, where only 25 cases have been confirmed compared to more than 9,000 in Italy – and more than 600 in the U.S. In fact, amid the storm of panic over coronavirus, Latin America and the Caribbean as a whole are so far a relative sea of calm.
By Monday, the region had reported only one death (in Argentina) from the respiratory infection also known as COVID-19. Meanwhile, the worldwide death total approached 4,000.
“That is a testament to how the national authorities [in Latin America] are preparing,” says Dr. Marcos Espinal, who directs communicable disease at the PanAmerican Health Organization (PAHO) in Washington D.C.
Espinal points out Latin America has confirmed just 100 of the world’s more than 111,000 coronavirus cases. And one reason may be memories of how unprepared the region was for its last major epidemic: the Zika virus.
Five years ago, the region looked run over by Zika and the heartbreaking images of infected babies born with undeveloped brains. On a conference call with health ministers last week, Espinal says they all told him this:
“The most important lesson is, if they get a case what they need to do is isolate it immediately. It is critical to stop the chain of community transmission.” That is precisely what appears to have happened with that first case in São Paulo, a middle-aged man who’d just returned from Milan.
But Espinal and other experts caution Latin America is still a developing region – with developing healthcare systems. Meaning: there’s still a lot to worry about.
"We can't overlook the economic fragility of the healthcare systems in the region," says Dr. Sergio Cimerman of the Brazilian Society of Infectious Diseases in São Paulo. "Risk factors like ICU [intensive care unit] capacity."
Especially in Venezuea, where doctors like José Félix Oletta are warning the country is an infectious powder keg if COVID-19 gets a hold there.
Oletta, a medical professor at the Central University of Venezuela (UCV) in Caracas, is a former Venezuelan health minister. He recently e-mailed a colleague in Miami, reminding him that Venezuela’s medical system has been decimated by the country’s epic economic collapse.
“Hospitals without water or electricity,” Oletta wrote. “Lack of equipment for diagnosing patient samples. Lack of intensive care capacity, antibiotics. Limited personnel resources – and no virus protection for the healthcare workers we still have, things as basic as latex gloves.
“The infrastructure simply doesn’t exist for an institutional response to this epidemic. And it doesn’t help when [Venezuelan] President [Nicolás] Maduro announces that coronavirus is some sort of international conspiracy.”
Oletta sent his email to Dr. Hermes Florez, the Venezuelan-born head of epidemiology at the University of Miami (UM) Miller School of Medicine and a public health expert who’s watching closely how Latin American officials respond to coronavirus.
“In Venezuela,” says Florez, “it’s obvious they are working with their fingernails at this point.”
UM often helps Latin American health systems develop tools like diagnostic test kits, which could eventually be in short supply in the region if COVID-19 cases grow there.
“With Zika,” Florez points out, “the University of Miami was ground zero for that.”
But Florez has another vested interest: he still has family back in Venezuela. The country has no reported cases yet – but he recalls how grossly Maduro and Venezuela’s authoritarian socialist regime underreported Zika cases. At the time, the Venezuelan government reported only thousands of infections – but nongovernmental doctors’ groups like the Defend National Epidemiology Network estimated hundreds of thousands.
What concerns Florez just as much, though, is that millions of Venezuelans continue to move out of Venezuela to escape the catastrophic humanitarian crisis there
“If coronavirus cases are emerging" in Venezuela, he says, “then the migration of the Venezuelan population affects Latin America and the Caribbean.” Their infections “will become a major burden on the [region’s] healthcare systems.”
Another fellow Venezuelan, Dr. Alfonso Rodríguez-Morales, echoes the fear that Venezuelan migration could potentially worsen a coronavirus transmission crisis in Latin America. Rodríguez-Morales, who is vice president of the Colombian Association of Infectious Diseases in Bogotá, says the massive exodus has already increased cases of illnesses like malaria in neighboring countries.
Last year, Rodríguez-Morales notes, “98 percent of imported cases of malaria in Colombia came from Venezuela.”
“Brazil will be a complicated scenario,” he adds. “They have migrant camps in the border with Venezuela.”
Rodríguez-Morales (and Cimerman in Brazil) recently co-authored an article examining the risks of COVID-19 in Latin America, published in the journal Travel Medicine and Infectious Disease. And he emphasizes the Venezuelan hazard is just one more on top of another in Latin America. In a word: syndemic. That essentially means, “We will have overlapping epidemics in the region,” says Rodríguez-Morales.
Brazil and the rest of Latin America and the Caribbean are already dealing with epidemics like the dengue virus. And because dengue and coronavirus share key symptoms, like fever, “this will make more complicated the differential diagnosis between the cases for the health care workers,” says Rodríguez-Morales.
In other words: it could create confusion if not chaos for health systems in Latin America as they try to pinpoint whether a case is coronavirus or not.
Another factor health experts say they'll keep an eye on is the onset of winter in South America's southern cone in the next few months, when conditions may be more favorable for coronavirus transmission.
But for now, the epidemic looks relatively controlled there. Colombia just launched a mobile app for COVID-19 information after the country confirmed its first case over the weekend. It’s worth noting Colombia had the second-highest number of Zika cases during that epidemic. It too has learned lessons since then.
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