Small Uruguay Is Big Proof That Committing To Public Health Can Contain COVID-19
Uruguay has recorded the lowest number of COVID-19 cases and deaths per capita in South America, if not the entire western hemisphere. The small but progressive country has done that despite sitting right next door to Brazil – which has the world’s second-highest number of COVID-19 infections and fatalities behind the U.S.
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WLRN’s Tim Padgett has been checking in with some of Uruguay’s top public health experts. WLRN anchor Christine DiMattei spoke with him about what Uruguay has done right, and what places that are still struggling with the pandemic – like Miami-Dade County, which has had to roll back its reopening this week – can learn.
Here is an excerpt from their conversation:
DIMATTEI: Tim, a couple months ago you reported that Costa Rica was the model for COVID-19 management in this hemisphere. But since then you think Uruguay has had more success?
PADGETT: It has. Back then Costa Rica had registered fewer than 800 coronavirus cases; today unfortunately that’s risen to almost 4500, although it’s still reporting only 20 deaths. Uruguay, meanwhile, still had fewer than a thousand cases reported at the start of this week and fewer than 30 deaths. Uruguay’s population admittedly is less than 4 million. Still, aside from a handful of small Caribbean countries, no other country in the hemisphere has numbers as low as Uruguay’s.
So what do health experts there say are the most important things Uruguay is doing right?
I spoke with Dr. Rafael Radi, a physician-biochemist at Uruguay's University of the Republic in Montevideo. He's the coordinator of the government’s scientific advisory group. (He's also the first Uruguayan to be a foreign associate member of the U.S. National Academy of Sciences.) Radi points to two key factors:
First, because Uruguay has such a well coordinated public health system, it was able to produce a lot of its own conventional PCR coronavirus tests. And so it had a really large supply ready for the second important factor: contact tracing – that epidemiological investigative work that tracks down who an infected person may have infected. And as you know that’s something places like Florida have had trouble with.
Uruguay had contact tracing task forces fully staffed, equipped and deployable from the very beginning of the pandemic. Radi offered me a good recent example: Two weeks ago there was a sudden COVID outbreak in Uruguay’s eastern Treinta y Tres province, close to Brazil. As Dr. Radi told me:
The Uruguayan system was prepared for this before the actual disease arrived – so we were able to get to work more or less a month ahead of it. –Dr. Rafael Radi
“The response was immediate. Within 24 hours there was a contingent of people – epidemiologists, nurses, physicians went to Treinta y Tres to completely follow the transmission chain, test every single person and follow up the contacts of the contacts. So we are very stringent.”
It sounds like Uruguay also has a serious public health culture going for it.
Exactly. Uruguayan officials haven’t issued a lot of strict lockdown orders because they haven’t had to. Uruguayans started practicing social distancing and wearing masks back in early March because public health officials there told them they should. And Uruguay’s political leaders let those scientists like Dr. Radi do the talking and set the guidelines. That’s a big reason Uruguay was able to reopen most of its schools in May, which is the beginning of its academic year. Again, as Dr. Radi said:
“We generated a 20-page report to the government. And we went through a scientific-based process of reopening of school, which has been very gradual. Also, it has been coupled to testing of teachers. Everything is looking good so far. So this is the way we are starting to open up activities in the country.”
As a result, Uruguay is one of the only countries in the hemisphere right now that can reopen its economy safely – and that word bears repeating, safely – as they’re doing, say, in Europe.
But another Uruguayan adviser, Dr. Alvaro Galiana, head of infectious disease at the Pereira Rossell Hospital in Montevideo, told me something that I think is also very important:
“From the early days of this pandemic, we have emphasized to Uruguayans that this virus is going to be around for a long, long time. It’s not going to magically disappear before a vaccine is found. And so we have to learn to cohabitate with it accordingly for the long term.”
But how have they been able to keep the pandemic under control when they share a border with South America’s coronavirus epicenter, Brazil?
Mostly because it largely closed its border with Brazil back in March. And that turned out to be very prescient because, as you just pointed out, Brazil has now passed 1.6 million COVID-19 cases and 65,000 deaths. I should mention Paraguay, another small country that borders Brazil, has also done an impressive job in that regard: it’s recorded fewer than 2,500 cases and only 20 deaths.
However: Uruguay, Paraguay, Costa Rica – a lot of people might conclude that it’s just easier for smaller countries like these to contain the pandemic.
To a certain extent that’s true. But then, look at a similarly small country like Panama: it’s reported 37,000 cases and 720 deaths. Or Honduras: 23,000 cases and 630 deaths. Uruguay and Costa Rica are small; but they tend to demonstrate large commitments to public health. That can make a big difference, no matter what size your country is. I’ll let Dr. Radi have the final word on that:
"The Uruguayan system was prepared for this before the actual disease arrived. So we were able to get to work more or less a month ahead of it. And we realized that everyone of us – the public, the health and science community, the government, including the political opposition which has supported the government in this – is part of the solution. It’s been a solid response with very few fractures if any. Not allowing either too much fear or too much indifference to take over. This is when it pays to have an educated country.”