A Covid-19 Analysis by Stanford CLAS Director

By CLAS Director Alberto Díaz-Cayeros

The COVID-19 pandemic has had a disproportionate impact on the peoples of Latin America. The number of cumulative deaths to date provides a compelling metric of the magnitude of the challenge faced on the continent in containing the spread of the SARS-CoV-2 virus. Around 1.4 million confirmed deaths, plus an unaccounted excess mortality of deaths that are not counted, but still there. 

Although there were exceptions in early decisive action of political leaders facing the public health emergency – namely Cuba and Uruguay – the average response across Latin America has been mediocre at best. Some Latin American leaders in the largest countries (most notably Jair Bolsonaro in Brazil and Andres Manuel López Obrador in Mexico) responded with skepticism and outright hostility towards the widely accepted recommendations of epidemiologists, including measures such as social distancing, reductions in mobility and economic activity, and face coverings. The death toll from such decisions was preventable. But even the countries that seemed to make the correct public health decisions, or the ones that were initially spared, have been suffering beyond the initial expectations. One would have predicted that with the relatively developed health systems in the region, and the experiences gained from decades of vaccination campaigns and other interventions, we would have known how to contain the spread of the disease. 

Epidemiologists, public health experts, and journalists alike – along with a growing segment of the public – have suggested that some of the failure to contain and control the spread of the epidemic is political rather than attributable to a lack of medical knowledge or any incapacity for response by public health systems. And yet we understand very little about the deep institutional, social, and political conditions that contribute to the differential responses to the COVID-19 pandemic between countries or within the states and regions of Latin American nations, particularly the federations (Argentina, Brazil, Mexico, and although a unitary system, the highly decentralized system of Colombia). And one cannot fail to note that the one defining characteristic of the Latin American nations most affected by the pandemic is the extreme degree of social exclusion and inequality.

It will take scholars quite a while to produce the research that may allow us to understand what happened, and the consequences for years or decades to come. And having a vigorous public discussion, coming to terms with our shortcomings in facing the pandemic will require courage and a certain dose of humility among experts, politicians and pundits throughout our region. But several features of the pandemic are already clear. The probability of dying once the disease is contracted is very high. Vaccinations are not proceeding at the pace they should if they are to outrun the genetic variants that will continue to emerge, that are likely to be more contagious from the selective evolutionary pressures of our own strategies of containment. This suggests we might not be seeing the last wave in any specific country, as has been the pattern in the past year and a half. And the death toll will remain unacceptably high.

Figures 1 to 4. Confirmed COVID 19 deaths in Latin America. It is likely that these figures represent an undercount, since studies of excess mortality calculations through administrative records suggest that significant COVID-19 deaths fail to be registered within the health system or might be misclassified as the causein cause of death. Under-registration may be more severe in some countries and states within a country, depending on the administrative capacity and availability of health clinics and hospitals. Confirmed COVID-19 cases are an even less reliable indicator of the impact of the pandemic because they depend on the testing strategy of each country, which in turn is also reflected in positivity and case fatality rates. Vaccination rates as the share of population will not reflect the distribution of vaccines across gender and age groups, where higher risk groups may already have been protected. Case Fatality Ratios (CFR) are determined by the denominator, namely the number of positive test results, which in turn depend on the testing regime. If tests are rationed and do not reflect the spread of contagion, CFR may not reflect the Infection Fatality Rate, which is the true magnitude of interest. The figures do not include Suriname, Belize, Puerto Rico and the small Caribbean Countries.