By GARRETT BOOKER
As Dickens writes in the opening of his great novel, “A Tale of Two Cities,” “it was the age of wisdom, it was the age of foolishness.” These lines capture the spirit of our times as well, especially if we consider the disparate manner in which governments around the world have approached the threat posed by COVID-19. In Latin America, as elsewhere, many countries are engaged in an ongoing struggle against the virus, yet depending on where you are, some have embraced wisdom, while others are haunted by the folly of their neglect.
Last week, The New York Times reported that deaths from the virus in Latin America are comparable to those in Europe; however, the capacity of those countries to address this crisis depends on how that country approached the outbreak early on, coupled with the capacity of their health-care systems to respond effectively.
As cases and deaths rise, the ability of Latin American governments to confront the medical challenges posed by the virus have been hampered by persistent economic malaise and underfunded health-care budgets that have severely limited people’s access to such services. And observers suspect that many deaths from the virus have gone unreported.
In spite of a general lack of resources to combat the virus, two countries that have confronted a rise in the cases of COVID-19, yet responded very differently, are Brazil and Cuba. By May 22, reported deaths from COVID-19 had topped 21,000 in Brazil, and were rising by well over 800 a day, making the country the focal point of the outbreak in Latin America. Testing there is limited to individuals that make it to a hospital.
Cuba, in contrast, while hardly immune from COVID-19 deaths, implemented a comprehensive plan to contain the virus in January that included training medical personnel, reserving spaces for quarantine, equipping medical facilities, and communicating to the public information about the virus. Cuba’s measures have proved effective and as of May 12, according to a report by Reuters, “new cases have fallen to fewer than 20 per day from a peak around 50 in April,” and the island nation’s ratio of testing to cases is the highest in Latin America.
While few in the U.S. media are reporting on Cuba’s response to COVID-19, reports on Brazil generally focus on its right-wing President Jair Bolsonaro’s flagrant disregard of the seriousness of the novel virus and link Brazil’s failure to contain the disease as emanating from his leadership shortcomings. Not only did he refuse to implement quarantine protocols early on, he criticized some governors and mayors for implementing strict quarantine protocols.
Bolsonaro’s attitude to the virus should not be dismissed as merely grounded in ignorance but rather a self-serving unwillingness to allow Brazil’s economy to suffer, which would certainly jeopardize his political future. His government deemed as “essential” businesses like gyms and hair salons, which have remained open notwithstanding the risk to public health. As the BBC reports, only 48% of the residents of Sao Paulo are adhering to quarantine, and vehicles are jamming city streets with traffic as people continue to commute to work.
The Brazilian government’s mismanagement of the outbreak has left the country confronted with one of the highest death tolls from COVID-19 in the world. When asked about this, The New York Times reports, Bolsonaro responded, “So what? I’m sorry. What do you want me to do?” Bolsonaro’s incompetence is contributing to tragic consequences for Brazil’s people, who are putting greater and greater demands on a health-care system that is inadequate to address their needs. His cavalier attitude to the disease and its lethality are obvious and certainly contributing to the spike in cases and deaths, but there are deeper systemic causes for Brazil’s inadequate measures to contain the disease.
Brazil’s Constitution of 1988, which was written to correct some of the worst excesses of the military junta that ruled the country from 1964 to 1985, established health care as a right that the state was responsible for providing its people. A national health-care system, the Sistema Único de Saúde, was created to fulfill its constitutional mandate and provide universal and free health-care services. In the ensuing decades, according to the World Health Organization, Brazil has struggled to realize the goal set by the constitution.
One area where Brazil is particularly challenged is a lack of medical personnel, and in particular, the equitable distribution of doctors throughout the country (as of 2012, there were two doctors for every 1000 inhabitants). While Brazil’s expenditures on health care as a percentage of GDP—11.77% in 2016, according to the World Bank—are the second highest in Latin America, its spending per capita—$1015.90 in 2016, which is down dramatically from $1301.10 just two years before—leaves Brazil outspent by several of its neighbors. These include Chile, Uruguay, and even beleaguered Venezuela, which not incidentally spent the highest per capita at $1578.44 in 2015.
Although these figures do not give a complete picture of the challenges facing Brazil’s health-care system, they are enough to illustrate that sick Brazilians will very likely overwhelm medical facilities, especially in the rural areas. The New York Times report showcased the city of Manaus, located deep in the Amazonian rainforest, which is struggling to care for those infected with COVID-19. The number of deaths during April in that city of just over 2 million people that the local government reported was 2800, three times the monthly average and similar to the spike in deaths experienced in Madrid, Spain, when deaths from the virus were at its peak, from mid-March to mid-April.
The mayor of Manaus, Arthur Neto, interviewed by The Times reporters, blames the lack of a federal response combined with an inability to purchase needed medical equipment and difficulty in transporting vital supplies to residents of the remote city. The region’s Indigenous population is suffering from both a lack of access to health care and difficulty in obtaining emergency payments from the government, which requires that they travel to larger cities, The Times reports.
Cuba represents a stark contrast to Brazil when one looks at their respective approaches to the COVID-19 outbreak. Cuba and Brazil share certain disadvantages for effectively fighting the virus, such as poorly developed infrastructure, a shortage of housing, etc. However, Brazil has enjoyed access to investment capital from developed nations and international institutions, whereas Cuba has suffered from the decades-long U.S. sponsored embargo and sanctions that has deterred foreign investment, hampered trade (including medical equipment), obstructed access to international finance and emergency funds.
Yet the small island nation is seeing a decline of new cases since their peak in April. In this context, Cuba’s centrally planned economy has proven to be its greatest asset. Cuba’s government began preparations for COVID-19 back in January and has aggressively mobilized its people and resources to contain the disease by implementing a strict quarantine, preparing its medical facilities, and training its staff to accommodate the influx of sick patients.
While both countries have a national health system with universal coverage, Cuba spends a greater percentage of its GDP on health care—12.19%, the highest in Latin America—which translates to $972.7 per capita. Cuba also has the highest ratio of doctors to population in the region, long life expectancy, low infant mortality, and advanced medical research facilities—which include three labs that can run virus tests. Cuba’s government has also mobilized activists tasked with tracking cases, which has greatly assisted its efforts to limit contagion.
As Cuba’s cases of the virus diminish, comprehensive testing represents a vital part of keeping new cases on the decline, specifically the ratio of tests to reported cases. According to a May 15 article in The Conversation, authors and public health experts Emily Morris and Ilan Kelman write, “According to available data, Cuba leads the region with a ratio of 25:1.” While tests are expensive, around $50 per test, Reuters reports that Cuban scientists recently announced that they “had adapted a computerized system developed locally to quickly detect antibodies of the new virus, allowing for mass testing in hospitals and clinics at little cost.”
Cuba has also demonstrated a commitment to internationalism through deploying the Henry Reeves medical brigades to over 20 countries around the world to assist them in their fight against the disease. The brigade was named after a U.S. soldier who fought in Cuba’s war of independence from Spain and was founded by Fidel Castro to address human suffering caused by natural disasters. It has not only been deployed to places like South Africa, Italy, and Honduras to serve patients infected by COVID-19, but was also on the front lines against Ebola during the outbreak in West Africa in 2014-15. Cuba’s Henry Reeves brigade is so well respected by the global community that it has been nominated by a French organization, Cuba Linda, to receive the Nobel Peace Prize for its efforts.