CM. Strategies and public policies of Latin America to control Covid-19.

Rafael Rangel-Aldao, Editor

Source: December 15th, 2020

Gaceta Médica de Caracas, just published on 12/15/2020, its Supplement 2, entirely devoted to the Covid-19 pandemic in Latin America, edited by Drs. Marino J. González, R. (Coordinator), and Mariano Fernández-Silano. This issue covers 21 articles spanning diverse fields of health and the economy affected by the pandemic, such as Regional Strategies to formulate public policies, as well as the study of Case Countries such as Colombia, Costa Rica, Dominican Republic, Ecuador, Honduras, Paraguay, Uruguay, and Venezuela. In addition, there are eight pieces of analyses regarding important topics such as Maternal-Fetal Care and Bioethics, The Elderly, and many others related to Confinement, such as Financial Management, Epidemiology in Venezuela, Educational Technology, Social Networks, and Psychological Wellbeing.

The above data of Covid-19 in South American countries, gives a glimpse of how bad Covid-19 have affected these countries, as well as others of Central America and Mexico (1,255,974 confirmed cases) and Panamá (194,619 cases). The regional strategies, therefore, have not been as effective as the local governments had pursued, that is, by following strict and effective rules to control the pandemic, such as a general lockdown or targetted confinements, mandatory masks, social distancing, effective testing, and tracing contacts. The sole exception in Latin America is Uruguay (10.029 cases, as of 12/15/2020) by means of a masterful combination of all the above measures, together with national coordination of science-based policies encompassing the public and private sectors. The case of Uruguay, among others of Latin America, was the subject of a conference published on these pages, on 10/24/2020, of the Latin American Association of National Academies of Medicine, Spain, and Portugal. Gaceta Médica de Caracas now updates Uruguay with the article by Dr. Aleman et al, which concludes as follows:

There is currently little community circulation of the virus. The largest increases in the number of cases have occurred mainly in clusters, institutional agglomerations, and small cities. In all these situations, index cases and contacts were quickly identified. An important role is attributed to the participation of the academic scientific community and the epidemiological surveillance system of the Ministry of Health, which has made it possible to effectively manage the outbreaks through surveillance and active search for cases.

The epidemic had its initiation milestone in a conglomerate (grouping of cases in a defined space, in a greater quantity than could be expected by chance). This first outbreak arose as a result of one of the first four cases entering the country and became a super spreading event. Although these types of events are difficult to predict and prevent, once detected, the speed of response is essential and rapid deployment of case identification and follow-up of contacts is critical (15). The speed with which this situation was addressed has been the constant in all other outbreaks subsequently generated in the country (Figure 2).

With regard to the whole region, Marino González explains in great detail why most countries failed whereas Uruguay succeeded with the right public policies to control the pandemic. Gonzalez analyzed 20 Latin American countries by focusing on the sequence in which their policies were implemented, by means of exploiting «Data from the Government Response Stringency Index (GRSI), developed by the Blavatnik School of Government at Oxford University.» On this matter, González concluded that «The sequence of policies implemented by Uruguay reveals greater flexibility in application than those implemented by Argentina and Panama.»

The Stringency Index measures several indicators of containment policies, like closings of workplaces and schools, as well as mass transit facilities and public gatherings, and home confinement. The Index is computed from 0 to 100, to reflect the score of those indicators, the higher the number the maximum stringency level. It follows, then, that greater flexibility by Uruguay, for instance, meant more assertive, targetted, and effective policies to control the pandemic. However, more recent data from March 14th to December 15th, indicate a relapse of daily and new confirmed cases of Covid-19 in Uruguay.

The case of Uruguay with respect to other Latin American countries is noteworthy, in part because of the sharp differences in the implementation of public policies to control the pandemic, but also for the abrupt rise of Covid-19 in the former country despite its initial successes. González, however, admonishes two limitations of his own analysis, first, that the dynamics and accuracy of daily data for each country may vary and, therefore, affect the validity of the corresponding database and; second, «the database does not include measurements of compliance,» affecting as well «the analysis of the recorded data.» None of these two factors, however, may explain the abrupt rise of cases in Uruguay, and the unimpeded wave of confirmed cases in South America and Mexico.

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