IIASA postdoc Raquel Guimaraes writes about efforts by the scientific community to encourage governments in Latin America and the Caribbean to increase COVID-19 test coverage to reduce vulnerability.
Together with a group of demographers from Latin America and the Caribbean (LAC), and endorsed by more than 250 individuals from the academic community, I contributed to a statement urging governments, the World Health Organization, and the Pan American Health Organization, to take immediate action to drastically increase the coverage of COVID-19 tests in the region. This call for action was disseminated by the British Society for Population Studies, Asociación Latino Americana de Población, Sociedad Mexicana de Demografía, Associação Brasileira de Estudos Populacionais, and the Population Association of America, among other important institutions.
I joined this initiative by invitation from Dr. Enrique Acosta and other colleagues, because I firmly believe that the prospects for the COVID-19 pandemic in the LAC region are rather dramatic. Several studies document that, apart from being globally recognized for its high levels of economic and social inequality, the region also suffers from institutional coordination failures and poor governance, a lack of appropriate resources, and presents a unique epidemiological and demographic profile of its population that escalates the negative prospects of the pandemic. I wanted to explore in more detail why these features of LAC are a source of major concern and require immediate action.
Social and economic inequality in LAC will hamper the enforcement of social distancing and isolation measures, which have proven to mitigate the COVID-19 epidemic in other settings. More than half of the population is in the informal labour market and does not have access to social safety nets. For those covered by the social security system, the benefits already proposed by a few governments of the region such as Brazil, fall short of the daily needs of families. In addition to economic inequality, social inequality, which leads to a high degree of cohabitation between adults and the elderly, increases the exposure of those with the highest risk of complications and death.
In addition, with the closure of schools, children who do not have access to day-care centres and the public- or private education system, often rely on the help of their grandparents, which again brings greater vulnerability to families. Not to mention that these children won’t have ensured their learning opportunities, because their parents are often working and not able to home-school them, thus compromising their education outcomes.
Moreover, LAC is facing a rapid demographic transition and aging process, which is temporarily increasing the prevalence of a young population, meaning that the population age-structure of potential infected individuals differs from that of other settings. However, unlike the more developed countries, LAC’s epidemiologic transition, that is, the transition in which the prevalence of infectious diseases is “substituted” by chronic and degenerative diseases, is not complete. Paradoxically, the region exhibits both the prevalence of diseases that have long been eradicated in more developed contexts (such as malaria, dengue, and tuberculosis) and diseases of richer countries (such as hypertension, diabetes, and neoplasms).
On top of all the above-mentioned vulnerabilities, crisis-management efforts in the region are uncoordinated, and lacking transparency and commitment. Taking Brazil as an example: while some mayors and governors adopt measures of social isolation and prevention against COVID-19, parts of the federal executive power not only disdain the problem, but encourages the population not to meet the requirements established by the Ministry of Health. Such conflicting rules are bound to cause misunderstandings among the LAC population. The COVID-19 pandemic is a crucial moment for institutional coordination to ensure the effective management of the crisis.
As an important and urgent call to action for the pandemic in the region, myself and other LAC researchers are calling for an increase in test coverage and measures of social isolation. As reported in the non-specialized media under the slogan “help to flatten the curve”, social isolation allows the rate of contagion of the virus to be reduced, in order to prevent overloading the capacity of the health system. Existing literature documents that while the virus does not cause major damage to health for the majority of infected persons, it brings a high cost to the health system. Furthermore, the impacts on the later lives of individuals who were hospitalized due to the disease are not yet known. Not to mention, of course, the human tragedy and the costs in terms of lives lost to the disease.
Finally, imperative and immediate action against COVID-19 in LAC will depend on the widespread and low-cost application of tests. This is required because the former rigorous isolation measures mentioned above are highly ineffective if not accompanied by aggressive strategies to detect cases of COVID-19. This highlights the relevance of data collection to better inform policymakers and provide researchers with clear diagnoses of the conditions in the region.