The Americas, Pandemic on the Back of Poverty: Peru and Ecuador; and a Southern Cone Contrarian

Environmental, Geography, Natural Environment, Public health,, Society & Culture

As Europe starts to pull itself out of the worst of the coronavirus outbreak, the Americas for the most part are still firmly mired in the devastating crisis of the pandemic…more worryingly, COVID-19 cases continue to rise and even accelerate in some countries as Latin America seems to be turning into “pandemic central”, the ‘new’ Europe❅. This is occurring despite the continent comprising only eight percent of the world’s population and having had the advantage of time to prepare for the virus which reached its shores some six weeks after ravaging Europe.

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(Source: www.maps-of-the-world.net)

Smallness helps
The picture of Central and South America is not uniformly bleak. Some of the smaller countries, such as Uruguay, Paraguay and El Salvador, have managed to restrict their nation’s outbreaks to low levels of infection and casualties. This last mentioned country was surveyed in an earlier blog entitled Courting Controversy in Coronavirus Country: Belgium and El Salvador – June 2020). Among the Southern Cone countries, Argentina and Uruguay stand in contrast to their neighbours Chile and Brazil. Argentina (population of >45 million)—its commendable performance vs the virus slightly tarnished by a recent upsurge following an easing of the lockdown—has a total of 39,557 COVID-19 cases and only 979 deaths, compared with Brazil (whose leader Jai Bolsonaro has taken a recklessly dismissive attitude towards the pandemic). Even on a per capita basis Argentina‘s figures are still a fraction of the human disaster befalling Brazil which has racked up 1,038,568 cases and 49,090 deaths (population: 212 million). The Argentine Republic’s results are also way better than Chile’s record of 231,393 cases and  4,093 deaths (from just 19 million) [‘Argentina’s president enters voluntary isolation amid coronavirus surge’, (Uni Goñi) The Guardian, 18-Jun-2018, www.theguardian.com].

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Brazil: COVID-19 mural message (Source: Getty Images)

Uruguay: Stellar success of an outlier
Uruguay has fared as well as anyone in Central/South America in avoiding a pandemic catastrophe on the scale of some of its neighbours. A tiny population (3.5 million) helps immeasurably but the sheer lowness of its corona numbers stands by themselves – just 1,040 confirmed cases and 24 deaths. This has been achieved despite a demographic profile that should have made it highly vulnerable to the disease: the largest regional proportion of  elderly citizens and a population which is 96% urban. And an outcome secured not by lockdowns and quarantines (allowing Uruguay to preserve its national economic health cf. the stricken economies of its large neighbours Brazil and Argentina), but by eliciting the voluntary compliance of its citizenry – and through the luxury of having a near-universal, viable health care system✺ [‘Why Is Uruguay Beating Latin America’s Coronavirus Curse?’, (Mac Margolis), Bloomberg, 30-May-2020, www.bloomberg.com].

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Uruguay (Photo: Daniel Rodrigues/adhoc/AFP via Getty Images)

Peru:   
Aside from Brazil the country in the region most in strife due to the pandemic at the moment is probably Peru. Peru’s statistics are stark – over 247,925 confirmed cases and 7,660 deaths in a population of 32 million. What is particularly troubling about Peru is that, unlike Brazil, at onset it seemed to be pulling all the right reins, implementing one of Latin America’s earliest and strictest lockdowns. Months of enforced lockdown have however failed to flatten the curve of infections. Peru finds itself in a demoralising “double whammy”, the public health catastrophe continues unabated❈ while the recourse to a tough national lockdown has further crippled the economy [‘Poverty and Populism put Latin America at the centre of the pandemic’, (Michael Stott & Andres Schipano), Financial Times (UK), 14-Jun-2020, www.amp.ft.com; ‘Peru’s coronavirus response was ‘right on time’ – so why isn’t it working?’, (Dan Collyns), The Guardian, 21-May-2020, www.theguardian.com]✪.

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⇑ Andean pabluchas patrol Cuzco streets to enforce social distancing and mandatory mask measures (Photo: Jose Carlos Angulo/AFP/Getty Images)

Indicators of the poverty trap
The economic predicament Peru finds itself stems from the country’s high reliance on an informal economy (reaching some 70%). What Peru has in common with Brazil—and has been exacerbated by the pandemic—is very high social inequality. The poorest Peruvians cannot afford to stay home, to isolate as they should. Many are without bank accounts and under the informal economy have to travel to collect their wages, those without home refrigerators also need to shop frequently – all of which makes them more vulnerable to be exposed to the virus [‘Latin America reels as coronavirus gains pace’, (Natalia Alcoba), Aljazeera, 15-Jun-2020, www.aljazeera.com]. Disease and impoverishment have converged in Peru to make the predicament more acute for those of the poor who need life-saving oxygen of which there is now a scandalous critical shortage – the situation being exploited by profiteering hit men (the sicarios) controlling the black market oxygen supplies [‘In Peru, coronavirus patients who need oxygen resort to black market and its 1,000 percent markups’, (Simeon Tegel), Washington Post, 18-Jun-2020, www.washingtonpost.com].

Ecuador and Guayaquil

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Ecuador:  
In Ecuador the pandemic epicentre is the western city of Guayaquil, the country’s largest city. This is thought to be due to a couple of factors, the city’s sprawling slums where “many residents live hand-to-mouth and routinely violate the government lockdown…in order to work”, and because many Guayaquil exchange students and migrant workers came back to the city from Spain and Italy in March [‘COVID-19 Numbers Are Bad In Ecuador. The President Says The Real Story Is Even Worse’, (John Otis), NPR, 20-Apr-2020, www.npr.org]. The unpreparedness and inability of the authorities to cope with the crisis has affected the woeful degree of testing done, the lack of hospital facilities for patients and even the capacity to bury the dead as the bodies of coronavirus victims were left piling up on the city’s streets. In the wake of the disaster the Guayaquil Council entered into a slinging match with Quito (the national government), asserting that the government has under-represented the city’s death toll by as much as four-fifths, that it failed to provide it with the health care backup demanded of the disaster, as well as calling out the corruption of public utilities which has accentuated the crisis (Alcoba). Ecuador currently has 49,731 confirmed cases and 4,156 fatalities in a population of 17 million.

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End-note: The hypothesis of virus protection at high altitude 
Among the multitude of worldwide research projects triggered by the pandemic, a multi-country study looking at Bolivia, Ecuador and Tibet has advanced the theory that populations that live at a height of above 3,000 metres have significantly lower levels of susceptibility to coronavirus than their lowland counterparts. The study attributes the capacity of high altitude to nullify the disease down to the fact that living at high altitude allows people to cope with hypoxia (low levels of oxygen in the blood), and that the altitude provides a favourable natural environment—dry mountain air, high UV radiation and a resulting lowering of barometric pressure—reduces the virus’ ability to linger in the air. The COVID-19 experience of Cuzco in Peru seems to corroborate this hypothesis, being lightly affected compared to the rampage elsewhere in the country – the high Andean city has had only 899 confirmed cases and three deaths. Similarly, La Paz, Bolivia, the world’s highest legislative capital, has recorded only 38 coronavirus-related deaths to date [‘From the Andes to Tibet, the coronavirus seems to be sparing populations at high altitudes’, (Simeon Tegel), Washington Post, 01-Jun-2020, www.washingtonpost.com].

 
<Þ> all country coronavirus counts quoted above are as at 20-June-2020

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❅ for week ending 20th June 2020, confirmed cases for Latin America represented half of all new coronavirus cases (Source: WHO)  
✺ a like-for-like comparison to Uruguay might be Paraguay – also a small population (6.9 million), only 1,336 cases and 13 deaths but at the cost of a draconian lockdown with an economy-crippling end-game. 
even prior to COVID-19 striking, the Peruvian public health system was struggling due to “decades of chronic underinvestment” (eg, spending <$700 a day on health care) (Tegel, ‘In Peru’)   
the strict lockdown has been less rigorous when removed from the urban centres…in outlying areas, in the northern coast and the Amazonas region (particularly bad in the Amazonian city of Iquitos) it was less “honoured in the breach than the observance” leading to the formation of new virus clusters (Collyns)  

⊠ other experts discount the study’s findings noting that most coronavirus infections occur indoors, negating the relevance of UV levels (Tegel, ‘From the Andes’)

Coronavirus Responses and Patterns in Africa: Southern and West Africa

Inter-ethnic relations, International Relations, National politics, Public health,, Society & Culture

1836333B-64AF-49C9-B21B-7F66F21411A6Three months ago when the COVID-19 outbreak started to move around the globe, the World Health Organisation issued a warning to the continent of Africa whose nations were just starting to feel its impact [‘Coronavirus: WHO tells African countries to ‘prepare for the worst’, Eye on Africa, 18-Mar-2020, www.france24.com]. The pandemic was late in reaching Africa and initially slow to make inroads, taking 98 days to register its first 100,000 confirmed cases but is now accelerating – only taking 18 more days to hit the 200,000 mark of cases [‘COVID-19: WHO warns of virus acceleration in Africa’, Vanguard, 14-Jun-2020, www.vanguardngr.com]. Overall African fatalities sit at 6,793 (16-Jun-2020) with just five countries (Algeria, Egypt, Nigeria, South Africa and Nigeria) accounting for 70% of the deaths.

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Southern Africa:
To date South Africa has been the nation most heavily affected by the public health emergency – over 73,000 confirmed cases and 1,568 deaths (16-Apr-2020). The Western Cape province has become the epicentre of the RSA pandemic, recording so far around 75% of the country’s fatalities. The province’s high incidence of cases has been attributed to the presence of poor, densely populated townships like Khayelitsha, a shantytown of 500,000 people. Cape Town’s thriving tourism (before the closedown) has also been advanced as contributing to the outbreak’s toll. South Africa, with a more developed economy and better health care system, has conducted more a million virus tests, while many other African countries have racked up only a few thousands. The clear implication of this is that ”the disease is spreading undetected elsewhere on the continent”  [‘Cape Town becomes South Africa’s coronavirus hotspot’, (Jevans Nyabiage), South China Morning Post, 12-Jun-2020, www.amp.scmp.com].

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Bulawayo, Zim.  (Photo: Philimon Bulawayo/Reuters)

South Africa’s smaller, northern neighbour Zimbabwe has done surprisingly well on paper in the crisis (four deaths recorded only), but with the rider that testing for the disease—hampered by a critical shortage of health equipment and infrastructure—has been very limited…by 10th April it had tested a mere 392 people [‘In Zimbabwe, lack of tests sparks fear COVID-19 goes undetected’, (Chris Muronzi), Aljazeera, 10-Apr-2020, www.aljazeera.com].

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(Image: SABC News)

West Africa:
Results of the fight against the pandemic in West Africa have been mixed. Senegal began its counter-measures early in January, closing the borders, implementing contact-tracing, etc. The country was able to produce a test kit for COVID-19 costing only $1 per patient and has managed to accommodate every coronavirus patient either in hospital or in a community health facility. African countries who experienced the 2013/14 Ebola virus outbreak like Senegal put that experience to good use, prohibiting large gatherings, strict night-time curfews, banning intercity travel, etc. Côte d’Ivoire (the Ivory Coast) followed Senegal’s approach, declaring a state of emergency and trying to impose curfews in it’s main city Abidjan, but the country’s buoyant economy has taken quite a hit from the coronavirus crisis. Ghana has utilised an extensive system of contact-tracing and a “pool-testing” mechanism which follows up only on positive results [‘Why are Africa’s coronavirus successes being overlooked?’, (Afua Hirsch), The Guardian, 21-May-2020, www.theguardian.com; ‘Women unite against COVID-19 in Senegal’, Relief web, 10-Jun-2020, www.reliefweb.int].

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The speeding up of coronavirus cases in a small African country like Guinea-Bissau has occurred notwithstanding it’s small population and limited testing, reflecting a reality stretching across the whole continent, the sheer incapacity of weak and under-resourced national health infrastructures to cope with the pandemic [‘West Africa facing food crisis as coronavirus spreads’, (Emmanuel Akinwotu),  The Guardian, 16-May-2020, www.theguardian.com].

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Kano   (Photo: Reuters/Luc Gnago)

B2ADCEDB-748F-4BBD-926C-6B2115F8760EIn Nigeria, Africa’s most populous country, the most worrying hotspot has been the north in Kano state and metropolis. The pandemic has gotten out of hand here because of a confluence of factors, including the state government’s early failure to admit the presence of coronavirus (which it initially tried to pass off as an upsurge in other illnesses), costing it vital lost time in the fight against the disease; the closure of Kano’s only testing centre for a week in April; acute shortages of PPE; and the pre-existing displacement of 1.8m people in the region [‘Covid-19 Outbreak in Nigeria Is Just One of Africa’s Alarming Hot Spots’, (Ruth Maclean), New York Times, 17-May-2020, www.nytimes.com].

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Dakar, Senegal   (Photo: John Wessels/AFP via Getty Images)

PostScript: A young and rural population
Africa’s avoidance of the worse excesses of COVID-19 thus far has prompted the theory that the continent’s demographics is working in it’s favour. A study in the journal BMJ Global Health attributes this to Africa’s young, rural-based population …60% of the population is under 25, cf. Europe (95% of its deaths from the virus have been people over 60). BMJ hypothesises that Africa will likely suffer “more infections but most will be asymptomatic or mild, and probably (go) undetected” [‘Africa’s young and rural population may limit spread and severity of coronavirus, study says’, (Jevans Nyabiage), South China Morning Post, 28-May-2020, www.amp.scmp.com].

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Egypt and South Africa alone account for nearly 48% of the entire continent’s corona-related deaths
the study focused on Kenya, Senegal and Ghana

Russia’s Coronavirus Anomaly, a Question of What You Count

Bushwalking, Politics, Public health,, Science and society

From the start of this month Russia began a gradual re-opening of services after a ten-week pandemic lockdown. This is happening despite new cases of COVID-19 continuing to materialise – the tally of confirmed case of the virus has now ticked over the 500,000 mark (as at 12-Jun-2020). There are several reasons contributing to the decision to re-open, some political and some economic.

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Concern for the damage sustained by the Russian economy by the pandemic was foremost to the Kremlin but President Putin also wanted things functioning as close to normal in time for two upcoming events important to him. The 75th end of WWII anniversary military parade in Red Square—a PR showcase of Russian power—postponed from May is rescheduled for 24th of June. Even more personally important for the Russian leader is the July 1 vote✱, Putin has put up far-reaching constitutional amendments for approval, the main outcome of which could see Putin’s iron-grip on the federation extend till 2036.

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(Photo: Reuthers / SPUTNIK)

Discontent with Russia’s approach to the crisis
An underlying reason for the hasty end to the national lockdown might be that it hasn’t been as successful as hoped. The tracing app utilised in Moscow (the epicentre of the country’s COVID-19 outbreak) has had issues with its effectiveness. Putin’s personal popularity was at risk with public resentment voiced at the prolonged restrictions (murmurings of Orwellian and Soviet-like echoes). The medical response by the Kremlin has been called out by many front-line responders for its shortcomings. One doctor, Anastasia Vasilyeva (leader of a Russian doctors’ union), frustrated at the president’s insistence that the public health crisis was under control, has been at great risk to herself distributing PPE to medical workers on the front-line, provoking retribution from the Kremlin [‘The doctor who defied a President’, ABC News, (Foreign Correspondent, Eric Campbell), 06-Jun-2020, www.abcnews.com.au]. This is symptomatic of Moscow’s neglect of the regions who are expected to handle both the outbreaks without the medical infrastructure to deal with a large volume of cases and the economic fallout from the crisis without adequate financial assistance [‘Russia’s coronavirus cases top 300,000 but deaths suspiciously low: ‘We conceal nothing’ Kremlin says’, (Holly Ellyatt), CNBC, Upd 21-May-2020, www.cnbc.com].

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Counting the virus’ toll: a small exercise in data massaging?
Some Russia watchers have cast doubts about the reported COVID-19 figures released by Moscow. This includes WHO has questioned Russia’s low death toll, describing it as ‘unusual’ [‘WHO asks Russia to review its Covid-19 death toll in rare rebuke’, (Natalia Vasilyeva), The Telegraph, 11-Jun-2020, www.telegraph.co.uk]. While the number of Russian virus cases is comparatively high, the official record of fatalities is disproportionately low compared to the rest of Europe…Russia’s fatality rate is 0.9% cf. UK’s, 14.4% (roughly 10% of the mean figure for Western Europe) [‘How Russia’s Coronavirus Outbreak Became One of the World’s Worst’, (Madeline Roache), Time, 15-May-2020, www.time.com]. The Kremlin has rejected the criticism that it is withholding the full impact of the pandemic, but outside observers pinpoint an anomaly in the methodology it uses to count cases. Unlike say Belgium (which is strictly inclusive), Russia has not counted deaths as caused by the coronavirus where other co-morbidities are present, ie, if a patient tested positive for the virus and then had a subsequent critical episode, the cause of death is not recorded as COVID-19 [‘Russia Is Boasting About Low Coronavirus Deaths. The Numbers Are Deceiving’, (Piotr Sauer & Evan Gershkovich), The Moscow Times, 14-May-2020, www.themoscowtimes.com].

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A deserted, locked-down Red Square 
(Source: www.citizen.co.za)

Compartmentalising the fatalities
This persuasively accounts for the recent discordant mortality statistics reported by Russian sources, eg, if you separate fatalities directly attributable to coronavirus from other fatalities for May, the unexplained “excess deaths” recorded for Moscow is up about 5,800 on that occurring during the previous three Mays [‘New data suggests Russia may have a lot more COVID-19 deaths than it says it has’, (Alexandra Odynova), CBS News, 11-Jun-2020, www.cbsnews.com]. A look at Dagestan, a region with one of the largest clusters outside of the capital, is also instructive. As of mid-May it had experienced 35 deaths listed as caused by coronavirus, but in the same timeframe it recorded 650 deaths attributed to “community-acquired pneumonia”. One explanation from Russia watchers is that “local officials want to present Moscow with ‘good’ figures” (Ellyatt). If the Kremlin were to publish both sets of figures in its official data, such transparency would deflect much of the doubt and questioning by outsiders (Sauer & Gershkovich).

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✱ that Putin is prepared to push through the referendum at this time and risk aggregating the public health and safety of Russians, confirms for many the president’s prioritising of his own  political motives [‘Russian officials, citing COVID-19, balk at working July 1 constitutional referendum’, CBC News, 11–Jun-2020, www.cbc.ca]
many medical practitioners in Russia have been disaffected by both a critical shortage of equipment to fight the virus and by unpaid wages [‘Exclusive: Did Russia pass the coronavirus test? Kremlin spokesman Dimitry Peskov Responds’, (M Chance, Z Ullah & N Hodge), CNN, 09-Jun-2020, www.amp.cnn.com]
the COVID-19 emergency has exposed the deteriorating state of the Russian health service in the Putin era – the Semashko system infrastructure allowed to run down while the private medical sector has flourished [‘Can the Russian Health Care System Cope with the Coronavirus?’, (Estelle Levresse), The Nation, 09-Jun-2020, www.thenation.com]

The Choral Powder Keg: A Health Hazard Tailor-made for the COVID-19 Crisis

Public health,, Science and society, Society & Culture, Town planning

When a pandemic or some similar “Black Swan” event sweeps the world, hitting many countries with great intensity, particularly in Western societies with a high degree of religiosity, comfort and solace is often sought within the spiritual “safe house” of the church. As soon as the novel coronavirus landed and spread, it was apparent the church services especially where high rates of attendance was commonplace, would pose a public health risk.

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(Source: www.newslocker.com)

Yet in the US eleven state governors chose to maintain freedom of worship over community safety by exempting religious institutions from the general prohibition on public gatherings, notwithstanding that some of the states registered the biggest clusters of COVID-19. Even in other states there was a pushback by church men and women against government bans on assembly in places of worship. As a consequent 71 members of a single church in Sacramento were infected by the virus [‘Pastor who refused to close church due to coronavirus killed by outbreak’, (Rebecca Nicholson), Express, 15-Apr-2020, www.express.co.uk].

This was mirrored in overseas scenarios, in South Korea in February, one infected churchgoer infected at least 37 other members of her church on a single contact [“‘Superspreader’ in South Korea infects nearly 40 people with coronavirus’, (Nicolette Lanese), Live Science, 23-Feb-2020, www.livescience.com].

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South Korean choir with face masks  (Source: AP)

The choral petri-dish
The holding of packed sermons in churches and other places of worship, like any close contact between confined, concentrations of people, breaches the prescribed social distancing guidelines and exacerbates the incidence of coronavirus infection. But just as dangerous and with even more potential to transmit the viral disease through communities is the choral activities of churches. The activities of choirs initially continued unabated in the early stages of the pandemic but an incident in Washington state in early March brought home how risky choir practice is. 61 people attended a choir practice at a Presbyterian church in Skagit County, within a short time 45 of the group had been infected by COVID-19 and two had died. Other choir outbreaks, some fatal, have occurred In Calgary (Canada), Amsterdam (Netherlands) and in South Korea [‘Scientists to choirs: Group singing can spread the coronavirus, despite what CDC may say’, Richard Read), Los Angeles Times, 01-Jun-2020, www.latimes.com].

Infectious diseases experts have pinpointed the obvious dangers of contagion associated with choir singing…unrestrained vocal activity at close quarters in often poorly-ventilated, confined space. The vocalists exhale and inhale deeply to sing which makes them highly susceptible to the passage of airborne particles. Through the process of aerosolisation, the virus floats freely in the air (and has been observed to survive for up to three hours) [‘Churches can be the Deadliest Places in the COVID-19 Pandemic’, (Kevin Kavanagh), Infection Control Today, 03-Apr-2020, www.infectioncontroltoday.com; Read].

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Inexplicable change of stance by CDC
With eyes fixed on the November elections and the need to shore up vital support from the Evangelical Christian Right, President Trump from his White House ‘pulpit’ intensified his call in May for 
governors to reopen religious institutions as an essential service, eliciting pushback from some governors. At the same time, surprisingly the Centers for Disease Control and Prevention (CDC) decided to drop their warnings against choral singing despite the inherent danger it poses. CDC justifies this change of position by downplaying the likelihood of airborne transmission beyond six feet [‘Behind Trump’s demands to reopen churches: Slipping poll numbers and alarm inside his campaign’, (Gabby Orr), Politico, 22-May-2020, www.politico.com; Read).

Heightening the risk of unleashing ‘super-spreaders’
CDC’s controversial move has drawn broad criticism from medical experts including specialists in bio-aerosol research who have refuted CDC’s claim, calling it “hazardous, very dangerous and irresponsible”, and that it exposes America to new waves of super-spreading from the activity of choir members (Read).

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  With religious singing relegated to the home, some American churches have tried to get round the prohibition on in-house congregational services by organising drive-in sermons

Fallout from the churches
Although many parishes and parishioners in the US have adjusted well to the new world of online sermons, some traditional congregationalists worry that 
the new ‘norm’ will spell the disappearance of the in-person church experience altogether [‘How the Pandemic Will Change Us’,  (Rod Dreher), The American Conservative, 13-Mar-2020, www.theamericanconservative.com].

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(Photo: www.stjohnswhitchurch.org.uk)

 

Endnote: The economics of the choral closedown
The halt to choral activities due to COVID-19 has led to a whole bunch of “knock-on” problems worldwide. Like anybody else with their income source impacted adversely by the crisis, choristers, classical musicians and organists attached to the churches affected have been deprived of livelihood. But it goes even beyond that. As the Royal School of Church Music in the UK indicated, the pandemic ”has literally ripped apart the many close-knit groups of singers and instrumentalists who (need to) spend significant amounts of time together”. Church musicians who rely on the service are especially hard hit. It is doubly hard for self-employed church organists who have lost their access to practice – unlike other musicians who keep their instruments at home, they rely on “using instruments in public buildings for the vital practice which enables them to maintain their hard-earned skill” (Royal College of Organists). [‘Pandemic has ‘ripped apart’ church choirs’, (Hattie Williams), Church Times, 01-Apr-2020, www.churchtimes.co.uk].

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(Source: eBay)

PostScript: There is another side problem resulting from the non-use of organs in churches. Like the raft of airplanes grounded due to the coronavirus, complex and expensive organs require continual attention. They need “regular playing to ensure that the fragile technical components are kept in good working order“ and  free from damage (Williams).

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the Washington Post states that CDC acted on a White House directive to omit the choir warning from it’s website guidance information. CDC may have also relied on earlier statements from WHO contending that “there is no evidence of transmission of the virus as an airborne pathogen”. WHO’s conclusions have themselves been debunked as “decades-old dogma that held that droplets only travel an arm’s length in the air” (Read)