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When Rufino Pacheco arrived at the hospital, his breath jagged and his legs buckling, a doctor thrust papers at his stepdaughter, asking for her approval to put him on a ventilator. But the elderly patient balked.
Less than 12 hours later, Pacheco died, hooked up to an oxygen tank in his bedroom, as his wife cried out, “Don’t leave me, old man.” Days later, she too fell sick with Covid-19, along with her adult son.
“There was a lot of tension and worry,” said Consuelo Vázquez of the time she spent caring for her mother and brother after the man she loved as her father was gone. “We thought we would go through the same thing.”
Each needed additional oxygen at times, and only after they recovered could the family begin to grieve for Pacheco.
Untested for Covid-19 and quickly cremated, Pacheco, who died on 24 November in the working class city of Ecatepec, may never appear as one of the fatalities that are mounting across parts of Mexico – especially the capital and its suburbs – in the worst outbreak since the summer peak.
For weeks, officials have pleaded with Mexicans to stay home. Even President Andrés Manuel López Obrador, whose public statements have rarely acknowledged the gravity of Mexico’s outbreak, began the month urging Mexicans to forego the holiday parties that stretch through December into January. But he refused to impose restrictions, declaring that Mexicans were “responsible, well-behaved and conscientious”.
The president’s soft touch highlighted what has been the essential contradiction of his government’s approach to the coronavirus. Keeping bars, cinemas and shopping malls open steadily undermines the message that people should go out only for the most essential of activities.
He has also said that many Mexicans cannot afford to stop working. Instead of giving help to people to allow them to stay home, though, the leftwing president has insisted on sticking to the austerity that has governed his two-year-old presidency. His government has proposed the barest of stimulus programs to tide over millions of the newly unemployed.
The result has been devastating. Almost 120,000 Mexicans have died of Covid-19, although health experts at Mexico’s National Autonomous University of Mexico, known as the UNAM, estimate that the number is anywhere from two to four times more. Even the reported figure makes Mexico one of the world’s deadliest countries for the pandemic based on its population.
But the government’s approach has changed very little, even when cases – and deaths – began to soar in November.
Finally, officials bowed to reality and on Saturday shut down most non-essential activities in Mexico City and the surrounding state of Mexico, home to the vast working-class suburbs that have been among the areas hit hardest by the coronavirus.
Dr Hugo López-Gatell, the deputy health minister in charge of the government’s effort, admitted that the inertia of the epidemic required “extraordinary measures”.
Exhausted doctors and nurses on the ground had known for weeks how grim the picture was.
“The failure to stop contagion really hit us with this second wave,” said Dr Belén Jacinto, a critical care specialist at La Raza general hospital in Mexico City.
Everywhere she turns, there are shortages. There is only one critical care doctor on duty each shift to manage 15 patients in her ICU, assisted by other doctors in other specialties.
There are not enough staff members to turn ventilated patients on their stomachs as protocol recommends and monitor them to ensure their breathing tubes remain in place.
“I told my bosses that intubated patients are almost – almost – condemned to die,” she said. “What service are we offering?”
The government has hired new doctors, bought ventilators and increased the number of ICU beds since the pandemic began. But that is not enough. “You can’t increase capabilities overnight,” said Dr Alejandro Macías, who handled the government response to the 2009 swine flu epidemic. “All these additional beds did not necessarily improve the outlook.”
Critics of López Obrador’s populist government argue that the approach to the pandemic was misguided from the start. “The Mexican government declared that doing testing was a waste of resources, “ said Dr Julio Frenk, a former health minister who is now the president of the University of Miami. Mexico has one of the lowest testing rates of any country in the world.
“The policy was to have enough beds,” he said. “The policy objective should be to control transmission.”
Part of the responsibility for testing falls to Mexico’s states, said Macías, and they too failed to increase testing. The exception is Mexico City, where Mayor Claudia Sheinbaum offered free, widespread testing.
Dr Samuel Ponce de Léon, who coordinates the Covid response group at the UNAM, said that the government’s attempt to strike a balance between allowing people to work and stemming contagion had failed. “More than half the population belongs to the informal economy,” he said. “They have to travel and go to work to have money for food the next day.”
Given that reality, he said, the government’s incoherence in communicating basic measures to protect against the coronavirus – beginning with López Obrador’s refusal to set an example by wearing a face mask – was hard to understand.
“Social distancing is an impossible dream,” Ponce de León said, referring to Mexico City’s packed public transport. “But we can minimize with face masks and hygiene.”
López Obrador’s insistence on maintaining austerity measures throughout the pandemic has also surprised many.
The International Monetary Fund– no fan of runaway public spending – recently called on Mexico’s leftwing government to increase its support for families and businesses devastated by the deep recession caused by the pandemic.
Noting that Mexico had budgeted only 0.7% of GDP in additional health and social spending to confront the pandemic, the fund said that Mexico should increase that amount to 2.5% to 3.5% of the country’s output, and make healthcare the top priority.
For decades, Mexico has underspent on public health, falling behind comparable economies such as Colombia and Brazil. Many hoped that López Obrador would change that when he took office, promising to make helping the poor the focus of his policies.
Instead “Covid hit us at a very bad time”, said Mariana Campos, an expert on public spending at México Evalúa, a thinktank. López Obrador’s government reduced the health budget in 2019, the third successive year of cuts. “We have the structural problems we have always had, and they have been aggravated since 2017.”
As the bustle of the capital begins to fall silent and the government turns its attention to the arrival of the first vaccines, Macías said that the country was only halfway through its battle.
“If this were a football match, we would be at minute 45,” he said. Viruses spread faster in the winter and “I foresee many more patients”, he said.
Source: The Guardian
Keyword: Covid fatalities soar in Mexico as president condemned for inaction | Mexico