HEPL blog series: Country Responses to the Covid19 Pandemic

Mexico’s Response to the Coronavirus Pandemic

Gabriel Moreno-Esparza

Northumbria University

Mexico was the epicentre of the A/H1N1 influenza (swine flu) pandemic of 2009. The way the country handled the pandemic won it praise from the World Health Organization (WHO). The WHO highlighted the promptness of then President Felipe Calderon’s administration in issuing an epidemiological alert which included social distancing measures and a transparent plan of public communication. The number of fatalities linked to the pandemic that year has been situated at around 500 deaths. The economic impact of the so-called swine flu, however, had a crippling effect on the country’s GDP, arguably accounting, alongside the financial meltdown of 2008, for a realignment of political forces which led to regime change in 2012.

While the focus of Mexico’s government in tackling the atypical pneumonia in 2009 was on saving lives, the current administration has emphasised the need to find a balance between the human and economic burdens that come with COVID-19. Thus, in a country where 31 million workers are in informal employment, the government of President Andrés Manuel López Obrador has opted for a piecemeal strategy. Noticeably, and to date controversially, traits in the approach include voluntary measures of social distancing, laboratory testing based on the model of sentinel surveillance, and the expectation that ongoing recovery trends are signalling a future scenario of herd immunity.

Mexico’s directorate of epidemiology (DGE) issued on 9 January a preventive alert for travel to China, with suggestions to avoid non-essential travel. Those who could not avoid travel to that country, the DGE said, should take general hygiene measures and avoid crowded places. Health authorities started issuing daily technical reports since 23 January and the country’s Institute of Epidemiological Diagnosis and Reference (INdRE) started to work on the protocol to identify the new SARS-CoV-2 virus. This protocol was fully implemented towards the 21 February and included a network of government and private laboratories with capacity to test suspect patients against the virus’ genetic material.

The first confirmed case in the country was announced on 28 February as a 35-year old man resident in Mexico City who had been to Italy. The country eventually reported the first death associated with coronavirus on 19 March, which involved a 41-year old man who had presumably been infected at a mass concert in Mexico City. The man in question, who was diabetic, had reported symptoms of infection on 9 March. When the country moved into the second stage of community transmission, on 30 March, it had reported 1,094 confirmed cases and 28 deaths.

Ratio of expert signalling to political noise

Health authorities put in place a platform of risk communication which has been systematically informing Mexicans since January. It can be argued, however, that the quality of the information has been diluted by the political polarisation which has been characteristic of López Obrador’s administration. It didn’t help that the President has been minimising the threat of the virus since well before the World Health Organisation (WHO) declared it to be a pandemic on 12 March.

At the end of January, for example, Obrador said the virus ‘was not as bad’. Throughout March, he continued to dismiss the gravity of the situation, appearing several times at press conferences and public events where he hugged, shook hands with, and received kisses from dozens of admirers as if campaigning for public office. Mr Obrador’s behaviour earned him criticism at home and abroad, thus amplifying the perception that Mexico’s response to the threat has been, to say the least, feeble.

In addition to appearing careless, Mexico’s controversial leader has rejected calls from industries and employers for loans, tax relief and other forms of intervention like those put in place by governments in other countries. He has instead announced a package to “rescue the people of Mexico”, based on early payments for vulnerable social groups that were already budgeted for this year.

Unorthodox strategy against the pandemic

Adding to that perception, the epidemiological strategy put in place by health experts has been deemed as going against the grain of decisions followed by other countries. For one, nearly one month after its first case, Mexico had blatantly dragged its feet in reacting to the dramatic signals that came from countries like Spain and Italy, and which prompted some big companies and state governors to unilaterally adopt measures of social distancing.

One specific aspect of the epidemiological response that drew heavy criticism was INDrE’s approach to testing, which from the beginning worked with small subsamples of patients who presented signs of a viral respiratory disorder. INDrE, which has been at the forefront of Mexico’s response to the A(H1N1) influenza, Zika and Dengue epidemics suffered by the population in recent years, has recently authorised laboratories to increase testing of ambulatory patients. But testing patterns have remained unresponsive to criticisms from visible and different sectors of society, including governors and business associations who criticised the government for going against testing orthodoxy. To 14 April, the country had undertaken 37,395 tests, or 290 per million population (pmp), compared to Chile’s 4,448 tests pmp, Ecuador’s 1,392 pmp, Venezuela’s 7,143 pmp and even Brazil’s 296 pmp.

It’s significant to note here that the Ministry of Health and INDrE have been working on a strategy that assumes an infection rate of 0.1% for the general population. This estimate was modelled, somewhat ironically, after a joint WHO-China report. Among other considerations, that report led to the projection that only 6% of patients in Mexico, out of 176,000, would necessitate attention in an intensive care unit.

Unsurprisingly, the static scenario which informs Mexico’s approach to testing goes against WHO’s guidance in the sense that the sentinel approach it has followed is inadequate to monitor changes in transmission patterns. Per the WHO’s guidelines, countries must at least be prepared to deploy testing capabilities, as well as make provisions, for different epidemiological scenarios. Hugo López-Gatell, Mexico’s deputy Ministry of Health, who has been the public face in charge of defending the government’s strategy, has been unfazed by criticisms. In multiple occasions, he has challenged the WHO to show that more testing leads to better containment outcomes.

López-Gatell, an epidemiologist who has a PhD from the Bloomberg School of Public Health at Johns Hopkins University, has also questioned the notion that closing borders can significantly reduce the rate of coronavirus infections. Whilst remaining defiant, López-Gatell announced a national emergency on 23 March which included school closures, temporary suspension of mass events and a call for people in non-essential activities to remain at home until the end of April.

López Gatell has also said that they intend to increase the number of tests, but it would not be a surprise if it turns out that it missed patterns of community transmission outside of catchment areas of sentinel sites.

Summary

Mexico adopted in late March measures that signal the authorities’ awareness that a significant increase in cases of coronavirus is about to begin, as the country gets closer to stage three of community transmission. At the peak of this stage, the Ministry of Health has said that the country’s network of hospitals is equipped to receive up to 1,000 new patients in its 30,000 hospital beds over a period of four weeks. The specialists have insisted the cases of hospitalisation will concentrate on at risk groups, especially over 60-year olds, smokers with respiratory diseases, and people with chronic conditions such as diabetes and hypertension.

But with an estimated 1.4 hospital beds per thousand people and only 10,000 ventilators, the country could be ill-prepared for anything outside the modelling contemplated by health authorities. To 13 April, Mexico’s count of confirmed coronavirus infections was at 5,014, with 332 deaths, 1,964 recoveries, and 2,718 active cases. Government reluctance to impose a lockdown on the population, largely employed in the shadow economy, makes it possible that the spread of coronavirus will not slowdown if only a yet undetermined percentage of the population stays at home.

On 30 March, Mexico’s President finally expressed the importance ‘that we stay home to look after each other’, but even then he minimised the chronic disease factor, on the basis that the country’s population is on average 28-years old. Another main advantage, he said, was that should the virus overrun hospital capacity, Mexicans tend to live in family settings with ‘millions of female nurses in households’ that would hold the country together. Unsurprisingly, the statement was used by Mr Obrador’s detractors as a sign that he represents sexist ideological values which added to the political polarisation that he provokes. While such polarisation has been endemic in the country for decades now, it has interacted with the extraordinary lethality of the pandemic at the global level. This has given ammunition to further undermine confidence in Mexico’s unorthodox epidemiological response, as well as its lax strategy to absorb the economic impact that the virus will leave behind.

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