IF MEXICO had performed better in managing the covid-19 pandemic, around 190,000 deaths from all causes (including those caused by other conditions that were no longer cared for) would have been avoided in 2020, a study reveals. on the country’s response to the health crisis, prepared by a group of specialists at the request of the independent panel that the World Health Organization (WHO) launched to analyze how nations and the world have acted in the face of this phenomenon.
In a sample of 39 countries, Mexico ranks fourth in excess mortality, with approximately 43 percent more deaths in 2020 than would have been expected in relation to the 2018-2019 average (under normal conditions, without a health crisis). ). Only Peru, Ecuador and Bolivia have had higher mortality among the countries analyzed, explains Carlos del Río, co-author of the study.
Del Río, who is chair of the Department of Global Health at the Emory University School of Public Health, in the United States, says in an interview with Political Animal than the average excess mortality of the sample countries (all those with more than 3 million inhabitants and complete mortality data for the last three years, including the United States, United Kingdom, Spain, France, Russia, Thailand, Israel , Brazil, Chile and Colombia) is 17.3 percent.
“If Mexico had had a performance similar to that of the other countries where the excess mortality was 17 percent, there would have been 190 thousand fewer deaths ”, he assures. And he adds that even in the United States, where many deaths have been registered, the impact has been less: there the excess mortality is 20 percent.
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The case study, which has already been submitted to the Independent Pandemic Preparedness and Response Group and will be published by WHO in the coming days,points out that official figures from the Mexican authorities report an excess of 326 thousand 609 deaths in 2020, 2.6 times the number of deaths confirmed by covid-19 for the same period.
Statistics from January 2021, when COVID-19 deaths peaked, were not available for consideration in the expert analysis, but a considerable increase in excess mortality is expected.
The document notes that a portion (61.2 percent) of deaths in excess of 2020 that have not been linked to a covid-19 diagnosis are likely directly attributable to the disease, given very limited access to tests and diagnosis. .
The other deaths reflect the indirect impact of the pandemic on mortality due to the interruption of care for other conditions. Data from the Health Secretariat, the experts’ document refers, indicate that as of December 2020, the diagnosis of malnutrition, heart conditions, uterine cancer, diabetes and breast cancer had been reduced by 56, 45, 34, 27 and 20 percent respectively.
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THE ERRORS OF MEXICO
Del Río assures that there has been a failed management of the epidemic in the country and that impacts the number of deaths. “One of the main flaws is leadership. When you have a country like the United States with poor leadership (like Trump’s) and strong institutions (like the FDA, for example), the performance is bad; when you have a country with poor leadership and weak institutions as in the case of Mexico, the performance is even worse ”.
The case study document indicates in this regard that in Mexico, the authorities avoided deliberation and collective decision-making at the appropriate time. The highest governance and coordination body for health, the General Health Council, remained relegated to a secondary role. Key public health decisions were not systematically subjected to independent oversight, nor consulted with external experts.
The response to the pandemic was fractured from the beginning, it is noted, due to a lack of understanding, on relevant issues such as the level of threat and the necessary actions, among national authorities, some state governments and other interested parties. Partisan conflicts and polarization exacerbated these disagreements.
The other problem, says del Río, has been communication, this “during the crisis has been bad. How many times have they said that this is going to end? The mask is still not strongly recommended ”.
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Authorities, the case study says, have been unable to send a correct and consistent message to enforce public health guidelines through their own behavior. There was incorrect, inconsistent and politicized information.
“For fear that hospitals would reach a saturation point – the study says – authorities released information that encouraged patients to cope with the disease at home and not seek medical attention unless severe symptoms appear. This has contributed to the high mortality rates. In fact, it is estimated that 58 percent have died outside of the hospital ”.
In addition, del Río points out that health institutions were too limited to be able to respond effectively to the epidemic. “It is even a problem for health institutions already in crisis. A health system that did not have the conditions to respond well ”.
Mexico faced the pandemic with a fragmented and weakened health system, the document states, due to significant budget cuts since mid-2010. By 2020, the health budget per capita accumulated a loss of 26.4 percent in real terms in relation to its 2015 maximum.
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In addition, the current administration initiated a disorderly and poorly planned restructuring of the national health system. Insufficient resources and staff shortages, before and during the pandemic, limited the quality of emergency care.
Efforts to increase the number of beds were limited by a lack of available trained staff, equipment, medications, and financial resources.
The lack of public investment to support the population has also affected. “There has not been, for example, the investment necessary to rescue the economy, businesses were told they can be seen there,” says del Río.
Mexico, according to the study, stands out internationally as one of the countries with the lowest public spending to support the response to the health crisis and allow compliance with confinement measures. Small businesses and the underprivileged were caught between seeking the daily income or ensuring their health.
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Another fault identified is that the country chose to do few tests, which decreased the ability to detect outbreaks, diagnose patients, control transmission and adequately estimate the burden of covid-19 in the country.
As of March 2021, Mexico ranks 155th in tests per million inhabitants, out of 203 countries with available information. The positivity rate (the number of people who do test positive out of all those who are tested) has remained in the range of 30 to 50 percent, suggesting that there is a high level of people who are not diagnosed for not accessing the tests.
To all this must be added, says del Río, the high burden of comorbidities in the population (diabetes, hypertension, obesity), which have also had a significant weight in excess mortality. N
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