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FROM THE FIELD: COVID-19, STRUGGLING IN LATIN AMERICA

The changing dynamics of the Coronavirus Disease 2019 (COVID-19) pandemic, relatively rapid, moved its epicenter from Asia to Europe, later to North America, and now, into Latin America. This is currently the region with the highest number of new daily cases.

In late February 2020, a group of experts in infectious diseases from Brazil, Colombia, Peru, Argentina, Bolivia, Chile, Honduras, Mexico, Panama, Uruguay, and Venezuela, addressed in an Editorial at Travel Medicine and Infectious Diseases, the implications of the arrival of the first imported case to region, in São Paulo, Brazil.

Latin America is a vast region, with over 642 million people living in 20 countries, from Mexico, in the north, to Argentina in the south cone. This geographical area has a significant social inequality and resource-limited healthcare systems. Before the COVID-19 pandemic, this region faced recent devastating epidemics such as those from chikungunya and Zika, even with long-term consequences (e.g. chronic chikungunya and Zika-associated neurodevelopment impairments), from 2014 to 2016, and dengue on multiple occasions over the last decades, especially in the urban slums. Additionally, with a marked impact of forced migration derived from the humanitarian crisis in Venezuela, leading to the spillover and outbreaks in other countries of the region due to vaccine-preventable diseases, such as measles and diphtheria, as well as from other vector-borne and zoonotic diseases, such as malaria. In this neotropical scenario, that includes the Amazon jungle, shared by nine countries of South America, other regional endemic and emerging infectious diseases such as Chagas disease and viral hemorrhagic fevers, such as yellow fever, Orthohantavirus or Chapare virus, also have significant disease burden and impact.

During the last week (before June 10, 2020), Brazil has reported up to 32,000 cases of COVID-19 in a day, for a median of 28,633 cases/day over the previous seven days, compared to 21,140 in the United States, which is decreasing since its peak in April, as seen in the figure. In Brazil, Ecuador, and Peru mainly, hospitals and intensive care units have begun to collapse due to the limited capacity that has been surpassed by the number of moderate and severe cases diagnosed in these countries.

Governments and health authorities in the region have reacted differently to the pandemic challenge, with countries adopting early nation-wide lockdown and quarantine, as well as others only taking other limited and less effective measures. For example, Colombia, Bolivia, Paraguay, and Argentina, implemented national lockdowns that have served to slow the speed of the pandemic in these countries. These nations have also focused especially on people at high-risk of severe disease progression and death, as those older than 60 years old and/or those with comorbidities, such as hypertension and diabetes.

In the region, the role of infectious diseases national societies has been vital in the development of clinical practice guidelines to improve medical care and reduce fatal outcomes. For example, in Colombia, with the support of more than 60 scientific societies and experts of different medical specialties (e.g., internal medicine, critical care, pneumology, pediatrics), the Colombian Association of Infectious Diseases (ACIN) developed the “Colombian consensus recommendations for diagnosis, management and treatment of the infection by SARS-COV-2/COVID-19 in health care facilities - Recommendations from expert´s group based and informed on evidence”. This updated guideline covers a vast number of topics to provide a document, periodically revised, with evidence-based information to improve the healthcare in the COVID-19 clinical practice.

Resources in the region, including information sources, certainly are limited, but national and international networks and societies in the field support the struggle against the pandemic. A vital tool on this has been the use of ISID’s PROMEDmail, PROMED-Esp in Spanish, and PROMED-Port in Portuguese, that provide daily updated epidemiological, clinical and scientific information on COVID-19 and other emerging infectious diseases, highly relevant for decisions in public health and clinical settings.

The complex epidemiological scenario in Latin America demands for a full commitment of multiple sectors, with infectious disease physicians playing a key role in the healthcare teams, scientific advise to health authorities and providing cutting-edge medical education tools, to offer the best available scientific information for medical care.

It is worthy to say, that “after the darkest hour, the sun will shine again”, for a region with a high biodiversity, a joint fertile culture, the wonderful coffee, most delightful food, and friendly people that believe in the health progress of the region and the world. The pandemic is challenging for the world, but even more for developing nations; we must stay all together and keep struggling with scientific evidence against this emerging disease in Latin America and the world.

Alfonso J. Rodriguez-Morales, MD, HonDSc, Professor and Senior Researcher
ISID Council Member
Pereira, Colombia

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