Information & Resources on COVID-19

in Latin America and the Caribbean

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An Overview of the Pandemic, Challenges, Impacts, and Responses

(last updated April 27, 2020)

Introduction

The Latin America and Caribbean region is being increasingly impacted by the COVID-19 pandemic. The incidence and policy responses to COVID-19 in the region are varied and rapidly changing. As in other countries throughout the globe, the advent of the virus has represented a daunting health, political, and economic challenge that has exposed fragilities in health systems and economies. Despite many similarities in the impact and responses with countries in other regions, countries in Latin America and the Caribbean have unique socioeconomic, political, cultural, and public health contexts that are shaping the nature of the pandemic and the ways in which governments and other actors are addressing its threat. Among the most notable factors for understanding the impacts and responses in the region are the high levels of poverty and inequality, combined with comparatively under-resourced health systems in most countries.     

COVID Confirmed Cases and Deaths

The first confirmed case in the region was in Brazil on February 26th (the first detected case in the US was January 20th)Argentina was the first country in Latin America to report a COVID-19 related death (on March 7th).  In several countries (e.g., Argentina, Bolivia, Brazil, Cuba, the Dominican Republic, El Salvador, and Guatemala), the first confirmed cases involved individuals from Italy or that had recently visited Italy.  In other countries (Honduras, Panama, Peru, and Venezuela), the first confirmed cases involved individuals that had been in Spain. These observations do not necessarily indicate the first or only sources of COVID-19 in these locales, considering that the introduction of the virus into countries is likely to have occurred through multiple sources and times, and many or most cases have not been confirmed. 

The largest countries are reporting at least ten thousand cases at this point. Numbers of confirmed cases and death are rapidly increasing in most countries in the region, although in some countries data suggest a slowing down. In the last week, cases and deaths have more than doubled in Ecuador. Other countries continue to have a rapid growth in cases and deaths, including Mexico, Peru, Bolivia, and Brazil, all of which have had at least a 50% increase in cases and deaths in this last week.  In Mexico, the number of deaths has almost doubled this past week.   In some countries, the increases in cases appears to be slowing down and leveling off (e.g., Uruguay and Costa Rica).   Despite the growing numbers, according to the available data at present the number of confirmed cases and deaths in the countries of the region are well below that of the US.

As of April 27, Brazil, Peru, Ecuador, Mexico, and Chile are reporting the greatest number of confirmed cases. Brazil currently has over 63,000 reported cases. Peru and Ecuador each have over 20,000 cases, while Mexico and Chile have over 13,000 cases.  The Dominican Republic, Panama, and Colombia, have over 5,000 confirmed cases at this point. Argentina and Cuba each have over 1,000 cases. Bolivia, Costa Rica, Honduras, Uruguay, and Guatemala have surpassed 500 confirmed cases, while Jamaica, Venezuela, El Salvador, Paraguay, and Trinidad and Tobago have reported at least 100 confirmed cases. Countries in the region with the highest confirmed cases as a proportion of the total country population include (in descending order) Panama, Ecuador, Peru, Chile, Peru, the Dominican Republic, and Brazil. 

COVID-19 related deaths have been by far the highest in Brazil (over 4,000). Mexico has the second highest numbers of deaths (over 1,000). Countries other than Brazil and Mexico with the highest numbers of deaths include (in descending order) Peru, Ecuador, the Dominican Republic, Colombia, Argentina, Chile, and Panama. Each of these have at least 100 COVID-19 deaths reported. The countries reporting the highest numbers of deaths relative to the overall country population are Panama, Ecuador, the Dominican Republic, Peru, and Brazil.

Below we provide a summary of incidence and mortality data for select countries in the Americas (Figure 1). Included are countries that have reported at least 100 confirmed cases. Please note that this is a rapidly evolving scenario and data are subject to daily changes (this chart was last updated on April 27, 2020). For the most current information on cases and deaths for each country globally see the John Hopkins COVID-19 Map (https://coronavirus.jhu.edu/), which is updated daily. We also recommend the interactive map of the region and chart with the progression of cases by country created by the Americas Society/Council for the Americas (https://infogram.com/covid-19-map-live-updating-1hdw2jr8lp8d6l0).

Note that the number of cases and deaths per country are difficult to compare due to a variety of considerations. The availability of and access to testing is highly variable, and data are affected by the different timelines of testing efforts in different countries. In addition, different countries are defining COVID-19 linked deaths in varying ways, which limits the comparability of data on deaths.

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The demographic profile of the region, which is younger and has a much smaller percentage of individuals over 65 in comparison with the US and Europe, means that the at risk population is proportionally smaller. According to PAHO, 9% of the population of Latin America and the Caribbean is 65 years or older, while in the US this age group accounts for 16% of the population. However, despite the region’s younger demographic profile, socioeconomic disparities in health and access to health, combined with limited health system capacity, means that the vulnerable population is still substantial, if not greater in comparative terms.  Further, the high prevalence of chronic diseases in the region increases vulnerability and raises the possibility of needing intensive care and of dying from COVID-19. The prevalence of chronic respiratory diseases is also higher among vulnerable populations, potentially increasing susceptibility to COVID-19 in countries with high levels of poverty.  

Besides population age profile and health systems considerations, other factors are relevant for assessing the vulnerability of the region and the potential impact of the pandemic. Although the region as a whole has a relatively low population density, it is more urban than the US, with many large, densely populated cities, which are fertile grounds for COVID-19 transmission.  In addition, the high levels of poverty pose challenges for social distancing measures for much of the population in the region.  

Challenges to Addressing the Pandemic

The health systems in Latin America and the Caribbean, like elsewhere, are not adequately equipped to address the COVID-19 pandemic. In general, health systems indicators for countries in the region indicate that health systems are under-resourced and have limited numbers of health workers (see Figure 2).  

Although on average countries in the region allocate a similar percentage of GDP to healthcare as the EU, Latin America spends substantially less money per capita on healthcare than the EU or the US.  According to a 2019 report from PAHO, Latin American and the Caribbean public health expenditure as a percentage of GDP was 3.7% (private spending was 3.4%), compared with 14.0% public spending in the US (and 3.1% private spending). 

Per capita physicians, nurses, hospital beds, and other health system indicators for the region are below those for the US and the EU, with many Latin American indicators half of that of the US and EU.  According to a 2019 report from PAHO, Latin America and the Caribbean had 21.4 physicians and 15.8 nurses per 10,000 people, while the US had 26.1 physicians and 145.2 nurses per 10,000. 

Like elsewhere, the availability of ventilators/respirators, hospital beds, protective gear for health workers present important bottlenecks for prevention and treatment. Access to respirators is a particularly significant bottleneck, considering limited regional production, the disruption of global supply chains, and global competition to secure respirators.    The consequences of such bottlenecks will likely be most significant in countries that have made little or no efforts to promote social distancing and quarantine measures. As cases surge, hospital systems are becoming overwhelmed, as has happened in Asia, Europe, and the US. 

The health systems capacity varies throughout the region, as well as the capacities and strategies for effectively implementing measures for prevention, containment, care, and treatment.  The ability to devise and disseminate effective and actionable public health communications is variable. There are also notable differences in the capacities and strategies of governments to enforce restrictions on movement and travel (including, for example, the extent of executive powers and the role of the armed forces in such efforts).

The relevance and efficacy of containment strategies for poor communities is an especially important issue. Social distancing, frequent hand washing, and other preventative measures are more difficult to implement with socioeconomically vulnerable populations. Greater social proximity in low income communities, and the lack of running water in informal housing conditions pose significant challenges. Further, remote working is largely not an option for those from households of lower socioeconomic status.  For those working in the informal sector or involved in manual labor in the formal sector, working from home is largely impossible, making it difficult to comply with social distancing guidelines or regulations (and ensure continued household income during this crisis).

The high levels of poverty, high prevalence of an informal economy, and insufficient labor protections within the formal sector create a situation of financial insecurity and vulnerability that also poses significant challenges to addressing the pandemic.  Household financial status limits the ability of those in poor households to stockpile food and essential goods, thereby potentially fostering increased opportunities for exposure to the virus. Beyond the immediate concerns of addressing the COVID-19 situation, the socioeconomic vulnerability that characterizes most of the region’s population has grave implications for their future economic resilience and well being.   

Impacts

Considering the general context of weak economic growth, stark socioeconomic inequalities, high levels of poverty, under-resourced public health systems, and highly variable health literacy, COVID-19 presents a particularly serious public health challenge for Latin American countries.  

Its economic consequences are also likely to be substantial and lasting, while being shaped by existing inequalities in wealth, income, and access to healthcare. The direct costs of addressing the disease, as well as the closing of businesses and the slowing down of industry and commerce is adding to the economic stress that was already affecting most countries in the region.  The economies of many countries in the region are dependent on commodity exports, tourism, and/or remittances, all of which are being impacted by the current global economic situation stemming from the COVID-19 pandemic. 

While it is clear that there will be significant economic consequences, it is still too early to tell to what extent and in what ways the disease and government responses will reshape the economic landscape. Potential outcomes include, for instance, greater involvement of the public sector in shaping the economy, increases in inequality, elevated commitment to public health, and/or increased social protections for vulnerable populations. At present, substantial layoffs in the service, industry, and other sectors are occurring and unemployment and underemployment have rapidly and significantly increased.  Informal workers are also being significantly impacted financially. Many countries are considering or have passed legislation to address the economic impact, including measures to bailout affected industries, augment unemployment benefits, provide other sorts of assistance (e.g., food and childcare) to the newly unemployed, and to provide financial support and/or other resources for those in the informal economy. 

There are also likely to be significant political transformations precipitated by this health crisis. In the short term, important political processes have been disrupted in some countries. In Chile, the constitutional referendum has been postponed, while in Bolivia upcoming elections have been postponed. The long term political consequences of the outbreak of the virus and government responses are unknown and likely to be quite heterogeneous.  But considering the magnitude of health and economic threat in the region and globally, this is a fertile moment for significant political frictions and political transformations.     

The outbreak of the virus and government responses have the potential to both deepen and attenuate political polarization in different contexts, as well as undermine or fortify existing political leadership and institutions. Political responses may include a deepening authoritarianism, to undermining the legitimacy of some leadership, to restoring faith in government institutions and political leadership. Already, there are already indications that approval ratings of executive leadership have shifted–both up and down–due to public assessments of their COVID-19 responses. In particular, both López Obrador and Bolsonaro seem to have seen their approval ratings tarnished and have alienated some of their former supporters as a result of their handling of the pandemic thus far.  Relationships between political parties are also being affected, with existing collaborative relationships strengthening or fraying, new alliances being formed, as political parties propose and negotiate public health and economic responses to the crisis. In Brazil, for example, collaborative relationships with parties that have been largely allied with the president have been strained. 

Responses

Most countries have placed restrictions on international travel, with some establishing complete or almost complete bans. Such measures have included restrictions or prohibition of the entry of foreign travelers, mandatory quarantines for foreign travelers, and border closures and controls for citizens and residents.  Most countries have also encouraged citizens to limit exposure by staying home and avoiding non-essential activities outside the home that increase the risk of exposure.  Measures have included restrictions or closures of public spaces, and prohibitions or limitations on mass gathering. 

Countries have been announcing or adopting a variety of economic responses to address job, income, and revenue losses. Some countries have taken measures to address unemployment and economic and food insecurity, which have been created or heightened by the pandemic and measures taken to limit the spread of the virus. Economic stimulus and recovery policies and plans have developed in many countries by national and subnational governments, including fiscal measures, social protection policies for vulnerable populations, policies for small businesses, and new labor protection policies.  Responses have come in varied forms, including executive decrees, provisional measures, and new legislation. 

A more detailed discussion of the health and economic policies being adopted by countries in the region can be found here: COVID-19 Health and Economic Policy Responses in Latin America

For further information and analysis on the impacts and responses of COVID-19 in the region, please visit the following:


Links & Resources

Below we provide links to useful resources on COVID-19 in the region and globally. Included are web pages of national and multilateral public health institutions with information on the virus and measures for prevention, testing, and care. We also include links to academic websites with information on the virus, its incidence, and its impact.  In addition, links are provided to media sites and think tanks with articles, opinion pieces, videos, podcasts, etc. that provide information and insights into COVID-19 and responses to the pandemic in Latin America and the Caribbean.

Multilateral Institutions:

Health Ministry web pages on coronavirus from select countries:

Academic Resources:

Latin American Newspapers:

US/European Newspapers:

Newspaper Articles & Opinion Pieces:

Articles, Opinion Pieces, and Interviews with Columbia Faculty:

Podcasts:

Other resources: