Several problems undermine the preparedness of countries in Latin America to face the spread of COVID-19. Talha Burki reports.

Coronavirus disease 2019 (COVID-19) has arrived late in South America. On February 25, 2020, Brazil was the first nation in the region to report the disease. Within weeks, countries across the continent had closed their borders and enforced lockdowns. As of April 14, Latin America has registered more than 65 000 cases of COVID-19. Ecuador, in particular, has been badly affected, with reports of corpses left abandoned on the streets. Pandemic preparedness varies across the region and several countries are particularly vulnerable to a destructive outbreak. For example, Guatemala and Haiti have little more than 100 ventilators between them. Mexico has high rates of hypertension, obesity, and diabetes, all of which are risk factors for severe disease after infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

“It is a very difficult situation”, explains Alfonso Rodríguez-Morales, Colombian Association of Infectious Diseases, Colombia. “Obviously the healthcare systems are not trained for coronavirus; we had a little extra time to get ready for the arrival of the disease but some places are really going to struggle.” Thus far, Brazil has recorded the largest number of cases—more than 23 000, as of April 13. The country has a good public healthcare system, and it is experienced in dealing with epidemics. The past few years have seen serious outbreaks of chikungunya, dengue, yellow fever, and Zika.
There is also the issue of the favelas, home to around 13 million Brazilians. In the favelas, conditions are crowded and access to clean water is limited. In such circumstances, social distancing and hand-washing are virtually impossible. “The recommendations for preventing infection are based on assumptions that do not apply in the favelas”, said Clare Wenham, Assistant Professor of Global Health Policy, London School of Economics and Political Science, UK. “It is hard to see how they will be able to prevent infection or control the virus once it has been let loose.” The outlook is similar for slums elsewhere on the continent.
Healthcare in Brazil is the responsibility of the municipalities. This includes pandemic preparedness. It means that matters such as the provision of personal protective equipment, rules on social distancing, and testing arrangements vary. But it also limits the influence of President Jair Bolsonaro, which could work in the country's favour. Bolsonaro has repeatedly minimised the threat of COVID-19 and undermined efforts to enforce social distancing.
After Bolsonaro returned from an official trip to the USA in early March, 24 members of his delegation tested positive for SARS-CoV-2. Instead of going into quarantine, the president attended a public rally. In late March, he issued orders preventing the states from restricting people's movements and removing the requirement for churches to comply with health regulations. Both moves were quickly overturned by the courts. “You have mixed messages in Brazil”, said Wenham. “The president is encouraging people to go out and resume their normal lives, while the mayors and governors are stressing the importance of maintaining quarantine”.

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