Women wearing face masks sell corn cobs outside the market in Xochimilco, Mexico City, on August 28, … [+] 2020, amid the new coronavirus pandemic. (Photo by PEDRO PARDO / AFP)
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With 65,241 confirmed Covid-19 fatalities (as of September 1, 2020), the pandemic has hit Mexico particularly hard. Mexico’s death toll has already exceeded levels originally conceived as “catastrophic” by local health authorities. But, what’s scary is how many Covid-19 patients in Mexico are dying before being connected to ventilators. According to Mexico’s publicly available epidemiological oversight database, only 20% of the country’s Covid-19 patients who died were intubated. An astounding 51,924 Covid-19 patients never received ventilator treatment before they died. Right now in Mexico thousands of Covid-19 patients are dying every week without access to the type of delicate intensive care that could have saved their lives.
In Mexico, Covid-19 patients are dying because public hospitals are failing to save them. Mexico’s president has actively encouraged people with symptoms to fight the virus at home. While the official number of total Covid-19 fatalities in Mexico is exceeded by only the numbers recorded in the U.S. and Brazil, it is roughly on par with India, a country whose population is ten times bigger than Mexico’s. We also know that the official death toll in Mexico is only a fraction of the real total. Tens of thousands of patients in Mexico never seek help, never get tested, and go unaccounted for. But, when excess deaths are tallied for the year, Mexico will stand out as one of the world’s most egregious cases of pandemic mismanagement.
The root of the problem in Mexico is leadership failure. Like the U.S. and Brazil, Mexico is led by an incompetent iconoclast. Over the last six months, Mexican President Andres Manuel Lopez Obrador has devoted far more energy to lambasting the media and his political “adversaries” than warning the public about the more immediate threat posed by the spread of coronavirus.
Today Mexico stands out for its abysmally low levels of testing and scarily high levels of uncounted deaths that are likely caused by the contagion. On a per capita basis Mexico is only doing 2% as much testing as the U.S. Mexican health officials believe that tens of thousands of additional Covid-19 deaths have gone uncounted. Arrogant and anti-intellectual, Lopez Obrador has bungled his way through the health crisis. While he claims to be delegating pandemic messaging and policy to the experts and scientists at his Health Ministry, he refuses to wear a mask in public and jokes that masks aren’t important. He has avoided mentioning the fact that 8 out of every 10 Covid-19 patients in Mexico were never intubated on a ventilator before they died.
Despite all of the evidence to the contrary, Lopez Obrador insists that his government is winning the fight against Covid-19. He lauds Mexico’s public hospitals for their work and re-assures the public that the death toll in Mexico is largely caused by the prevalence of chronic diseases in Mexico. He hasn’t commented on the fact the mortality rate of Covid-19 patients in public IMSS hospitals is three times higher than in private hospitals. Only 15% of the Covid-19 patients treated in Mexico’s well-regarded private hospitals die, while around half Covid patients at under-equipped IMSS facilities do not survive. Even while the overwhelming majority of Covid patients in Mexico are dying before receiving ventilator treatment, Lopez Obrador brags that the majority of the country’s intensive care beds and two-thirds of all ventilators are still available.
Lopez Obrador’s communication strategy appears to be focused on shifting blame for Covid-19 deaths away from public institutions and onto the public. After all, Mexico is the world’s top market for per capita soda consumption. Overall, around 40% of Mexico’s adults are overweight and more than 1 in 10 have diabetes.
Hospitals around the world have seen that overweight Covid-19 patients are more likely to require intensive care. But, it’s still inaccurate to argue that Mexico’s Covid-19 patients are dying because they are overweight or unhealthy. Mexico’s Covid-19 patients are succumbing to a specific virus that causes respiratory failure and they are dying in hospitals that are under-funded and ill-equipped for providing delicate intensive care to tens of thousands of patients, many of whom would likely require prompt admission to hospitals and weeks of critical care in order to survive.
Overall, nearly three quarters of all Covid-19 patients treated with ventilators die in Mexico, a much lower survival rate than patients at hospitals in the U.S. In Mexico’s hospitals, just 26.6% of Covid-19 patients who are intubated survive, but survival rates for patients with diabetes or obesity who are intubated are not significantly worse. Just over 26% of obese patients and 23.2% of diabetic patients survive after being intubated in Mexico.
The key trend to observe isn’t that Mexico’s Covid-19 patients are unhealthy, it’s that the intensive care units at Mexico’s public hospitals are failing to save the majority of patients that they treat. Mexico’s data confirm the concept that the quality of hospital care is a key determinant in whether Covid-19 patients survive. In the U.S. and other countries ventilators have proven to be an essential tool for saving lives during the pandemic.
The most shocking phenomenon occurring in Mexico is the staggering number of Covid-19 patients have died without being connected to ventilators. Just in Mexico City 6,218 Covid-19 patients are categorized as dying without receiving ventilator treatment. In the surrounding State of Mexico, 7,825 Covid-19 patients died without being intubated. In the neighboring state of Puebla, 2,777 patients have died without being connected to a ventilator. Yet Lopez Obrador continues to boast that thousands of intensive-care beds are available.
Mexico’s president appears to be hoping that his country’s voters will accept his attempt to connect Mexico’s tragic Covid-19 mortality rate to the pre-existing phenomenon of widespread chronic disease. But, a team of doctors and public health experts studying the outcomes of Covid-19 patients in U.S. intensive care units found that when other factors are held constant, diabetes and obesity are not associated with increased risk of death from Covid-19 once patients are intubated in the intensive care unit (ICU.) Even though patients with some underlying conditions appear to be over-represented in the data set of Covid-19 fatalities, people with these conditions are still able to survive if they receive adequate hospital care. An in-depth study of Covid-19 patients admitted to ICUs in the U.S. found that over 60% survived, but on average survivors spend nine days in the ICU and 16 days in the hospital. In Mexico, over half of all Covid-19 patients spent less than a week in the hospital before dying and more than a third were hospitalized for three days or fewer before they died.
While in the U.S. nearly 9 out 10 critical care patients are intubated within two weeks of arriving at an intensive care unit, in Mexico the reverse is true: most patients die before ever being connected to a ventilator. In Lopez Obrador’s home state of Tabasco only 1 in every 10 Covid-19 patients was connected to a ventilator before dying.
Information in Mexico’s publicly available National Epidemiological Oversight (SINAVE) database shows how hard the virus has hit the country. In Mexico, 44.5% of the people who have died of Covid-19 were 60 years old or younger. As of September 1, 2020, according to the official tally, 28,419 Covid-19 patients younger than 61 years old died in Mexico. The main factor these patients have in common is that they were never intubated before they die. Overall, in Mexico 81% of the 35 to 55-year-olds who have been confirmed to have died of Covid-19 were never connected to a ventilator. Even among 35 to 55-year-olds who were not categorized as obese or diabetic, only 18% were ever connected to a ventilator, an appallingly low figure compared to general levels of ventilator access for Covid-19 patients in the U.S., Italy, and even China. In Mexico, patients who are relatively young and healthy are dying because public hospitals are failing to provide effective treatment.
I talked to one of the authors of the study on U.S. Covid-19 patients. He explained that given prompt and effective hospital care, even people with chronic diseases can survive Covid-19. Underlying conditions such as excess body mass, diabetes, or hyper-tension may make it incrementally more difficult for any individual patient to survive, but do not amount to a death sentence. On the other hand, if a ventilator is not available when a patient is dying of respiratory failure, it’s being lost at sea with no life boat. The patient will fight to survive on his own but will receive no external assistance. Being overweight might make it more likely that a Covid-19 patient will require medical assistance, but it’s the quality of care and access to ventilator treatment that will determine whether the patient lives or dies.
The fact that Lopez Obrador’s Health Ministry devotes hours of press conferences to talking about chronic diseases during a pandemic is at best distracting and at worst a disingenuous attempt to skirt responsibility for the humanitarian disaster unfolding in Mexico. But, with over 100,000 confirmed patients predicted to die of Covid-19 in Mexico, Lopez Obrador needs to stop playing politics as usual and start prioritizing saving lives. Lopez Obrador needs to start treating Covid-19 as a historic emergency that merits a paradigm-shifting mobilization of public and private resources instead of blaming the media for negative coverage of Mexico’s steadily rising death toll. The message in Mexico (and elsewhere) needs to focus on encouraging people with symptoms to get tested and seek medical help well before they are struggling to breathe. If Mexico’s hospitals and ICUs are operating at far below their capacity there is still a big opportunity to save lives. Up until now, however, Lopez Obrador has stubbornly pushed forward with his existing agenda, seemingly believing that the pandemic is an unfortunate distraction rather than the crisis that will define his legacy as a failed policy-maker.
Note: this article contains references to statistics gathered from Mexico’s National Epidemiological Oversight database. Figures for current death totals are from the file from September 1, 2020. All other statistics are from the file from August 14.