Few tests, little contact tracing as coronavirus spikes in Mexico

In the first 12 days of July, the total number of COVID-19 deaths since the pandemic reached Mexico surpassed those of Spain, France and Italy. Mexico is on track to exceed the United Kingdom’s pandemic’s death toll by the end of the month. By mid-July, the outbreak had claimed more lives in Mexico than 2019’s record-high number of homicides. In June, COVID-19 killed more people in Mexico than any other natural, violent or accidental cause of death that month.

Top officials in Mexico seem unfazed, projecting calm and confidence in press conferences. President Andrés Manuel López Obrador habitually scolds the “conservative, sensationalist press” for reporting on the outbreak in terms of overall mortality. He urges journalists to scale the numbers to account for Mexico’s larger population size. When viewed from the lens of deaths per million, Mexico’s outbreak appears less severe than in other hard-hit countries. 

But accurate “apples to apples” comparisons rely on comprehensive data of an equal standard. That’s not the case when it comes to Mexico’s restrictive testing policy. 

In Mexico, patients sick enough with COVID-like symptoms to require hospitalization can supposedly access a test. However, the criteria is much more stringent for “ambulatory patients,” people with symptoms whom doctors believe can reasonably recover at home. Only about one in ten ambulatory patients can qualify for a free test, usually individuals in a high-risk category due to preexisting conditions or pregnancy. Testing through accredited private labs in an option that is financially out of reach for many in Mexico.

Face masks for sale in Puebla, Mexico in July 2020. Photo: Dawn Marie Paley.

By way of comparison, in July the United States has been averaging around the same number of tests every day than the total number of tests performed in Mexico since the start of the pandemic. In fact, Mexico ranks last in the hemisphere for coronavirus testing. Mexico also has the world’s highest rate of positive results per tests performed: an average of one of every two PCR tests comes back positive. High test positive rates are widely regarded as an indicator of insufficient testing levels.

Testing is arguably the most important tool by which to measure an outbreak’s dimensions. In an April 8, 2020 press conference, Mexico’s coronavirus response coordinator Dr. Hugo López-Gatell explained that for most people, “testing is not useful because there’s no clinical basis for it.” He said eight of 10 infected individuals will not require hospitalization and can “fully recover within a span of 10 to 14 days and thereafter be immune to the illness.”

While evidence that disputes the speed of full recovery and duration of immunity conveyed has emerged over the course of the pandemic, the man in charge of Mexico’s coronavirus response continues to dismiss widespread testing as an essential tool for controlling the outbreak.

This ongoing refusal to adopt widespread testing puts Mexico’s approach at odds with advice from the World Health Organization (WHO). 

When asked about the outlook for Mexico during a WHO briefing on July 10, Dr. Michael Ryan suggested Mexico “intensify public health surveillance, intensify communications with communities.” Dr. Ryan noted that Mexico is in a difficult position of having to balance economic pressures with public health, but that easing restrictions during an intense community transmission phase requires additional vigilance. 

Regardless of the uncertainty related to the size of the outbreak, after a partial shutdown that included school closures, some of Mexico’s 32 states have begun to reopen according to a color system modeled after a stoplight. States under a “red light” must continue with the stay-at-home measures and closures of many non-essential businesses. Businesses in “orange light” states can reopen with certain restrictions, like caps on hotel room and dining hall occupancy. 

“Blind reopening not associated with the careful step-wise process, based on data, based on open communication may not lead to where anybody wishes to go in any country, Mexico included,” said Dr. Ryan, who is the WHO’s Emergencies Program Executive Director.

Economic pressure to get back to some semblance of a “new normal” is palpable due to the lack of direct government aid many here would need in order to be able to afford to stay home. In a country where half of the population lives in poverty, small business owners and self-employed vendors have had little choice but to continue to go out and try to earn income. 

In nightly press conferences, health officials often point to pre-existing conditions like hypertension, diabetes and obesity as the main risk factors driving COVID-19 mortality. This obscures the fact that many of the dead were –or lived in households with– low-income workers without access to government assistance. One analysis found that 71 percent of those killed by the virus in Mexico had only studied up to the sixth grade level or less.

Mexico’s pandemic strategy can be summed up as a paced herd immunity approach, with a focus on expanding hospital capacity to handle the most severe cases. When the UK openly floated the idea of letting the virus run through the population unchecked in the hopes of developing immunity, public health experts quickly and strongly pointed out the high cost in terms of avoidable loss of life. 

But Mexico has not witnessed similar mainstream push back nor have projections for loss of life been a part of the official discourse. A variety of factors come into play in disease modeling but public health experts generally agree that around 70 percent of a population would need to become infected with the virus and survive it in order to develop a level of immunity that could protect the larger society. One frequently-cited modeling project estimates less than six percent of Mexico’s population has been infected with COVID-19 thus far. 

The herd immunity approach is based on two possibly faulty assumptions: the attainability of herd immunity and the availability of medical personnel.

Part of coronavirus czar Dr. López-Gatell’s stated rationale for Mexico’s restrictive testing policy is that scarce resources are best channeled towards expanding bed space to handle an influx of serious cases without reaching a saturation point. 

But there’s a massive gap between available beds and quality care, especially in a public health system that has been systematically starved of resources. “Beds don’t always mean that that person who is in that bed is going to get adequate care,” said Dr. Mandeep Dhillon, an emergency room physician in the Mexican city of Orizaba. “Perhaps there’s not an oxygen port, or a functional cardiac monitor, or a nurse, or a doctor, or medications, or even an oxygen mask for that bed or for that patient who is in that bed.”

As the outbreak remains intense in most of the country, it’s taking a toll on both the physical and mental health of medical workers. Thousands of healthcare workers in Mexico have fallen ill with the virus and at least 248 have died, according to a recent Amnesty International report.

Coronavirus response leader Dr. López-Gatell openly bristles at suggestions that Mexico is hiding data and questions the ideological motives behind media stories that indicate the scope of the country’s outbreak extends far beyond the numbers presented in government data. But official data is based on test results and testing is restrictive by design. While that may not amount to hiding data, it is a policy that refuses to pursue solid leads, even when they come to the doors of health centers in the form of patients with symptoms.

That leaves journalists and researchers with one last option: to count the dead. 

All of the more than 39,000 people the government acknowledges died from COVID-19 had access to a test that proved they were carrying the virus. The vast majority of those who die from COVID-like symptoms, but without having taken a test while alive, are classified separately.

Healthcare workers and medical examiners are able to write “suspected COVID” as a cause of death in the absence of lab-confirmed test results, but officials have yet to release data on those cases. Credible independent research based on Mexico City death certificates, as well as leaked national civil registry data show deaths in Mexico may now be at levels twice to three times as high as average. Authorities have said an investigation into those deaths is forthcoming, but details have yet to become public. 

Conclusive evidence in the form of official statistics may not come until mid 2021, when Mexico’s census and statistics bureau is due to publish mortality data for 2020. Coronavirus response leader Dr. López-Gatell has advised Mexicans that the virus will continue to circulate and it’s best to “learn to live with it.” Just what it will cost remains as unknown as the outbreak’s true dimensions.

Author Bio:

Shannon Young is an independent journalist based in Oaxaca, Mexico. You can follow her work and comments on Twitter at @SYoungReports.