Isabel Vazquez clutches a photo of her late mother Irene Bernal, 87, remembering the final moments of her life. After 20 days in hospital, she died of COVID-19, with Vazquez at her side.
“Two minutes before my mother died, she was screaming, and I said to her, ‘What do you want?’ and she said ‘No more, for mercy’s sake,'” Vazquez told CBC News, sitting in her home in Iztapalpa, a suburb of Mexico City and an area hard hit by the virus.
The family says Bernal was taken to a public hospital in June suffering from an intestinal infection. Two days later, she was transferred to a private hospital. The family suspects Bernal may have contracted the virus during that first hospital visit because, until that point, they had been in self-quarantining as a precaution.
Their story highlights just some of the challenges facing Mexico, which sits behind only the U.S. and Brazil in the total number of deaths from COVID-19. From a fear of doctors to a public health system under pressure, the country has struggled to contain the virus.
According to figures from the Mexican government, the country has close to 560,000 confirmed cases and this week surpassed 60,000 deaths.
In early June, Deputy Health Minister Hugo Lopez-Gatell had said that reaching 60,000 deaths would represent a “very catastrophic scenario.” At the time, the country had just over 12,500 deaths.
Despite the extent of the crisis, the country has decided not to pursue mass testing. Lopez-Gatell has argued that limited testing and statistical modelling were a more effective and efficient use of resources.
A health care worker takes a swab from Narcizo, 64, inside his house in Xochimilco on the outskirts of Mexico City. Mexico is testing about seven people per 100,000 compared to 130 per 100,000 in Canada. (Edgard Garrido/Reuters)
It’s a decision that has confounded public health experts. Currently, Mexico is testing about seven people per 100,000 people in a country of approximate 129 million people, according to data compiled by Oxford University-run Our World in Data. The United States, by comparison, tests about 214 per 100,000 in a country of 330 million people, and Canada, with a population of roughly 38 million, tests about 130 per 100,000.
On Friday, the World Health Organization said the scale of the pandemic in Mexico is “under-represented” and that the country is seeing a significantly higher impact in poorer and indigenous communities.
“More could and probably needs to be done to really address the surveillance issues and the differential outcomes for patients and different groups,” said Mike Ryan, executive director of the WHO’s health emergencies program.
WATCH | In Mexico, case and death numbers don’t reflect the full scale of the crisis, says Mike Ryan of the WHO:
Coronavirus deaths among the poor and Indigenous people of Mexico are sharply higher than for wealthier people, says Mike Ryan of the World Health Organization’s health emergencies program. 1:43 A political gamble
From the beginning of the pandemic in March, Mexico’s president, Andres Manuel Lopez Obrador, has also argued that widespread testing isn’t necessary. He has continued to hold public events and refuses to wear a mask.
Like U.S. President Donald Trump and Brazil’s Javier Bolsonaro, AMLO, as he’s known, has dismissed the severity of the virus and highlighted the economic cost of quarantines.
“Early on, he held up a sort of a little prayer card and a four-leaf clover that had been given to him by a migrant and said that these things will protect him from the virus,” said Gladys McCormick, an associate professor in history who studies Mexico-U.S. Relations at Syracuse University in New York state.
McCormick said the Mexican government’s approach has been haphazard but that the government had to balance the pandemic response with a precarious economy. The challenge: close to 60 per cent of the workforce is classified as informal — labourers and vendors working in sometimes unregulated businesses without a safety net.
“The logic from the Mexican government was to basically hold off until they could no longer and then impose quarantine measures, knowing full well that individuals in the informal economy wouldn’t necessarily be able to abide by social distancing or staying home, in part because they needed to be out to be able to make a living,” McCormick said.
Thousand of students sit for an admission exam for UNAM held inside a soccer stadium in Mexico City because of the pandemic. (Hector Vivas/Getty Images) The hidden toll
McCormick says some state and local governments are trying to tackle the virus on their own. In Mexico City, for example, the mayor has set up testing kiosks in the worst-hit areas.
A recent study of excess mortality suggests that between the end of March and the beginning of July, the number of excess deaths when compared with the same period last year is more than three times higher than the number of COVID-19 deaths reported by the Ministry of Health in that period.
That hidden toll, experts say, could be the result of inadequate testing but also a population with a deep-seated fear of doctors and the health care system. Some people are waiting until they’re very sick before seeking treatment or dying before they ever make it to hospital.
“That distrust [of the medical system] really can go all the way back to colonial times,” McCormick said. “Then there’s also this fear that medical personnel, such as nurses and doctors, are carriers of the virus.”
In a survey taken last month, close to 70 per cent of those surveyed said they’d be reluctant to take a loved one to the hospital because they don’t think it would be safe.
A broken health care system
Adding to the fear is a reality that the level of care available to many Mexicans outside the private system is inadequate at the best of times, said Dr. Mandeep Dhillon, a Canadian who works in the emergency room at Hospital General Regional de Orizaba, about four hours east of Mexico City.
A health care worker talks with a woman waiting for a COVID-19 test at a public hospital in Monterrey. (Daniel Becerril/Reuters)
“People don’t receive the care that they need or deserve, I think that’s a constant,” said Dhillon.
She says a lack of personal protective equipment, medicine and other equipment has thwarted her and her colleagues’ efforts to fight the virus. Those problems were made worse by the lack of testing and medical staff themselves falling ill, including Dhillon.
“Things could have been done a lot better at every level, from federal down to state, municipal and even at individual hospitals,” she said.
She says the lack of testing has left health care workers fighting in the dark as they try to stop the spread of the virus.
“It doesn’t allow us as health care workers to actually have an idea and predict how to best organize ourselves in terms of providing care.”
WATCH | Isabel Vazquez describes her mother’s struggle with COVID-19:
Mexican officials say COVID-19 cases are on a “sustained decline,” but the country has the world’s third-highest death toll globally, and there are concerns that thousands of people aren’t getting tested or treated. 2:21 The social divide
Studies looking at the impact of COVID-19 on vulnerable populations in Mexico reveal the toll this takes. One study found that COVID-19 is three times more deadly for a patient in a government-funded hospital than in a private one.
It also found a 40-year-old with serious COVID symptoms in a public hospital is as likely to die as an 80-year old in a private hospital.
“Perhaps it could be a lack of equipment, lack of medications, a lack of care, or that patients themselves also wait too late, but that is nevertheless a damning statistic of how it breaks down by class,” McCormick said.
Dhillon says she thinks the government should have done more to ensure those who contracted the virus stayed home and quarantined.
“I think we could have mobilized a lot more resources during these last couple months to allow people to stay home when they were sick or were in contact with someone who was sick … and that hasn’t happened.”
A woman and her daughter in Mexico City wear masks to guard against the spread of the coronavirus. The country has close to 560,000 confirmed COVID-19 cases, but the WHO fears that number might not reflect the true toll of the disease. (Irene Barajas for CBC News)