COVID-19 Global Perspective from Argentina
Dr. Flor Ledesma is a Family Medicine Specialist and Full Professor at the University of Zulia. As part of our COVID-19 Global Perspective Series, we reached out to Dr. Ledesma to hear how the COVID-19 pandemic is affecting Argentina.
What ways has your country's government responded to the COVID-19 outbreak and pandemic? When did you begin seeing a response?
COVID19 got to Argentina on March 3 through a traveler returning from vacation in Italy. For personal reasons, at the time, I had to travel to Venezuela. In the plane, I did not notice any change in the usual procedures, I did not know if I had to protect myself or not. During the week in Venezuela, I followed the news closely with great concern. More and more countries were closing their borders and international travel. Indeed, Venezuela closed its flights on March 14, the day of my return. Argentina followed and closed borders on March 15. I was lucky to be able to return just in time; currently thousands of people have not been able to come back. On my arrival to the Argentinian airport I observed more thorough health measures: a survey about previously visited countries and symptoms, a doctor at the exit of the plane with all their personal protective equipment, thermal cameras for temperature recording, maintenance of the separation between people, hand sanitizer, employees with chin straps and gloves, cancellation of flights from high risk countries, etc.
On March 7, the first death from this disease occurred in Latin America. On March 11, the WHO declared COVID19 as a pandemic. For people returning from a trip, it was “recommended” to do 14 days of self-quarantine. A few days after, this became mandatory. Moreover, it was also strongly recommended to do self-isolation for those over 65 years. Meetings of more than 200 people, religious services, cinemas, theaters, classes in schools and universities were suspended, sport events would be held without an audience and soccer, which has huge importance in the country, was suspended. Shopping centers were closed, train trips and long-distance buses were cancelled, and non-resident foreigners from high-risk areas were prohibited from entering the country, and paid time off was given to elderly, pregnant women and other populations at risk.
On its end, the government had declared a national health emergency and took measures accordingly. It announced the donation of medical supplies to hospitals and laboratories, construction of 8 modular hospitals and more than 500 therapy beds, financial aid to vulnerable groups, loans at low rates of interest, price control and tax reforms.
On March 19, with 10 people infected and 3 deaths, social isolation was announced throughout the country. Exceptions were made for pharmacies, supermarkets, health centers and service stations, and only essential trips were allowed. On March 21 there was the first applause to the health workers.
During the next 10 days, more than 16,000 people were arrested due to non-compliance with the isolation measures. Return flights of thousands of Argentinians that the pandemic took by surprise are closed. More aid for unemployed workers and stimulus payments to workers in the health and safety sector were announced.
News related to the testing of the disease appeared for the first time on the twentieth day, up to then, coverage on this topic had remained centralized and limited. Testing kits for private laboratories and authorization of different testing systems was approved by the control agency of the country. On March 25, it also announced the purchase of half a million reagents. Moreover, the country recognizes its slow detection of cases and the impact on the decisions to be made. On March 29, the quarantine was extended until April 13. The use of face masks has been implemented in the community and instructions are given for their homemade manufacture.
Additionally, in order to respond to all the needs derived from this pandemic, the Ministry of Health issues weekly protocols with recommendations for the care of pregnant women, adolescents, LGBTQ+ groups, cancer patients, and renal, hepatic, and mental patients. Moreover, it continuously issues recommendations for telecare in intensive care and support guidelines in mental health and protection of health workers. Recently, guidelines for the management of dead bodies in cases of COVID 19 were published.
Today, April 13, we have 2,277 cases, 98 deaths, 295 tests per million inhabitants. Currently, the mandatory quarantine has been extended until the end of the month of April.
How do you anticipate your country's health systems will be impacted? What are you and your institution doing to prepare for COVID19?
Medifé is a private medical insurance company where I work. It has 280 thousand affiliates, mostly workers. They receive medical attention in more than 25,000 health providers throughout the national territory, including treatments for oncological and chronic diseases, mental health, dentistry, kinesiology, optics, home care, emergency and disability care.
At the time of this epidemic, the company was undergoing a major transformation with the integration of two business units. On top of that, we faced the need to maintain services remotely and incorporate telework. Therefore, they were days of a lot of activity, effort and cooperation to keep the company afloat, transferring most of the efforts to online. We created WhatsApp groups and Team calls and each team rearranged their functions and roles. The telemedicine platform was reactivated incorporating more doctors, achieving a 2000% increase in teleconsultations. We created a system to issue prescriptions for digitally. Additionally, we suspended authorizations for elective surgeries and diagnostic procedures. Mental health care is preserved as a positive containment mechanism.
To anticipate the development of the pandemic, we review the behavior of the epidemic in different countries, and the behavior of previous epidemics. We chose the German model to estimate the behavior of cases in our population. Based on it, we made cost estimates of hospitalization and intensive care units. Nonetheless, the provision of medicines, which was centralized by the government, is still unclear. On March 17 our first affiliate tested positive. Today, April 8, after 22 days, we have 98 suspected cases, 18 positive cases and 2 deceased who had important risk factors. This information is transmitted to all employees daily, as well as the measures that are being implemented.
In what ways will your country/city/community be uniquely affected that differs from other places in the world?
Argentina is a country where only 33% of the population has free public assistance, 63% is part of the social security system, which includes the National and Provincial Social Works, the PAMI (Retiree and Pensioner Care Program) and the 3% is affiliated to a prepaid medicine company.
Internally, the different health and the economy sectors dialogued and made decisions together. They have the same objective, determined by all areas of government, national and province: "privilege life over the economy." This has been a fundamental change. Today we know what the weaknesses are in the infrastructure of the public and private health system as well as the gaps in how many beds and professionals are required in a state of emergency, and we have made simulation and impact exercises. A centralized communication system for professionals and the community in general has been established from the Ministry of Health of the Nation, which has allowed to have a unified guideline about the measures taken. This type of collaborative work between the sectors and the community has been a notable change. However, there is no certainty of the capacity of the different sectors to execute them.
On another topic, the country's scientists have not opted for mass testing or the group immunity model to stop the spread of the virus. Instead, they have decided to maintain confinement as a measure to slow the growth of the curve, while in Chile and Brazil they are betting for the opposite approach. We do not know what effect this discrepancy of measures and those of neighboring countries will have for Argentina.
It is also important to highlight the partial paralysis of primary health care, care for chronic diseases, vaccination, disability care and home care. These situations deserve adequate attention and solutions - we should have been prepared for this. Moreover, the proper attention of them could represent an important factor containing the curve of serious cases of COVID19.
Another aspect is the proximity of winter that puts us in a situation of greater risk when coupled with the usual seasonal influenza epidemic.
What are people doing locally to build support for their most vulnerable community members, neighbors, and family members?
In general, the community rates as positive the measures imposed and has complied. Surveys reveal that 95% of people are afraid of getting infected.
Remote work and telecommuting have been quickly set up.
The daily applause continues to be heard every night from the balconies. Social media is full of quarantine jokes, videos about nature, reflection messages, as well as nostalgic, crazy, religious and apocalyptic posts. All day, news is related to COVID19. Home services, online shopping, family games, television series save leisure time.
NGOs and private companies stimulate donations to serve the most vulnerable sectors of the population.
"On important issues we are united," is the message transmitted by the president. In Argentina, a country that has lived long periods of social and economical instability, a phrase like this is undoubtedly historical.
What have you seen happen in your community that gives you hope or solidarity for positive outcomes?
Argentina has great potential: it has important natural resources and a capable and critical population of great cultural diversity. It is a solidary country that has welcomed us, migrants from Venezuela and many other countries, with great openness and inclusion. This crisis has revealed many potentialities in the most of sectors such as:
- Social measures have taken to prevent layoffs are enacted daily, rent increases are delayed, and evictions are prohibited.
- There are calls to incorporate more health personnel and investment in the provision of personal protective equipment.
- Schools and universities incorporate distance education impressively quickly. Teachers and students maintain daily communication to continue the school year.
- Decentralized labor relations have changed the way we relate to our colleagues; we must be flexible in order to adapt without losing the warmth of personal interaction.
- There has been an increase in the number of online courses focused on virtual communication, teleworking, and crisis leadership.
- Large companies are using their social networks to disseminate information about the pandemic. They transmit both official news and information to bear with the psychological effects of quarantine in the community.
- In families and neighborhoods, we are learning to take care of ourselves and our neighbors, especially older adults. We hold back on shaking hands or hugging each other, because we know it is in everyone's best interest to stop the spreading of the disease. We are also learning to use our personal time in other activities and to stay connected through distance.
- Death is present every day, each country counts its deceased in its own way, fatality rates cause a whole public debate, but little is said about how it is lived by those who say goodbye in a hospital bed alone, without their dear one. These are new topics for current medicine and the impact on mental health in the future. We are interested in how they are experiencing the crisis in different parts of the world.
- This crisis will change our ways to adapt to stressful events. It will foster creativity, change everything from businesses to the way we relate and support each other. This crisis will make us more cautious. We will learn to anticipate, to always work one step ahead. It will teach us to have a more global or holistic view of the world, it will promote developments in communication and information technologies in different fields. In short, there is certainly hope that there will be positive changes.
Why is it more important now than ever before to collaborate with global partners?
Within Argentina, this pandemic has shown that there are measures, changes and resolutions that can be implemented in a more straightforward way when social interests are considered before the economic and political ones. This is only possible if there is global thinking from all the different sectors; if everyone sees “the big picture”.
In the region, it is important that countries work together on actions to return to activities after the end of quarantine. In Latin America, each country worked in isolation and revealed how political positions prevail over the collective good. This crisis requires rethinking technical cooperation agreements, in joint purchases of supplies, in the exchange of experts and expertise, in the support in the generation of the vaccine and the development of research in medicines and other prevention measures. All in the spirit of accessibility and equity.
On the other hand, international organizations need to make efforts to regain confidence in the world, their actions sometimes raise doubts about the discretionary and political handling of information since the start of the pandemic, which has triggered significant criticism of the actions and the times that were used to implement the measures to contain the epidemic.
The increasing development and complexity of international relations have the potential to carry out actions that favor the coordination of public policies and joint efforts to achieve common objectives for the well-being of people and the economic sustainability of their people.
COVID-19 Global Perspectives
Our COVID-19 Global Perspectives Series features insights and updates from our global health partners around the world.