Early on, Mexican officials were optimistic their strategy was working — and by some measures, it appeared to be. Mexico City recorded its first coronavirus case a day before similarly sized New York City. While New York has suffered more than 16,000 confirmed deaths, Mexico’s capital has reported about 3,000.
But now, as Mexico City hits what officials say is the peak of its outbreak, it’s facing an onslaught of cases with an understaffed and undersupplied hospital system. There is concern that the country’s death toll is far higher than the official figures.
The government originally projected 6,000 to 15,000 deaths nationwide, with a small chance they could rise to double that upper limit. By Monday, authorities had confirmed 10,167 deaths. López-Gatell has acknowledged that the catastrophic scenario of 30,000 fatalities is no longer remote.
“We hope there aren’t that many deaths,” he told senators last week. But he noted that Mexico is afflicted by high rates of obesity, diabetes and other conditions. “These chronic illnesses have a stunning effect on the death toll.”
Mexico’s government maintains that it is trying to balance public health concerns and the economic needs of the large low-income population. Critics say authorities failed to communicate the gravity of the challenge early on, and took a huge risk in not testing more of the population. Many worry whether the fragile health-care system can hold up.
The brightly colored graph displayed at López-Gatell’s nightly news conferences showed the capital’s hospitals at 80 percent capacity on Monday.
“We all ask ourselves if we can hold on,” said Ana Belem Castro, an internist at La Raza, one of the capital’s better public hospitals. “Or if there will be a point in which the number of patients becomes uncontrollable.”
The country tried an unorthodox strategy
Mexico reported its first case of covid-19 on Feb. 28. President Andrés Manuel López Obrador, a leftist populist, initially seemed to shrug off the disease. He said it was “not even as bad as the flu,” and attended rallies with throngs of supporters.
López-Gatell began meeting with López Obrador, explaining the intricacies of virus transmission in long afternoon walks through the Spanish colonial National Palace. He found the president receptive to his concerns.
“In no moment did he say, ‘calm down,’ or ‘for political reasons you can’t say this’ or ‘tone down the information,’ ” López-Gatell said in an interview. “This is very unusual in Mexican politics.”
López Obrador changed his tone to project a new seriousness about the outbreak. Still, the country embarked on an unorthodox strategy. The World Health Organization was urging mass testing for the coronavirus, to identify victims and their contacts.
López-Gatell considered that impractical. The United States had administered millions of tests and recorded more than 1.5 million positives. But in reality, he said, there were probably 12 or 15 million cases.
“You can’t count them all,” he said. Trying to trace contacts and isolate the ill in a country as big and poor as Mexico was impossible. “I’d be fooling the public if I said this was the right control mechanism” at the height of a pandemic, he said.
Instead, López-Gatell’s team watched data on suspected coronavirus cases from a sample of 475 medical centers across the country. On March 13, they noticed a jump in cases, from three to 11. “The curve was bending” upward, López-Gatell said. “We said, ‘That repertoire of measures we’d prepared for mitigation — let’s go.’ ”
On March 20, Mexico shut down its schools. Three days later, it closed offices, malls and most shops. Officials felt they’d kept the virus from spiraling out of control.
“We spotted the right moment,” López-Gatell said.
“Many of these deaths would have been prevented with an earlier response,” said Frenk, now president of the University of Miami.
Gustavo Cruz, a mathematician at the National Autonomous University of Mexico who models epidemics, said Mexico had “flattened the curve” more successfully than Spain or Italy. But new cases have recently been climbing faster than expected, he said, probably because people were ignoring the quarantine.
Mexico resisted an early, strict lockdown. More than half of the country’s adults work in the informal sector, as gardeners, plumbers, taco vendors. If they were forced to stay home too long, López-Gatell said, “this would cause huge disturbances.” The government declined to deploy security forces to enforce quarantines, as other countries have done, fearing clashes between police and the hungry poor.
Critics say López Obrador’s early dismissal of the coronavirus might have prompted people to flout lockdown rules. Cruz suggested another reason: They needed to earn money.
“These people surely had no way to survive beyond a few weeks,” he said.
‘At night, my goodness, it’s chaos’
Before the pandemic struck, Mexico City had 500 intensive-care beds — about one-third the number in New York City. Nationwide, there was a chronic shortage of doctors and nurses in the mostly government-run system.
Authorities launched a crash program to scale up.
More than 40,000 people were hired. Private hospitals agreed to take on thousands of patients for routine surgeries to free up the public system. The military and social security systems opened their hospitals. Beds were added in tent hospitals, a convention center, a racetrack.
Samuel Ponce de León studies infectious disease at the National Autonomous University of Mexico. Without the massive effort, he said, “the scenario would have been people dropping in the streets outside the hospitals.”
But Mexico’s health system had been weakened by years of underinvestment. It quickly showed signs of strain.
“We begged for face masks,” said Gabriela González de Cosio, an internist at a government hospital in Tlalnepantla, just outside Mexico City. Without decent equipment, she and 43 colleagues ended up infected.
At least 149 Mexican health-care workers have died of covid-19. That appears to be a smaller number per capita than in some countries, but a frightening blow to a fragile system.
There’s now more protective gear available, González de Cosio said, but staffing remains insufficient. “At night, my goodness, it’s chaos,” she said. Sometimes there are only two doctors on the late shift to handle 40 covid-19 patients, she said.
There aren’t enough monitors, so they’re moved between patients on ventilators. “We want to monitor them all constantly,” she said. “But we don’t have the equipment.”
The government says it has acquired enough ventilators. But a longtime doctor at the National Institute of Medical Science and Nutrition, one of Mexico’s most prestigious public health centers, said it occasionally ran out of them. Patients were then taken to other hospitals. Some didn’t make it, she said, speaking on the condition of anonymity because she was not authorized to comment.
“It’s traumatic seeing people die because you can’t offer them intubation,” she said.
Olivia López, Mexico City’s secretary of health, said she thought the hospital system would survive the coronavirus tsunami. “We are adding beds every day,” she said.
But no one knows how long the virus will besiege the capital . Rafael Lozano, of the University of Washington’s Institute for Health Metrics and Evaluation, said he didn’t envision the city hitting its peak for a few more weeks. The institute initially projected 3,400 deaths in Mexico City. Lozano said updated figures, due out soon, will be “much higher.”
Questions about the death toll
Officials acknowledge that the death toll is greater than the official numbers. As in many countries, Mexico includes only coronavirus fatalities confirmed with a lab test. But there are indications that the undercount could be greater than expected.
The civic group Mexicans Against Corruption and Impunity found that 4,577 death certificates filed in the capital in two months listed covid-19 as a possible or probable cause. Just one-third of those were confirmed with a test.
Critics say the government is hiding the real toll. The truth might be more prosaic. Mexican authorities have ordered testing of all patients with serious coronavirus-like symptoms. But “since there’s too many patients for the number of [health] personnel, sometimes the test isn’t done,” said Benito Alonso, an internist at the 20 de Noviembre hospital. And many patients die before a test is administered.
Death certificates that list “possible” coronavirus, based only on symptoms, are being sent to medical committees to evaluate. Separately, Mexico’s bureaucracy will estimate “excess” deaths — including people who couldn’t get treatment for other conditions during the outbreak. But that could take months.
López-Gatell said that it was too time-consuming to compile the full numbers at the height of an epidemic. Unless the real count is far higher than the official data, he said, “the number of deaths doesn’t change my decisions” on urgent matters such as ensuring hospital beds for the ill.
Some say Mexico is missing the opportunity to break chains of transmission. Nahid Bhadelia studies infectious disease at Boston University.
“How can you say you have a handle on an outbreak if you don’t know how many people are dying?” she asked.
López-Gatell says that authorities are seeing signs of a reduction in covid-19 cases in Mexico City. But outbreaks probably will flare in different cities in coming months, he said.
“We have to prepare for a long epidemic,” he said.
Gabriela Martínez contributed to this report.