WWhen Rufino Pacheco arrived at the hospital, with irregular breathing and wobbly legs, a doctor handed papers to his stepdaughter, asking him for permission to put him on the respirator. But the elderly patient hesitated.
Less than 12 hours later, Pacheco died, connected to an oxygen tank in his room, while his wife shouted, “Don’t leave me, old man”. Days later, she also fell ill with Covid-19, along with her adult son.
“There was a lot of tension and concern,” said Consuelo Vázquez of the time he spent caring for his mother and brother after the man she loved when her father left. “We thought we would go through the same thing.”
Each needed additional oxygen at times, and only after recovering could the family begin to suffer for Pacheco.
Not tested for Covid-19 and quickly cremated, Pacheco, who died on November 24 in the working-class city of Ecatepec, may never appear as one of the fatalities that are increasing in parts of Mexico – especially the capital and its suburbs – in the worst outbreak since the peak of summer.
For weeks, the authorities begged the Mexicans to stay home. Even President Andrés Manuel López Obrador, whose public statements rarely acknowledged the seriousness of the epidemic in Mexico, started the month by asking Mexicans to resign from the end of the year to December. But he refused to impose restrictions, declaring that Mexicans were “responsible, well-behaved and conscientious”.
The president’s soft touch highlighted what has been the essential contradiction in his government’s approach to coronavirus. Keeping bars, cinemas and malls open continuously undermines the message that people should go out only for the most essential activities.
He also said that many Mexicans cannot stop working. Instead of helping people to allow them to stay at home, however, the leftist president insisted on maintaining the austerity that governed his two-year presidency. His government has proposed the most basic of stimulus programs to deal with millions of new unemployed.
The result was devastating. Nearly 120,000 Mexicans died from Covid-19, although health experts at the National Autonomous University of Mexico, known as Unam, estimate the number to be two to four times more. Even the reported figures make Mexico one of the most lethal countries in the world for the pandemic, based on its population.
But the government’s approach has changed very little, even when cases – and deaths – began to rise in November.
Finally, the authorities gave in to reality and on Saturday ended most non-essential activities in Mexico City and the neighboring state of Mexico, home to the vast working-class suburbs that are among the areas most affected by the coronavirus.
Dr. Hugo López-Gatell, the deputy minister of health in charge of the government’s effort, admitted that the momentum of the epidemic requires “extraordinary measures”.
Exhausted doctors and nurses on the ground had known for weeks how bleak the image was.
“The failure to prevent contagion really hit us with this second wave,” said Dr. Belén Jacinto, an intensive care specialist at La Raza general hospital in Mexico City.
Wherever it turns, there is a shortage. In each shift, there is only one intensive care physician on duty to assist 15 patients in his ICU, attended by other doctors of other specialties.
There are not enough staff to turn ventilated patients face down, as recommended by the protocol, and monitor them to ensure that their breathing tubes remain in place.
“I told my bosses that intubated patients are almost – almost – put to death,” she said. “What service are we offering?”
The government hired new doctors, bought ventilators and increased the number of ICU beds since the pandemic began. But that is not enough. “You can’t increase your capabilities overnight,” said Dr. Alejandro Macías, who handled the government’s response to the 2009 swine flu epidemic. “All of these additional beds didn’t necessarily improve the outlook.”
Critics of López Obrador’s populist government argue that the pandemic approach was wrong from the start. “The Mexican government declared that testing was a waste of resources,” said Dr. Julio Frenk, a former health minister who is now president of the University of Miami. Mexico has one of the lowest test rates of any country in the world.
“The policy was to have enough beds,” he said. “The objective of the policy must be to control transmission.”
Part of the responsibility for testing lies with the states of Mexico, Macías said, and they have also failed to increase testing. The exception is Mexico City, where Mayor Claudia Sheinbaum offered free and widespread testing.
Dr. Samuel Ponce de Léon, who coordinates Covid’s response group at UNAM, said the government’s attempt to strike a balance between allowing people to work and containing contagion has failed. “More than half of the population belongs to the informal economy,” he said. “They have to travel and go to work to have money to buy food the next day.”
Faced with this reality, he said, the government’s incoherence in communicating basic protection measures against the coronavirus – starting with López Obrador’s refusal to set an example using a face mask – was difficult to understand.
“Social detachment is an impossible dream,” said Ponce de León, referring to the crowded public transport in Mexico City. “But we can minimize it with facial masks and hygiene.”
López Obrador’s insistence on maintaining austerity measures during the pandemic also surprised many.
The International Monetary Fund – no fan of uncontrolled public spending – recently asked Mexico’s leftist government to increase its support for families and businesses devastated by the deep recession caused by the pandemic.
Noting that Mexico had budgeted only 0.7% of GDP in additional health and social spending to tackle the pandemic, the fund said that Mexico should increase that amount to 2.5% to 3.5% of the country’s production, and make health a top priority.
For decades, Mexico has spent nothing on public health, lagging comparable economies like Colombia and Brazil. Many expected López Obrador to change that when he took office, promising to make aid to the poor the focus of his policies.
Instead, “Covid hit us at a very bad time,” said Mariana Campos, a public spending specialist from Mexico Evalúa, a thinktank. The López Obrador government cut the health budget in 2019, the third consecutive year of cuts. “We have the structural problems that we have always had and are getting worse since 2017”.
As the agitation in the capital begins to subside and the government turns its attention to the arrival of the first vaccines, Macías said the country is only halfway through the battle.
“If it were a football match, we would be in the 45th minute,” he said. The viruses spread faster in the winter and “I predict many more patients,” he said.