Caracas Chronicles

Photo: Sofía Jaimes Barreto.

Coronavirus is officially a pandemic now. Over 160,000 cases have been reported in 140 countries. The situation in Europe, particularly in places like Italy and Spain, is starting to look more and more like a scene from Contagion, and the disease has already reached most of the world—including, of course, Venezuela. The strategies to fight the pandemic vary considerably between territories and doubts arise as to what’s the best way to proceed. Sadly, we’re sailing uncharted waters and mistakes will be made, even by the most prepared governments.

The one thing most positions share is the intention to “flatten the curve” of the disease spread by reducing the probability of transmission from infected individuals to healthy ones (they’re trying to control the number of people getting infected during a particular period, so the simultaneous number of cases in a population is small enough to be properly handled by health services). The World Health Organization (WHO) and health authorities across the globe so far recommend frequently washing hands with soap or hand sanitizer, self-isolation, and social distancing.

While the first two strategies are straightforward and relatively easy to implement, social distancing refers to any measure meant to reduce the exposure of healthy individuals to infected ones. In practice, this means canceling large events, working from home and shutting down schools, malls, bars, and eventually supermarkets and stores in general, anything to limit the time people spend away from home. While this is effective in slowing down the progression of the epidemic (therefore, flattening the curve), it’s also a strategy with its own limitations.

The benefits of social distancing are unquestionable, but the measure is not a silver bullet.

Social distancing, coupled with testing of asymptomatic patients to detect carriers, has proven to be very effective in the management of the epidemic in South Korea. In mid-February, a patient who had been presenting symptoms for days, spread the disease through a religious group in the city of Daegu, triggering an outbreak that kick-started cases from 30 to 5,000 two weeks later. South Korea, however, has tested over 200,000 people, identifying many patients before they develop symptoms, a key factor in limiting further contagion.

The benefits of social distancing are unquestionable, but the measure is not a silver bullet. Italy recently became the country with the highest number of cases and deaths outside mainland China; on January 31st, a couple of Chinese tourists in Rome (a husband and wife in their 60s) became the first patients, which then led the government to immediately suspend flights from China and declare a state of emergency. 

An independent transmission cluster, apparently initiated by a patient who remained asymptomatic for weeks, was detected on February 20th, in northern Italy. Two days later, the government quarantined 11 municipalities and suspended public events and most commercial activities. The initial measures failed to contain the epidemic, which reached more than 7,000 cases by March 9th, forcing the government to strengthen restrictions and expand them to the whole country. As of March 15th, Italy had reported more than 21,000 cases and over 1,400 deaths.

It’s clear how some of these measures mean a severe disruption of the normal functioning of society and are, therefore, very hard to maintain for long periods as people just won’t be willing (or able) to comply with them indefinitely. Not to mention the huge economic impact this all might have.

This reasoning has led the United Kingdom to take a much more controversial approach. 

It’s clear how some of these measures mean a severe disruption of the normal functioning of society and are, therefore, very hard to maintain for long.

Although some social distancing measures have been taken (universities switched to online classes and large gatherings and sporting events have been suspended since last week), the approach has been considerably more relaxed than the measures taken in other European countries.

This has been so far justified by the assumption that exposure to the virus creates a certain degree of immunity, something supported by early animal models, but not confirmed in humans. The idea is that if you manage to create immunity in part of the population, you would be reducing the chances of those still susceptible to get sick. This concept, known as “herd immunity,” is usually achieved after public health vaccination campaigns. Testing it with a novel virus is very risky, as harshly pointed out by WHO spokespeople and several scientists.

There is, however, some logic behind this approach. Social distancing can’t be maintained indefinitely and, by definition, it doesn’t contribute to herd immunity—once lifted, the epidemic could just reappear. Also, adopting this strategy too early could lead to “self-isolation fatigue,” with people ignoring it as the epidemic reaches its apex. Some projections also indicate that early interventions don’t necessarily translate into better results if they can’t be sustained. 

Computer models now suggest the UK is approaching the peak of transmission, a critical point where tougher measures must be enacted. The rapid increase in cases and deaths during the weekend, however, forced the government to adopt some actions this very Monday; in a press meeting earlier today, Prime Minister Boris Johnson informed that people with the slightest suspicion of being sick, as well as their families, should stay home for at least 14 days. He also announced that gatherings, big or small, should be avoided, including those at cinemas or pubs, adding that although the government has the means to enforce these measures, they’re confident that it won’t be necessary. He took the time to ensure the population about the help to overcome the economic strain that this will put on them.

The UK’s stance has so far been based on assumptions, a risky approach that will show results in upcoming weeks.

Closing schools, another tactic taken by many countries (Venezuela included), won’t be imposed in the UK yet, although Johnson’s advisors said that moment will come soon. The reluctance to close schools is based on the apparent minor role that children play in the transmission of COVID-19 compared to the flu, and the additional strain the measure could impose on those healthcare workers who would have to take care of their children at home.

The UK’s stance has so far been based on assumptions, a risky approach that will show results in upcoming weeks. The country has confirmed 1,551 cases and 53 deaths so far.

In Venezuela, uncertainty rules as 17 coronavirus cases have been confirmed. Nicolás Maduro’s regime has adopted airport checks for a couple of weeks now, an approach that, although reassuring, is now seen as pointless due to its inability to catch most infected patients, as it actually occurred: the first two cases in Venezuela entered from Europe, going through temperature controls without problems. 

Following the detection of the virus in Venezuela, Maduro announced that flights from Europe, Colombia, Panama, Iran and the Dominican Republic are suspended, effectively isolating the country from the outer world. All passengers from flight 6673 from Iberia, where the two original cases arrived, were also ordered to quarantine, while local transmission in the country has been confirmed. Social distancing measures are also in place, with schools and most university activities suspended, and movie theaters and parks being shut down. In a recent broadcast, Maduro announced a lockdown in seven states: Caracas, Miranda, La Guaira (formerly Vargas), Zulia, Táchira, Apure and Cojedes, where all non essential economic activity will be halted.

Guaidó’s government lacks the operative capacity to actually rule, much less tackle a pandemic.

Considering Maduro’s horrendous track record, this is a somewhat logical approach, for a change. Nonetheless, the government has done nothing to tackle the elephant in the room: Venezuela lacks the health infrastructure needed to face a pandemic, and this is the result of 21 years of massive corruption and mismanagement.

A day before the first cases in Venezuela were reported, Maduro said he had received a Cuban medication to treat the disease. The drug, Interferon 2ab, although used in China, has no proven activity against the virus and isn’t part of any treatment protocol. 

Furthermore, although the government has designated 46 hospitals throughout the country as “sentinel hospitals” to treat COVID-19 patients, most of them don’t even have a steady service of running water. Another concerning aspect is Venezuela’s limited testing capacity, where all samples collected across the country must be transported and diagnosed by the National Institute of Hygiene, in Caracas. Limited testing has proven to be a major obstacle to the proper control of the disease, even in developed countries such as the United States.

The regime has also ordered cleaning Caracas’ subway system, a good measure that must be sustained in time to be effective. Using surgical masks is mandatory to board trains and enter supermarkets, but given the prohibitive cost of these supplies for the vast majority of Venezuelans, people have been instructed to make their own even when these handcrafted masks offer no protection against the disease.

On the other hand, Juan Guaidó’s caretaker government appointed a commission of Venezuelan health experts to help devise a strategy against the disease, and asked Maduro to let the humanitarian aid collected abroad to enter the country and be distributed across local hospitals. The situation highlights an uncomfortable truth for the opposition, recognized by most of the world: Guaidó’s government lacks the operative capacity to actually rule, much less tackle a pandemic.

As pointed out before, Venezuela is extremely vulnerable to a COVID-19 outbreak and the structural problems of the Venezuelan health system are way too deep to be quickly solved during this pandemic. A good first step would be guaranteeing basic conditions (running water and soap) and supplies to health centers, as well as cooperating with private labs to increase testing capabilities in the short term. while keeping social distancing in place.

The fact that the most developed countries in the world are having a very hard time fighting the disease makes the prospects of the crisis-stricken nation much grimmer.