Caracas Chronicles

Photo: Kennyjo.

At this point, the center of the COVID-19 epidemic has been Europe, which is where most cases are—and from where the virus spread to pretty much every corner of Earth. This means that most research on how to tackle the epidemic has been based on the experience of highly developed countries with some of the best health systems in the world, ignoring that conditions in low-income countries, especially in Africa and Latin America, might be very different.

This is exactly the point of a group of authors from the London School of Hygiene and Tropical Medicine’s Centre for Health in Humanitarian Crises (where I’m currently studying medical parasitology). The group identifies a series of conditions that make COVID-19’s behavior unique in underdeveloped countries: large household sizes, poor access to running water, weak health systems, comorbidities such as undernutrition, tuberculosis, and HIV. Furthermore, strategies used in high-income countries, based on social distancing as the sole most important way to flatten the transmission curve, may prove unviable in lower-income countries, where vulnerable, export-based economies and largely impoverished populations might be fatally hit by their implementation.

Most of these conditions are present in Venezuela, a South American country that’s more similar to war-torn Sub-Saharan nations. 

According to the paper, it’s unrealistic to believe this kind of country can scale up diagnosis or intensive care capacity the way strong economies can.

According to the paper, it’s unrealistic to believe this kind of country can scale up diagnosis or intensive care capacity the way strong economies can. Similarly, to achieve a considerable reduction of transmission rates, social distancing measures require that most, if not all non-essential workers work from home. Although easy in paper, this presents a huge challenge for most undeveloped countries like Venezuela, for example, where a stable internet connection or even constant electric service are unreliable luxuries.

So what to do if our most effective interventions are not realistic? 

According to the authors, protect the most vulnerable.

This means focusing the limited resources available to shield people over 60 years old, with non-communicable diseases (cancer, diabetes, hypertension, etc.) or with co-infections such as HIV or tuberculosis. For this, susceptible individuals will likely have to be isolated from the rest of the population, and this can be done at a household-level (keeping a room for them alone), or at street or community level, designating a house or even sections of a particular settlement to be exclusively occupied by them. Thorough infection control measures could then be focused to protect these areas, reducing the proportion of patients who will require intensive care, while keeping overall costs sustainable.

So what to do if our most effective interventions are not realistic? 

This approach presents some pretty obvious ethical dilemmas though: the possible discrimination these groups may face, as well as the social impact of keeping loved ones apart from each other in the middle of a pandemic. However, in places like Venezuela, where the health system was already falling apart before COVID-19, and where no major improvements seem to be likely in the short term, it’s a strategy that’s worth discussing.

Nonetheless, the regime has been too busy complaining about how Twitter deleted a series of tweets where Nicolás Maduro recommended a homemade remedy to treat coronavirus, based on the recommendations of a quack. It’s worth mentioning that Aporrea, the pro-government blog that originally posted the recipe, has since published a disclaimer recommending treatment protocols approved by the World Health Organization. A group of scientists from the Venezuelan Institute of Scientific Research (IVIC) also published a statement debunking the use of alternative treatments for the disease, as well as other crazy conspiracy theories presented by Maduro last Sunday.