Caracas Chronicles

Venezuela’s tiny diagnosis capability was identified as a critical weakness when facing the COVID-19 crisis long before the virus reached the country. Only two labs, both in Caracas, must process PCR samples coming from all regions, while provinces facing widespread gasoline shortages add an extra strain to a process already prompt to delays.

The result of this equation is that people outside Caracas are dying with COVID-like symptoms and, since the results often are unavailable at the time of their deaths, they’re not included in the official death toll presented by the authorities every night. This is what Isayen Herrera’s recent article, in investigative outlet ArmandoInfo, just revealed.

By August 10th, the Venezuelan government had officially acknowledged 229 deaths, nationwide, attributed to the new coronavirus. In her report for ArmandoInfo, Herrera found that two weeks earlier, only two hospitals, in Maracaibo and Barcelona, had already registered at least 283 suspicious deaths. As of August 7th, only 65 of these had received confirmatory diagnosis before dying, and were therefore included in the official figures.

This kind of underdiagnosis doesn’t affect Venezuela exclusively and it’s certainly possible that not all these deaths were caused by COVID-19, since respiratory infections were already a leading cause of death worldwide before the pandemic.

Even though COVID-19 is included in the death certificate as a probable cause, these cases are not taken into account by the Ministry of Health’s statistics.

The World Health Organization has recommended including suspected cases in official reports, but this has not been applied universally. The United Kingdom and Belgium, as well as some states in America do so, Spain doesn’t.  Colombia accounts for suspicious cases, but they’re kept in registries different from confirmed ones. 

The situation in Venezuela is particularly problematic, with the delays in results. According to ArmandoInfo’s report, results can take up to 18 days to be delivered. Therefore, the Venezuelan Medical Federation instructed doctors to assume that all deaths caused by respiratory failure should be considered to be caused by COVID-19 until proven otherwise. But as Herrera describes in her post, even though COVID-19 is included in the death certificate as a probable cause, these cases are not taken into account by the Ministry of Health’s statistics, so nobody knows for sure what happens when positive results of deceased patients are eventually received. They should be retrospectively included in death tolls, but they’re apparently not, since daily reports, rather than consolidated weekly or monthly figures, are the only ones available.

As tirelessly repeated by Dr. Julio Castro—an Infectious Diseases specialist and the National Assembly’s Health Advisor—and by the National Academy of Sciences,  the only way to tackle this problem is increasing testing capacity and reducing the time doctors must wait to get a confirmatory diagnosis. This is possible, since several university and private labs around the country have the capability to run the required PCRs, but given the government’s historical unwillingness to share epidemiological data openly, it still seems like an unlikely scenario.

You can access ArmandoInfo’s report here.