(above) Healthcare workers stand dressed in full protection gear during an inspection in La Paz, Bolivia, on 28 May before departing to the Amazonian region of Beni in a caravan of medical teams to help in the fight against the new coronavirus pandemic. Photograph: Juan Karita/AP

Bolivia in danger of squandering its head start over coronavirus
July 3, 2020 - Original article: The Guardian

Despite imposing an early lockdown, containment may be unravelling amid poverty, an underprepared health system and a bitter political standoff

Laurence Blair

When Pedro Flores and a group of fellow doctors arrived in the Beni, Bolivia’s tropical northern province, at the end of May, they knew the crisis caused by coronavirus would be severe. But what they found still left them shaken.

“The health system, public and private, collapsed,” said Flores. Many doctors in the regional capital of Trinidad fell ill. Other medical staff, terrified, locked themselves in at home or fled to remote farmhouses. As critically ill patients multiplied, the death toll began to climb.

“There were no medical supplies, there were no ventilators, no oxygen,” explained Flores, who was initially hired by a local cattle ranchers’ association and has since returned as a volunteer. “Here in Trinidad most people have a relative, a friend, a neighbour who has died. We’re in a health disaster.”

Since then, Covid-19 infections and deaths have proliferated – even in Bolivia’s western, highland half, which had been relatively unscathed. A regional human rights body expressed its “alarm” at hospitals leaving at least six patients to die in the street and fearful gravediggers turning away grieving families.

Latin America is now the global centre of the pandemic, with more than 2 million cases, at least 100,000 dead, and little sign of the regional curve flattening. Bolivia’s 33,000 confirmed cases and over 1,100 deaths to date are still dwarfed by neighbouring Brazil – where the same number are perishing from Covid-19 daily, and 1.4 million people have been infected.

But an underprepared health system, poverty and a bitter political standoff have worsened Bolivia’s belated encounter with coronavirus. The six intensive care beds at La Portada hospital in La Paz – the seat of government – are all full, said a doctor working there, who asked not to be named. “There’s not enough spaces and the patients die waiting.”

Bolivia, one of Latin America’s poorest countries, was among the region’s earliest countries to impose a strict lockdown, on 17 March. Jeanine Áñez – who assumed power last November after the leftist president, Evo Morales, was forced out of office – deployed soldiers in the street and along Bolivia’s high-altitude borders, leaving returning emigrants stranded at desert frontier posts.

“This gave us a magnificent result for a while,” said Virgilio Prieto, the national epidemiology chief. “We had great success until the end of April.” Daily new cases remained in the low dozens and clinics, scrambling to secure protective clothing and supplies, could just about cope.

Some scientists hypothesised that western Bolivia’s harsh Andean environment helped kill the virus, and that the physiological effects of altitude inoculated locals against the worst effects of Covid-19.

“It’s like having taken a preventative pill against this infection,” said Jorge Soliz, a professor at Laval University, Quebec, and co-author of a recent study. “High-altitude regions in Bolivia are 10 times more protected than the regions located closer to sea level,” Soliz argued, pointing to 1,900 cases to date in La Paz compared with 15,000 in Santa Cruz, a lowland city also home to about 1.5 million people.

But cracks soon began to show in Bolivia’s defences. Government grants for sheltering families took weeks to arrive – if at all. Many informal workers, who make up more than 60% of the workforce, started to flout the quarantine in order to put food on the table.

The interim Áñez government “failed to understand the day-to-day reality of many in the country”, said Ximena Velasco, a Bolivian political scientist at the University of Essex. “A lot of low-income families don’t even have the documents necessary to collect the money from the banks.”

As in Mexico and Peru, Bolivia’s bustling street markets and cramped commuter minibuses soon became Covid-19 hotspots. “People who are working in markets and transportation appear to be getting the virus at much higher rates and are passing it on to their clients,” agreed Calla Hummel, a professor of political science at the University of Miami.

(below) The interim President of Bolivia, Jeanine Áñez, donates blood in a mobile unit located in in La Paz last month. Photograph: EPA

A deeply polarised political situation has also weakened public willingness to obey the lockdown. Áñez has reluctantly agreed to hold a rerun of last November’s cancelled elections, originally scheduled for May, on 6 September – and is running as a candidate herself.

Politicians loyal to Morales’s Movement towards Socialism (Mas) have organised demonstrations to demand elections sooner and protest against the lockdown. This may have driven up the infection rate in places like Cochabamba, a highland Mas stronghold, Velasco suggested.

On 1 June, parts of Bolivia moved to a “flexible quarantine” with greater freedom for shoppers to circulate, only for the infection rate to accelerate still further to over 1,000 daily cases in late June. Bolivia’s top general, appointed by Áñez, is among those infected.

“We’re in this absurd struggle,” said Prieto, who accused the Mas-controlled congress of holding up increases to health spending and emergency funding for crisis-hit regions.

“We should all stop looking after our own interests, because the catastrophe that’s occurring in Chile and Peru, where people are dying by the thousands, will happen to us,” he warned. “That’s what frightens me.”

“If we keep fighting, the dead and the sick are going to pile up,” he added. “That way, none of us will get to vote.”

But critics also accuse Áñez of squandering Bolivia’s hard-won head start. “All the government said was ‘don’t go out,’ but they did nothing to equip the hospitals,” said the health worker at La Portada. “All they have done is steal.”

Áñez’s health minister was arrested in May, after it emerged that Bolivia had purchased 179 faulty ventilators from a Spanish company for vastly inflated prices.
And while Morales ramped up healthcare spending in his 14 years in power, Bolivia still has just 430 intensive care beds for its 11.5 million inhabitants: barely a third of the level recommended by the World Health Organization.

A lack of testing means Bolivia is fighting coronavirus blindfolded, lamented Flores, the volunteer doctor. “Right now we need to pull together and fight for life in Bolivia, and above all forget politics,” he added, “because this affects us all.”

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