Bloomberg Línea — The festive season resulted in an avalanche of new Covid-19 infections and, in some countries of Latin America, the situation has been exacerbated by the difficulty of accessing tests following governments’ and health authorities’ advice to avoid large gatherings.
Even before 2021 had ended, Argentina recorded the highest number of infections since the start of the pandemic with 42,032 positive cases reported on December 29, according to the Health Ministry. And on January 6 the country surpassed 100,000 cases in 24 hours for the first time, before surpassing 110,000 the next day.
Mexico surpassed 15,000 daily cases for the first time in four months on January 4. According to the Health Ministry, estimated active cases rose by 273% between December 21 and January 4. Four days later a further 30,000 cases were reported, surpassing August’s record and the peaks of the pandemic’s first and second waves.
The level of testing varies from country to country across Latin America, according to limitations and each country’s strategy. However, the common factor emerging is the weakening of public health services due to the high demand provoked by the arrival of the Omicron variant.
And with the public sector the most overwhelmed, the most affected are low-income citizens.
Mexico’s Public Hospitals, Pharmacies and Laboratories Overwhelmed
Mexico began the year with particular difficulties in access to free tests in two hospitals in the capital and neighboring Mexico state, where the highest accumulations of cases have been reported throughout the pandemic.
People have flocked to public health points to take a test, having to wait in some cases for up to five hours or more, and even then only if they manage to get one of the 50 turns available before the clinic opens. Otherwise they are forced to search for an alternative clinic, which could take all day.
Drugstores and private laboratories are not exempt from the overcrowding, where there are also long lines of several hours to purchase a rapid test, and which costs an average of between $13.20 and $22, respectively. Some pharmacies have even set up an appointment-based system to avoid longer queues. In several attempts to contact a private laboratory chain by telephone, the message was that “there are a limited number of operators available due to the health contingency”.
Amid the overwhelming demand, Mexico City’s Health Secretariat extended opening hours at 117 health centers from January 4 and pledged to replenish supplies to double the increase the number of tests to 23,400 per day. In addition, free testing modules were reactivated in eight malls in different parts of the city.
“In the last week we have increased on average the number of free tests in Mexico City by 150%, performing almost 23,000 tests on January 7 compared to 7,000 the previous Friday,” Eduardo Clark, who is in charge of technology at the Mexico City government, told Bloomberg Línea.
City authorities said the reopening of the so-called Covid-19 macro-kiosks, where mass testing can take place, in the municipalities with the highest levels of positive cases and demand, as well as the use of self-application tests through nasal scraping.
In Toluca, capital of Mexico state, which is the state with the second highest number of cases in the country, the population is also struggling to procure tests, with appointments given up to three days after being requested, according to the Quadratín news portal.
Demand for tests is also outstripping supply in the states of Sonora, Guanajuato, Chihuahua, Zacatecas, Tabasco, as well as in the states most popular with tourists, Yucatan and Quintana Roo, while each state has different strategies for test enforcement.
Since the onset of the pandemic, health authorities’ strategy has been to apply a limited number of tests, focusing on surveillance of people with major symptoms, arguing that there are other strategies to control the spread apart from mass testing.
Across Mexico, 122 tests are performed daily per million inhabitants, according to information as of January 1 from the Our World in Data platform of Oxford University, which collects data from official sources. In the United States, 3,957 tests are performed per million, in comparison.
According to the Gisaid platform, which promotes the constant exchange of coronavirus data, Mexico is the Latin American country where there is the highest number of cases of the new variant, followed by Argentina and Brazil.
Mexico’s President Andrés Manuel López Obrador, who tested positive for Covid for the second time since the start of the pandemic on January 10, has rejected claims that the country is now in a fourth wave of Covid, as claimed by the head of the capital city’s government, Claudia Sheinbaum. López Obrador has said that, although infections are increasing, hospitalizations and deaths are not.
So far, the government has not admitted to a shortage of tests. Bloomberg Linea asked the federal Health Ministry for an estimate of the number of tests available in the country, but no response was received.
48 Hours for a Test in Colombia
Health authorities in Colombia’s capital Bogotá have not admitted to a shortage of available tests either.
Only the health authorities of Cali, a city in the west of the country, have publicly stated there is a test shortage, and warned about the high number of cases in that city. “I want to announce that today we ran out of supplies for testing at this point and some other points of the city. We regret the inconvenience and we are working to provide the service to the community,” Miyerlandi Torres, Cali’s Secretary of Health, said on January 3.
While Colombia’s Ministry of Health says the provision of free tests depends on the district authorities and these in turn, at least in Bogotá, say the issue is the responsibility of private clinics IPS and the country’s social security administrator EPS, since the end of 2021 in Bogotá there have been lines stretching for blocks from the early hours in order to obtain a free test.
Colombians have two options to take a PCR test: at district health authority clinics and private laboratories, with the latter charging around $70 for a PCR test, while the antigen test costs around $30. Two private laboratories confirmed to Bloomberg Línea that the number of tests applied has increased, but that the increase is due to the travel season and the requirements for departure and entry into other countries.
Alexandra and Mario, a couple in Bogotá with a headache and general malaise, told Bloomberg Línea they queued for two days to take the test, but after several hours of waiting the clinic informed them that they had run out of tests. Over the following 48 hours they visited several points of the city, traveling in cabs and public transport, until they managed to get a test. They both tested positive and now wonder how many people they may have infected during their search for a test.
The Colombian government said last September it aimed to perform 50,000 tests per day. And on January 5 and 6, a total of 100,000 tests were performed each day, compared to an average 50,000 per day in December.
In view of the peak in infections and the high demand for tests, on January 7 the Ministry of Health said it would prioritize tests for people with symptoms and at greater risk.
Secrecy Surrounding Tests in Venezuela
Since President Nicolás Maduro’s administration acknowledged the first case of Covid-19 in March 2020, the government has been the sole provider of PCR tests.
The laboratory of the National Institute of Hygiene Rafael Rangel (INHRR) was the only one authorized to give tests until July 2020, until the government authorized the Venezuelan Institute of Scientific Research (IVIC) to also offer testing amid warnings by experts and academies concerning the unrealistic number of infections, which they attributed to the centralization of tests.
By the end of 2020, a handful of private laboratories in Caracas were offering rapid and molecular tests to detect the virus.
The approximate cost for each PCR test with results in 24 hours is up to $80. Although there was no endorsement of the use of such tests, they were accepted at the Simón Bolívar International Airport in Maiquetía, as well as those applied by INHRR, specifically for travelers, free of charge. Those tests were suspended in August, however.
After the decentralization process, there were fewer complaints about the impossibility of accessing PCRs in the country. The population that could not access paid-for tests was asked to go directly to the field hospital installed by the Maduro government in Caracas, or to one of the CDI diagnostics centers. Those centers only exist in Caracas, however.
Secrecy surrounding the number of daily tests has been maintained and since April 2021, the Ministry of Health stopped informing of the figures, according to Médicos Unidos por Venezuela, which by May placed the number at just 2,000 daily tests.
Flor Pujol, an IVIC virologist, says that although the number of tests and cases has decreased, this could change with the arrival of the Omicron variant.
Avoiding Collapse in Argentina
In Argentina, health authorities’ main concern is not the number of deaths and hospitalizations, but the levels of positive cases, which in recent days has exceeded 50%. That is to say, one out of every two people who are tested - the percentage is somewhat higher - test positive. This has led to a collapse in the testing centers, and has led the Ministry of Health, together with the Federal Health Council, to draw up new guidelines to resolve the issue.
The government informed on January 6 that no direct contacts will be swabbed, whether they present symptoms or not, and instead those persons should self-isolate for five days.
“It is not strictly necessary to perform a test to confirm diagnosis, since, given the high viral circulation, confirmation can be established by a clinical and epidemiological link,” Health Minister Carla Vizzotti said, adding that “in the event that the person has had close contact with a confirmed case, but has no symptoms, the corresponding isolation should be undertaken, but testing is not obligatory”.
Amid the peak in demand for swabs and the record number of infections, the National Administration of Medicines, Food and Medical Technology (Anmat) approved in the first week of the year the exclusive sale in pharmacies of the four coronavirus self-testing kits: Panbio COVID-19 Antigen Self-Test, SARS-CoV-2 Antigen Self Test Nasal, SARS-CoV-2 Antigen Rapid Test, and the WL Check SARS-CoV-2, with prices ranging between 2,000 and 2,500 Argentine pesos ($19.30 and $24).
Nicolás Kreplak, health minister of the province of Buenos Aires, said: “any diagnostic procedure and also medication that is freely available has a particularity: it is segmented in terms of who can access it and who cannot, and some control is lost”.
The Confederation of Argentine Biochemists criticized the application of these samples, considering them inconvenient because “they have no diagnostic value” and “do not ensure the traceability chain, the reliability of the result, nor the corresponding epidemiological report”.
Lengthening Queues and a Data Blackout in Brazil
The official tally of case numbers in Brazil has not kept up with the real pace, which now points to a spike in infections. While the country is trying to get out of a “data blackout” by the federal government, with the failures of the official system, the Conecte SUS platform that serves as a communications bridge between the public and health authorities, private laboratories and pharmacies have not been able to account for the jump in the demand for tests, while queues are growing at public clinics.
“There is a silent Omicron pandemic in Brazil,” Pedro Hallal, an epidemiologist and professor at the Federal University of Pelotas, told Bloomberg News. “There is not enough evidence or official statistics to show by how much the number of infected people is growing.”
Rio de Janeiro has installed seven healthcare centers at strategic points in the city to lessen the burden on hospitals and clinics. Despite this, there are daily reports of long queues and many hours of waiting for tests.
The city of São Paulo has expanded the service and application of rapid tests in basic health units.
Across the country, pharmacies have faced an increase in the demand for tests, with an “explosion in the number of positive cases,” according to the Brazilian Association of Pharmacies and Drugstore Chains (Abrafarma), which reported a 50% jump in the number of tests between the week of December 27 to January 2 compared to the previous week. The percentage of coronavirus diagnoses was the highest since the implementation of the service in April 2020.
In response to questions by Bloomberg Línea, an Abrafarma spokesperson said there is no official information on lack of testing other than reports of scheduling difficulties and high demand, something that was not expected for this time of year.
Pharmacy test scheduling systems have been unable to keep up with user demand, displaying messages on their websites apologizing for the inconvenience.
Customers report that they have had tests scheduled at laboratories after more than an eight-day wait, followed by a 48-hour waiting time for test results.
Pay Less Pharmaceuticals told Bloomberg Línea that between the second half of December and the first five days of January there was a 200% increase in the number of tests performed, compared to the same period last year. The wait to schedule a test is four days.
A survey conducted by Dasa Data & Analytics, a network representing brands such as Hospital 9 de Julho, Laboratório Bronstein, Sérgio Franco and Lavoisier, identified an increase in the rate of positive test results from 18.98% to 40.46%, between December 29 and January 5. The volume of RT-PCR tests for Covid increased by 53.4% during the same period.
Tests Only By Appointment in Ecuador
Since January 4, Ecuador’s public health system has only been carrying out Covid-19 tests with a doctor’s prescription.
Health Minister Ximena Garzón announced the measure due to the high demand for free tests nationwide. In the private sector there is no such restriction however, and tests continue to be performed normally. But laboratories are overrun and although they have the supplies available, results are delivered later than usual.
Garzón assures that the high demand for PCR and antigen tests has caused “stress on the healthcare system”, despite the fact that there are 1,343 centers for free sample collection and processing throughout the country.
“Tests and consultations in the public system will continue to be free, although we do not want the tests to go to waste due to the shortage that exists,” she said at a press conference. The country currently has about 250,000 antigen tests and another 80,000 PCRs, a quantity Garzón considers sufficient for epidemiological surveillance.
Shopping Around in Peru
In Peru, long queues can also be seen for the free tests provided by the state, and there are widespread complaints that there are not enough tests for all who require them. However, the government doesn’t talk about shortages.
Health Minister Hernando Cevallos said the government has more than 1.2 million reserve tests available and there is the possibility of making new purchases to avoid a shortage.
He said the cabinet has discussed the exact budget needed to hire more personnel and exceed the 10,000 tests currently performed daily with the Ministry of Economy, and that agreements will be made with universities and the private sector to provide more tests.
High Demand in Two Chilean Regions
Chile has significantly decreased the number Covid-19 cases after a mass vaccination campaign that has inoculated most of its target population, and after performing millions of tests to detect the virus.
According to the Ministry of Health, a total of 27,738,019 tests have been analyzed nationwide since the onset of the pandemic. The highest number of infections in the last six months was recorded on January 6. One day later, the figure was the highest for two months, with 3,799 daily cases, while of 74,482 tests conducted, 4.75% were positive.
Health Minister Enrique Paris said that Chile has been prepared, reinforcing its testing, traceability and isolation strategy.
Meanwhile, in the Chilean regions of Tarapacá and Biobío there has been high demand for PCR testing, according to the newspaper El Mercurio. In the former, there is a wait of up to four hours at the testing centers, or Active Case Search (BAC) points.
The regional health secretariat of Tarapacá called on the population to be patient and to return the following day if they do not get a test, while its counterpart in Biobío called for testing on both outbound and return trips during the current summer season.
On January 10, Chile began the application of a fourth dose of the vaccine against Covid-19 for immunocompromised persons.
Andrés Garibello, Raylí Luján, Mariano Espina, Kariny Leal and Maolis Castro contributed to this report.