Mexico (along with Brazil, the United Kingdom, and the United States) is one of countries most affected by the spread of the novel coronavirus that causes Covid-19. Mexico’s President Andres Manuel Lopez Obrador has been ridiculed across the world for his slow response to recognize the severity of the crisis and his stubborn refusal to wear a mask. On July 24, 2020 while visiting one of the country’s poorest states, Lopez Obrador publicly questioned whether masks provide any benefit. Ministry of Health spokesman Hugo Lopez-Gatell is also facing increasing criticism for his willingness to bend his message to accommodate the caprices of his boss. The image of a mask-wearing Dr. Anthony Fauci throwing the first pitch at a professional baseball game in a mostly empty, outdoor stadium in Washington D.C. stands in stark contrast to a widely publicized photo of Dr. Lopez-Gatell sprinting in to a crowded indoor press conference, flashing a thumbs-up sign to reporters, with a broad smile visible on his uncovered face. While Dr. Fauci has bristled against Donald Trump’s incompetence and worked to craft a message designed to educate the public and minimize the damage caused by the Covid-19 contagion, Dr. Lopez-Gatell has placed partisan propaganda and his personal loyalty to President Lopez Obrador above his obligation to educate Mexico’s public about the risks posed by Covid-19. Both Lopez Obrador and Lopez-Gatell continue to blame Mexicans’ poor health as an excuse for why the virus has hit the country so hard.
On July 23, 2020 Dr. Lopez-Gatell advised the public that in addition the pandemic, Mexico is also dealing with “national health emergencies” related to diabetes and obesity. The tweet pinned to the top of Dr. Lopez-Gatell’s Twitter profile, an account that has over 1 million followers, isn’t a warning about the benefits of social distancing or widespread mask use. It’s a political statement about Mexico’s need prevent chronic illnesses by improving individual behaviors, promoting exercise, reducing tobacco use, and improving dietary habits. At their lengthy daily press conferences Lopez Obrador and Lopez-Gatell repeat the message that Mexico’s hospital system has not collapsed and still has plenty of capacity to treat patients and that Mexico’s public is partially to blame for the lethality of the virus, because people who struggle with diabetes, obesity, and other underlying health problems are more likely to succumb to the virus.
The publicly-available data in Mexico’s National Epidimilogical Oversight System (SINAVE) database, however, seems to contradict the message that hospitals in Mexico City are providing adequate treatment and undermine the concept that people are dying because of the prevalence of underlying health problems. I reviewed the data contained in the SINAVE database as of July 22, 2020. I found that while people over age 61 account for the majority (53%) of the confirmed Covid-19 deaths in Mexico City, relatively young people, aged 41-60, account for 39% of the total. Furthermore, 2,450 people age 35 to 55 have died of Covid-19 in Mexico City, nearly a third (29%) of the total tally of officially confirmed deaths.
There is little evidence in the data to support the narrative that these relatively young patients are dying because they are unhealthy. Nearly half of the 35 to 55-years-old patients confirmed to have died of Covid-19 in Mexico City (1171 out of the 2450) ARE NOT listed as having asthma, diabetes, or obesity. Among these relatively healthy patients who don’t have diabetes, obesity, or asthma, one characteristic stands out: three quarters of them died before they were ever connected to a ventilator.
Overall, in Mexico City two-thirds of the patients confirmed to have died of Covid-19 were never intubated before they died. Furthermore, in general out of the 2,782 confirmed Covid-19 patients who were ever connected to a ventilator, 2,018 died, a fatality rate of over 72%. While some hospitals in the U.S. are able to save a majority of critical patients through ventilator treatment, in Mexico City most people never get a chance to find out how they would respond to intubation. Overall, there are only two patients in the database who are listed as “cured” after receiving ventilator treatment in Mexico City’s hospitals.
Part of the problem is that Mexico’s President Lopez Obrador has encouraged the public to treat family members with Covid-19 symptoms at home to help avoid overwhelming hospitals. In March, early on in the pandemic, he said that families could rely on their daughters for help at home. “We have millions of [amateur] nurses because in this crisis, this pandemic, we’re not going to solve it in hospitals, we have to solve it at home,” he explained.
“The tradition in Mexico is that daughters take care of their parents,” he said again in late June.
But, because Dr. Lopez-Gatell has not urged patients with symptoms buy cheap oximeters to monitor their oxygen levels at home, most people don’t show up at the hospital until they are in critical condition. On average the patients who have been officially confirmed to have died of Covid-19 in Mexico City passed away after only 9 days in hospital and 27.1% died after spending fewer than 3 days in the hospital.
While Mexicans in general do suffer from high levels of chronic diseases, it’s disingenuous to blame people dying of a specific deadly virus for unrelated health problems, especially when many of the young people dying of Covid-19 appear to be relatively healthy. While 30% of the 35 to 55 year old patients who died had diabetes, 70% did not. While 29% had asthma, 71% did not. While 31% were categorized as obese, 69% were not.
Shifting blame away from public institutions towards individuals is a key component of the “neoliberal” model that Lopez Obrador has spent his political career criticizing. In Mexico City, however, there are thousands of critically-ill Covid-19 patients who don’t suffer from asthma, diabetes, or obesity, and the overwhelming majority are never connected to ventilators.
While Mexico City’s Mayor Claudia Sheinbaum warns that hospitalizations are starting to rise as the economy-reopens, overall the daily tally of officially confirmed deaths has stabilized. There are still hundreds of patients dying every week in Mexico City and an unknown number of thousands of asymptomatic and non-critical patients circulating in the general population. The pandemic is far from over. There is still an opportunity to reduce the impact of the disease by encouraging social distancing and mask use in line with World Health Organization guidelines.
The 35 to 55 year olds who are dying of Covid-19 in Mexico City are concentrated in working class neighborhoods such as Iztapalapa, Gustavo A. Madero, and Alvaro Obregon. Many of the deceased patients in this age group worked as livery drivers (158 or 6.4% of the total), as shop keepers at public markets (294 or 12% of the total) or as day laborers (495 or 20.2% of the total.) People in Mexico City’s marginalized communities are disproportionately dying of Covid-19. Rather than blame the people dying of Covid-19 for their unhealthy lifestyles, President Lopez Obrador and his advisors should work to craft a clearer message to help reduce the ongoing impact of the contagion.
I spoke to Dr. Oscar San Roman, a Mexican physician who is currently completing a Master’s in Public Health at New York University. He said that looking at the problems in Mexico City isn’t about blaming the over-worked and under-equipped doctors and hospitals, it’s about improving the government’s overall communication strategy and better educating the public about the risks of airborne droplets and spending time in confined spaces and promoting the importance of mask-use and social distancing.
“In Mexico, we don’t have a coherent message. If the president would do something as simple as put on a mask it would impact millions of people who follow him. Small messages, simple actions can treat this and solve this pandemic,” he said.