Uruguay: how to have one of the worst death rates from COVID-19 without having collapsed the health system?

Uruguay, a country that since the beginning of the pandemic has stood as an example to the world on the management of the pandemic, today has one of the highest death rates. This Monday, the country celebrates 20 consecutive days in the ranking of countries with the highest per capita rate of new deaths registered by the coronavirus, according to the platform "Our World in Data". At the moment, Uruguay has surpassed the states that were at the centre of the pandemic last year, such as Spain, Italy and the United States, but Uruguay has avoided reaching the level of alert due to the collapse of its health system, which occurred in countries with a much higher GDP than Uruguay, such as Brazil or India. 

Dr Alicia Cardoza was interviewed by the BBC, she is one of the most important doctors in the country, as she is the director of the Spanish public hospital in Montevideo: "Without doubt there were some nights when it was difficult to sleep thinking if we were going to be able to control this ... although it is true that we are in a complicated moment of the pandemic in terms of numbers, the health system has not collapsed".

Uruguay has always had a benchmark health system, and before the pandemic spread, the Uruguayan nation already had a health system that was quite advanced compared to other countries in the region. In its national budget, the South American country has one of the highest healthcare expenditures, accounting for 9.2% of its GDP, with the highest number of doctors per 1,000 inhabitants and also has the most intensive care beds per 100,000 inhabitants, according to the regional "Health Outlook 2020" prepared by the World Bank and the Organisation for Economic Co-operation and Development (OECD).

The first wave of COVID-19 infections arrived much later within the national territory, which allowed the country's authorities to prepare in time to deal with the first wave in a more professional manner. ASSE, which is the State Health Services Administration, is the largest public health provider in the country, covering 43% of the territory, and took care of doubling the number of intensive care unit beds and also doubling the number of respiratory units. Eduardo Henderson, manager of ASSE, made a statement explaining why Uruguay did not reach an ICU occupancy rate of more than 80%. "Why didn't we reach 80%? Because in parallel to the increase in intensive care admissions, we were providing new beds," he concluded. "We didn't wait until we were saturated to implement measures," Henderson said. 

In all of 2020, 181 people died in Uruguay, and currently there are 1,000 deaths every 18 days. The cause is uncertain as to how the numbers changed so radically, but there are suspicions, for example, the P.1 variant, which entered the country. This variant, which is more contagious, appeared in 99% of the samples taken from patients in Uruguay in the first two weeks of May by the Pasteur Institute in Montevideo. 

The government refuses to go back to a general confinement, as has happened in other countries, the Executive opts for restrictions on various sectors of activity, experts recommend that the Executive, through decrees, can regulate mobility, in order to lower the number of contagions.
 

Latin America Coordinator: José Antonio Sierra.