Wwhen Rufino Pacheco arrived at the hospital, his breath crooked and his legs bent, a doctor laid papers against his stepdaughter and asked for her approval to put him in a ventilator. But the elderly patient pushed.
Less than 12 hours later, Pacheco died, connected to an oxygen tank in the bedroom, when his wife shouted, “Do not leave me, old man.” Days later, she also fell ill with Covid-19 along with her adult son.
“There was a lot of excitement and worry,” Consuelo Vázquez said of the time she spent caring for her mother and brother after the man she loved when her father was gone. “We thought we would go through the same thing.”
Each needed extra oxygen at times, and only after they recovered could the family begin to grieve over Pacheco.
Untested for Covid-19 and quickly cremated, Pacheco, who died Nov. 24 in the working-class city of Ecatepec, may never appear as one of the deaths rising across parts of Mexico – especially the capital and its suburbs – at worst eruption since the summer peak.
For weeks, officials have begged Mexicans to stay home. Even President Andrés Manuel López Obrador, whose public statements have rarely acknowledged the seriousness of Mexico’s outbreak, began the month by urging Mexicans to give up the holiday festivities that run through December to January. But he refused to impose restrictions, declaring the Mexicans “responsible, well-behaved and conscientious.”
The president’s soft touch highlighted what has been the significant contradiction of his government’s approach to coronavirus. Keeping bars, cinemas and shopping malls open steadily undermines the message that people should only go out for the most important activities.
He has also said that many Mexicans cannot afford to stop working. However, instead of helping people leave them at home, the left-leaning president has insisted on sticking to the cuts that have ruled his two-year-old presidency. His government has proposed the densest stimulus programs to flow over millions of newly unemployed.
The result has been devastating. Nearly 120,000 Mexicans have died from Covid-19, though health experts at Mexico’s National Autonomous University of Mexico, known as Unam, estimate the number is anywhere from two to four times more. Even the reported figure makes Mexico one of the world’s deadliest countries for the pandemic based on its population.
But the government’s approach has changed very little, even as cases – and deaths – began to rise in November.
Finally, officials bowed to reality and on Saturday, most non-essential activities in Mexico City and the surrounding part of Mexico closed home to the suburbs of the large working class that have been among the areas hardest hit by coronavirus.
Dr. Hugo López-Gatell, Deputy Minister of Health responsible for the government’s efforts, admitted that the progress of the epidemic required “extraordinary measures”.
Exhausted doctors and nurses on the ground had known for weeks how bleak the picture was.
“The lack of stopping infection really hit us with this second wave,” said Dr. Belén Jacinto, a specialist in critical care at La Raza Hospital in Mexico City.
Everywhere she turns, there is a shortage. There is only one physician with critical care on duty each shift to manage 15 patients in her ICU, assisted by other physicians in other specialties.
There are not enough staff to turn ventilated patients on their stomachs as the protocol recommends and monitor them to ensure that their breathing tubes remain in place.
“I told my bosses that intubated patients are almost – almost – sentenced to death,” she said. “What service do we offer?”
The government has hired new doctors, bought fans and increased the number of ICU beds since the pandemic began. But that is not enough. “You can not increase capacity overnight,” said Dr. Alejandro Macías, who handled the government’s response to the swine flu epidemic in 2009. “All of these extra beds did not necessarily improve the outlook.”
Critics of the populist government of López Obrador claim that the approach to the pandemic was misleading from the start. “The Mexican government stated that testing was a waste of resources,” he said. Julio Frenk, a former health minister who is now president of the University of Miami. Mexico has one of the lowest test rates in any country in the world.
“The policy was to have enough beds,” he said. “The political goal should be to control transmission.”
Part of the responsibility for testing falls on the states of Mexico, Macías said, and they also failed to increase testing. The exception is Mexico City, where Mayor Claudia Sheinbaum offered free, widespread testing.
Dr Samuel Ponce de Léon, who coordinates the Covid response group in Unam, said the government’s attempt to find a balance between letting people work and straining the infection had failed. “More than half of the population belongs to the informal economy,” he said. “They have to travel and go to work to have money for food the next day.”
Given that reality, he said, the government’s inconsistency in communicating basic coronavirus protection measures – beginning with López Obrador’s refusal to be an example of wearing a face mask – was difficult to understand.
“Social distancing is an impossible dream,” Ponce de León said, referring to Mexico City’s crowded public transportation. “But we can minimize with face masks and hygiene.”
López Obrador’s insistence on maintaining austerity measures throughout the pandemic has also surprised many.
The International Monetary Fund – no fan of current public spending – recently called on Mexico’s left-wing government to increase its support for families and businesses devastated by the deep recession caused by the pandemic.
Pointing that Mexico had budgeted only 0.7% of GDP in additional health and social spending to confront the pandemic, the fund said Mexico should increase this amount to 2.5% to 3.5% of the country’s production and make health care top priority.
For decades, Mexico has underconsumed public health and is lagging behind comparable economies such as Colombia and Brazil. Many hoped that López Obrador would change that when he took office, promising to help the poor focus on his policies.
Instead, “Covid hit us at a very bad time,” said Mariana Campos, an expert on public spending in México Evalúa, a thin tank. López Obrador’s government reduced the health budget in 2019, the third year of cuts. “We have the structural problems we have always had and they have worsened since 2017.”
As the bustle of the capital begins to subside and the government turns its attention to the arrival of the first vaccines, Macías said the country was only halfway through its struggle.
“If this was a football game, we would be in minute 45,” he said. Viruses spread faster in the winter, and “I anticipate many more patients,” he said.