Why Mexico got a slow start in stopping COVID-19

Mexican doctors risked their lives with the countries first COVID-related death. This story is about the human impact that faulty testing criteria have during a pandemic. It is also, a possible explanation behind the low number of people with COVID-19 in Mexico.

Originally published in Spanish in Aristegui Noticias

It was past midnight in Mexico City on Sunday, March 15th. José, 41 (not his real name) walked into the National Institute of Respiratory Issues, known as INER. He clutched his wife’s arm. José had been sick for a week with a dry cough and fever. By now he could barely breathe. White lights blazed in the emergency room. The waiting area was almost empty except for two people, each huddled in their own chair.

The intake nurse questioned José. Had he traveled? No. Had he perhaps been in contact with someone who traveled recently? No. Did he have any underlying medical conditions? Yes. Another nurse called José into a white room where a doctor would take his vitals and say he didn’t need to be tested for COVID-19.

Back then, Mexico was in the first phase of the pandemic with only 41 confirmed cases and 559 performed tests. The Health Department’s guidelines relied on a simple definition of COVID-19 that assumed the virus could only come from beyond Mexico’s borders. Therefore, doctors only tested people who had traveled themselves or been in close contact with travelers.

José did not meet this criteria. It was not until doctors intubated him, two hours after he came in, that they took a sample from his lungs and sent it to the hospital’s lab to run a test. For two long hours, no one gave José a facemask. No one disinfected the areas of the hospital that he passed through.

The doctor who intubated José finished his shift and went home. Hours later, he developed a “strong headache” and an overwhelming sensation of fatigue. He took two Tylenol. Twenty-four hours later, he got a call from the hospital: his patient has tested positive for COVID-19.

José died on March 18, three days after being admitted to the hospital’s intensive care unit, breathing with a respirator. By then, the country’s official number of infected people had gone up to 93.

There was nothing that could be done to save him: “The X-rays showed that his lungs were completely swollen,” said José’s physician. “He unfortunately was a patient with very bad prognosis.”

José’s death was the first named COVID-related death in Mexico. It was also the first case of local transmission in the country, according to four doctors who treated him. But he didn’t initially qualify for a test.

March 15th was early in the epidemic timeline for Mexico, merely two weeks after the first confirmed case of coronavirus, on February 28th. And because the government’s working definition was blind to the reality of “community spread,” doctors at hospitals across Mexico say physicians didn’t take appropriate measures to protect themselves.

“Medical staff treated a patient with COVID-19 as if he had any other type of respiratory disease,” said José’s doctor who used goggles, a facemask, gloves and disposable scrubs. But that’s not enough for COVID-19: both the gear and the room have to be sealed. “Physicians, nurses, janitors, receptionists, no one took the right precautions”.

José’s case is not the only one.

“There’s at least hundreds of similar cases here in Nutrición,” said a doctor from another hospital in Mexico City. “It’s impossible for me to tell you how many because for a while, we were only writing down the names of the people who got tested.”

By the time José walked into the ER, the countries around Mexico were already testing for community spread and enforcing stay at home orders to contain COVID-19. On March 18th, the day José died, the World Health Organization tweeted that “isolating, testing and treating every suspected #COVID19 case, and tracing every contact, must be the backbone of the response in every country” to end the pandemic.

The Mexican government’s definition generated the opposite of that, and was later coupled with the president’s irresponsible actions.

Only a day before José walked into the ER, AMLO was out in Oaxaca, taking selfies with crowds and kissing babies. A massive concert congregating more than 70,000 people took place on March 15th in Mexico City. On March 19th, indigenous peoples wisely asked the Mexican president to cancel his tour, fearing for the precarious health infrastructure in their communities.

The Mexican government finally broadened testing criteria on March 24th — after the World Health Organization reported local transmission in Mexico. Only then did AMLO, the Mexican president, announced Mexico’s transition to phase two of the pandemic and made tests available to more people a day.

Finally, almost a month since the epidemic hit the country, doctors had the official green light to test locals who had not traveled or been in contact with a recent traveler.

But the measure came too late: some of those untested people in Mexico have gone on to infect others. No one knows how many.

“We could have prevented some degree of local spread,” said one of José’s doctors. “Back then, no one was in quarantine, no one was practicing social distancing.”

During the first 25 days of the pandemic in Mexico, no local transmission was tested for or tracked.

“The official definition should have been changed near the beginning of the COVID19 pandemic to the current, broader one, so we would have known where the focal points were, and could have socially isolated those people in time,” said one of Mexico’s leading epidemiologists, Dr. Alejandro Macías.

For nearly a month, Mexico only tested travelers because of a faulty definition, which in turn explains why Mexico’s number of infected people are still so low. In other words, initial testing criteria significantly underestimated the number of infected people during a crucial preventative phase. The Mexican government not only risked the lives of frontline medical staff, but also put millions of people’s health on the line.

On Sunday, March 29th in the afternoon, José’s doctor was getting ready to go back to work after he tested negative for COVID-19 following his exposure to José.

The day before, the advice from the government had changed overnight.

“Stay home, stay home, stay home,” said a sweaty and nervous-looking chief epidemiologist. Meanwhile AMLO, the president, shared a video message saying: “I want to address you (the Mexicans). Our collective sacrifice and obedience will allow us to face and conquer the coronavirus epidemic… Everyone shall remain inside their houses.”

It took AMLO only 72-hours to flout social distancing norms again, this time to publicly greet El Chapo’s mom, to a nation’s dismay.

The time to flatten the curve has passed as healthcare professionals brace for the worst. Because of Mexico’s definitional fiasco in the early stage, the nation lost time that can never be regained. Physicians and nurses on the frontline are actively bracing for the worst.