Halpern et al.
The COVID-19 pandemic struck the world in 2020 and was particularly harsh in Latin America, where a combination of social disparities and vulnerabilities led to unprecedented health and economic crises.1 One remarkable impact is the exceedingly high death toll in the region, especially given the “excess mortality rate,” which is probably the measure that best reflects the total numbers of direct and indirect deaths during the COVID-19 pandemic.(2,3)
When the pandemic hit Latin America, there was a misconception that its effect in the region would be lighter than that in Europe, considering the younger Latin American population. However, after accounting for the population age difference, the infection fatality rates were worse in Latin America and in low- and middle-income countries compared with higher-income European nations.(2,4) Although age is an objective measure, different life course stressors could mean that individuals (and populations) with the same biological age will have extremely different health risks.(5,6) Vulnerable individuals in low- and middle-income countries are commonly exposed to hazardous nutritional, environmental, and occupational factors and suffer from social marginalization, structural racism, and poverty. Therefore, comparing countries with large inequities with those with much less inequity based solely on age addresses the life course history and risks of populations facing COVID-19 only superficially. The implementation of social protection systems is a way to tackle vulnerabilities in the region. A governmental commitment to fiscally support such efforts and actively work with vulnerable populations to solve constraints and disparities is critical for Latin American states to adequately respond to future health crises.
Unequal health care access clearly plays an important role in the increased COVID-19 mortality rates seen in vulnerable populations.7 However, the coexistence of this new, unexpected pandemic and other chronic diseases, has worsened this scenario, resulting in what is referred to as a “syndemic.”(8,9) Poor nutritional status probably contributes to this problem (10) in low- and middle-income countries, where obesity and malnutrition (both associated with COVID-19 severity) frequently coexist. (11–13) As a component of social protection strategies, the transformation of health systems toward universal coverage is warranted. Additionally, a health care shift from disease treatment to health promotion and illness prevention in the near future would allow the regional states to save money that can be reinvested in implementing additional social and equitable policies.
Children and adolescents also comprise a vulnerable population that has been disproportionately affected by the COVID-19 pandemic in Latin America, and they are affected by life factors related to the disease. (14–16) The United Nations Children’s Fund estimates that, for nearly a year, more than 168 million children were out of school because of closures related to the COVID-19 pandemic. Two thirds of the countries where schools were fully closed during this period were located in Latin America.16 These closures affect not only learning and development but also nutrition, as many families in low- and middle-income countries rely on schools to provide daily meals to children. Expectedly, several reports have highlighted a decrease in the overall food quality among poor individuals during the pandemic,(13,15,17) which may lead to increased malnutrition and childhood obesity rates, with long-lasting consequences.
Reopening schools while monitoring children’s and educators’ health status is an urgent need for all the countries in the region to minimize the impacts mentioned earlier. Therefore, education and health systems must work collaboratively to develop plans for a safe and healthy return to onsite schools. Moreover, future health crises such as the current pandemic may again occur; hence, governments should plan for future disruptions and invest in social programs that benefit students and the educational community.
Finally, another important lesson from the pandemic is that medical schools urgently need to improve evidence-based science and statistics education. Dangerous misinformation regarding “early treatment” for COVID-19 in Latin America was widespread (18) by individuals with large communication platforms and economic conflicts of interest. Furthermore, a large portion of the medical community broadly adopted clinical practices that were not based on evidence, unveiling these practitioners’ poor scientific backgrounds. Medical and other health sciences schools must be made aware of the importance of well-designed studies, notions of probability, and behavioral biases in clinical practice.
We believe that the misinformation spread is another symptom of “vulnerability leading to more vulnerability.” By communicating the false idea that COVID-19 was easily treatable with drugs, millions of people were unnecessarily exposed to the virus (increasing the transmission rate and, consequently, the total burden of COVID-19 in the region), not to mention the potential health consequences of the drugs themselves and the economic costs of ineffective treatments. In addition, misinformation created vaccine hesitancy in Latin America, a region that has historically had high vaccine uptake.(19) The public health sector should coordinate action that focuses on training to improve communication and supporting it during health crises, which might lead to broader public trust in science and adherence to effective public health measures.
All articles from this supplement are available free of charge and in full text in English in the American Journal of Public Health and Spanish in the Revista Panamericana de Salud Pública.