The Crisis

The LAC region has been affected by the pandemic more intensely than any other region in the world. About 17% of reported COVID-19 cases and 29% of confirmed deaths have occurred in this region, which has only 8% of the world’s population. The region’s economies contracted by 6.7% in 2020 – almost twice the average global decline of 3.5%. An estimated 30 million people lost jobs between February and June 2020 (IDB b, 2021); over 55 million people have been impoverished (IDB c, 2021); and around 120 million children lost an average of a year of schooling, representing a loss of 6.3% to 10.5% of GDP (López Bóo et al., 2020). The pandemic essentially generated a triple crisis: in health, in the economy, and in society. 

Countries in the region knew that COVID-19 was on its way after watching it spread from Asia to Europe and the United States. By April 1, 2020, most LAC countries had implemented stringent containment and closure policies to try to stop the pandemic (Oxford Covid-19 Government Response Tracker). Similar policies seemed successful at slowing the pace of infections and deaths in the United States and Europe during the second quarter of 2020, but the level of transmission remained high in LAC for a longer period than in other countries (OECD, 2020).

The region’s health systems were not prepared for such a quickly moving pandemic. The initial response was hindered by limited capacity for testing, contact tracing, and establishing isolation and quarantine protocols. Most countries simply lacked sufficient equipment, laboratories, supplies, information systems, personnel, and planning for an effective response.

During 2020, the region’s health worsened, although some groups and conditions saw improvements. Mortality rose sharply in 2020 not only because of COVID-19 cases but also because of the pandemic’s indirect effects. In 17 LAC countries, over 800,000 more people died in 2020 than in previous years (The Economist Tracker).

Deaths from NCDs generally rose. Brazil, Chile, and El Salvador reported more deaths from diabetes mellitus, an increase of 14%. Deaths from hypertension rose by about 11% in Brazil and Chile but grew by 49% in El Salvador. The causes behind these increases in mortality from chronic conditions are not well understood but probably were a combination of disruptions in health care services and complications associated with COVID-19 (Technical Note: Going Beyond Normal, 2022).

FIGURE 4: CHANGE IN DEATHS FROM SELECTED CHRONIC CONDITIONS DUE TO THE PANDEMIC: 2020 VS. 2015–2019

Children’s health worsened in some countries. For example, in Guatemala, almost twice as many children suffered from acute malnutrition in 2020 compared to the average of previous years (Technical Note: Going Beyond Normal, 2022). However, child health continued to improve in other places. For example, during 2020, infant mortality continued to fall in the Dominican Republic and Peru, by 16% and 13%, respectively, relative to historical averages. In Peru, chronic malnutrition also decreased, by about 7%, and the prevalence of anemia in children under five years of age fell by almost 11%.

Overall, maternal health faced increased risk. Mexico, Colombia, and Peru reported increases in maternal mortality, which were largely attributable to complications related to COVID-19 among pregnant women. Some studies have also shown that pregnant women have become more likely to develop depression and anxiety since the start of the pandemic (Berthelot et al., 2020; Liu et al., 2021; Medina-Jimenez et al., 2020).

Resilience

The region had to adapt quickly to face the pandemic. Governments, health care workers, private-sector firms, and communities all responded in numerous ways. Governments struggled to acquire necessary supplies by passing emergency legislation to allow nonconventional procurement approaches. Medical staff were retrained and reassigned to infection treatment wards. Other kinds of health and community workers were trained and deployed for testing and contact tracing.

Physical infrastructure was reorganized to limit the spread of infection. Other facilities —such as arenas, summer camps, and hotels— were repurposed as field hospitals or quarantine sites. Health care providers were allowed and often encouraged to offer consultations by telephone or computer —often referred to as telemedicine— as a way to prevent potentially infectious contact and maintain other health care services (García Zaballos et al., 2020; Figure 5).

New medical protocols for treating serious cases of COVID-19 were developed around the world and then rapidly communicated to and adopted in the region. For example, health care practitioners initially thought that patients with breathing difficulties should be placed on ventilators as soon as possible. Subsequent experience and research showed that other techniques, some as simple as placing a person face down on their stomach instead of their back (i.e., proning), could lead to better outcomes while reducing demand for scarce ventilators.

The region was slow to expand COVID-19 testing, in part because of limited equipment, supplies, laboratories, and trained personnel. As the world gained experience with this new disease, the region adopted techniques to make better use of limited resources for testing and contact tracing. For example, some countries used pooled testing, which made it possible to use a single test kit for a group of people. Many countries also promoted the use of smartphone apps to obtain information about contact with infected people and symptoms in order to improve the speed and effectiveness of contact tracing (Smarter Crowdsourcing: Coronavirus 2020).

Recovery

COVID-19 is still taking its toll on the region, but several factors have helped countries reduce the death toll and resume health care services. During 2020, governments mobilized substantial funding for pandemic response. The average fiscal package in the region was 8.5% of GDP, which offset declines in economic activity, expanded social welfare and cash transfer programs, and financed critical health services. Part of this spending (or commitment to spend) included advance purchase commitment agreements during 2020, which played an important role in obtaining access to life-saving vaccines in 2021 (Amrita et al., 2020).

The arrival of vaccines in 2021 has probably been the most important factor for slowing COVID-19 transmission, reducing the severity of infections, protecting health care workers, and resuming health care prevention and treatment. The initial rollout of vaccines in the LAC region was slow, but by the end of 2021, almost half of the region’s population had received the required vaccine doses. Brazil, Colombia, Costa Rica, Ecuador, Nicaragua, Panama, Peru, and Uruguay vaccinated over three-quarters of their populations. Argentina (90%) and Chile (93%) achieved vaccination coverage that exceeded the OECD average (77%). Some countries, however, continue to lag, with vaccination coverages below 50% of their populations.

Finally, health care systems eventually re established supply chains, obtained more supplies and diagnostic equipment, adopted new technologies and re-engineered protocols to handle the new challenges posed by the pandemic. As a result, some health care services have resumed their historical levels. For example, in El Salvador, cervical cancer screening reached its pre-pandemic levels by the end of 2020, but the decline during most of the year created a backlog. Nevertheless, many health care services remained below their historical levels. For example, care for diabetes and hypertension were 16.7% and 23.4% lower than the historical averages in Ecuador.