In few countries the pandemic has come, passed and left. In most, the virus has returned after a brief absence. Or it never quite left, as in Mexico. In recent days and after the country exceeded 100,000 deaths from coronavirus, President Andrés Manuel López Obrador defended his Government’s management stating that other countries, including more robust economies and with better health systems, such as Spain, recorded worse figures than the local ones. The accumulated deaths that the disease has left is a hard piece of information to compare emotionally. But it can also be informative if done with caution. The epidemic is not over and countries have different capacities to collect information, so it is not convenient to draw sharp conclusions about what each nation has done during the health emergency.
“I have to say that there are more deaths in other European countries – not to mention one by one – and in American countries, than those who died in our country according to the population of Mexico,” López Obrador said last week from Palacio National. The president criticized the media coverage, including that of this newspaper, that his Administration received after exceeding 100,000 official fatalities. Last Friday, Mexico reported more than 12,000 new infections, the highest number reported since the start of the pandemic. The second highest figure was also registered in recent days, thanks to the increase in tests that some entities, mainly Mexico City, are doing. The estimated cases have increased by 8% according to the authorities.
Mexico is one of the most affected countries, according to the figures published daily by the EL PAÍS data team. Just considering the deaths officially certified as a product of covid, it exceeds 800 per 100,000 inhabitants. Spain, one of the most affected in Europe, and harmed by the devastating effect that the virus had on its nursing homes (something that was not seen in Latin America), reaches 900, more than Mexico. In Peru or Belgium the ratios are even higher. These are among the 10 or 15 countries hardest hit in the world by the disease.
The database of confirmed cases and deaths in Mexico is long and deep. Each entry offers a wealth of individualized information. Not only the ages and dates of the victims, but also the comorbidities and the treatments they received. Now, that they are deep does not mean that they are complete. There are many details of the cases, but not all the cases. There are two clear indicators that the underreporting, common in most countries, is higher in Mexico. The first is the number of tests performed per positive. The World Health Organization recommends a ratio of 10 to 1 or even 20 to 1. Mexico is almost at 2 to 1. That is to say: around 40% of the tests facts return confirmed result, indicating a test system saturation.
The second is the ratio observed between confirmed deaths and detected cases. The epidemiological team at Imperial College London recently estimated fatality ranges for different types of countries: in upper-middle-income countries, such as Mexico (which has less elderly population than Europe or the United States), it is expected that less than 1 of every 100 infected die. It is possible that obesity and diabetes, very present in the country, make the calculation grow a little. Also due to the apparent lack of access to hospitalization for the most serious cases. The authorities recently reported that Mexicans take an average of 3.3 days to go to a hospital, when it is recommended that it be less than 2. It is unlikely that, as the division between deaths and official cases suggests, the virus is between nine and twenty times deadliest in Mexico. This gap probably represents the different capacities to at least approximate the real number of infections. Among the countries most affected by the virus, none is as badly off as Mexico with this metric.
All this raises suspicions not only of a lack of counting of mild or asymptomatic cases, something that the Undersecretary of Health himself, Hugo López-Gatell has admitted from the beginning. It is possible that this underreporting also occurs in the most serious cases, which lead to death. Mexican institutions are already, in fact, compiling data that do not depend on diagnostic tests for SARS-CoV-2 infection. Their results so far are even more negative than those shown so far.
The dizzying excess of deaths in Mexico
It is difficult to make systematic comparisons of excess mortality, a criterion that estimates expected deaths using models that use historical averages fed by deaths in the last 10 years. This has been the best metric to measure the effect of a long-term extraordinary event, such as the pandemic. As it depends only on the comparison of deaths in 2020 with that expected according to previous years, it is not tied to the availability of tests, the application of these or the delays in records of causes of death. Most countries are able to count more or less effectively and promptly the deaths (without entering into causes) that occur in their territory. It is more difficult to set up a detection system for a new virus.
Some countries keep more up-to-date data; others less. In some places, like Mexico, transparency in this data has been growing in recent weeks. This Sunday, the Health authorities updated the figures on excess deaths. There are 217,989 more deaths in the country than expected in the mathematical model. An increase of 38% until the end of October. It is estimated that seven out of ten of these deaths, about 155,990, are attributable to the coronavirus. In other countries, like Russia, there is no way to trust excess mortality figures. And in still others, see Brazil, its provision is irregular. Mexico stands out even among those that combine the impact of the epidemic and relatively recent data, even surpassing Spain.
With the most recent data, on October 24, in Mexico an excess of mortality accumulated during the pandemic of 173 deaths per 100,000 inhabitants. That same data, for Spain, was about 135 even considering two more weeks (until the first of November).
This fact perhaps contrasts with the memory that the world keeps of the first wave of contagion in the European country. Overflowing hospitals, strict quarantine, fear, tragedy and sadness both in the streets and in the headlines of the newspapers. A break that was as intense as it was short-lived. Spain’s epidemic peak in March was much higher than the highest in Mexico. But also, and here’s the key, it was shorter.
Spain, like the rest of Europe, tried and managed to suppress the virus during the months of May, June and part of July. There was a false closure. Right now, the excess death metric is rising again, while Mexico’s continues a slow decline. The same happens if we compare another pair of European and American countries. It is the difference between a suppression strategy, like the Spanish one, and a contagion mitigation strategy, like the Mexican one. Sometimes by initial election, as it was in Brazil and the United States, others because the pandemic prevailed, as it happened in Argentina, Colombia or Peru. Beyond comparisons, the truth is that all countries still face a virus that does not have a clear horizon to disappear. There will still be a good time between us all.