Fake news, an obesity crisis and decades of underinvestment in public health have exacerbated Mexico’s deadly battle against the coronavirus

Fake news, an obesity crisis and decades of underinvestment in public health have exacerbated Mexico's deadly battle against the coronavirus

“We can end the pandemic in eight weeks.”
“But building a hospital, that will take us about 12 years.”
This cartoon shows Salomón Chertorivski (left) and José Narro (right), former government health secretaries, insisting that the proposals they have presented to the current government could “put an end to the pandemic in eight weeks”. The initiative has only added to the confusion whilst a lack of investment over the years (as illustrated, for example, by the abandoned building sites where hundreds of new hospitals were once to be built) has clearly contributed to people’s lack of faith in the public health system at a time as crucial as this.

(José Hernández )

During the Covid-19 pandemic in Mexico, where 95,000 lives have already been lost to the virus and signs of a second wave started to appear in October, I became aware of a highly disconcerting phenomenon: there are sick people who refuse to go to public hospitals, or delay going, because they are convinced that “people are being killed there”, and that “doctors are killing the old people” on government orders.

What is behind this disbelief in the virus’s ability to kill and the determination to blame the doctors? A psychiatrist told me that paranoid feelings can be triggered by the level of mystery surrounding the coronavirus and its effects. It is also clear that there is still a lack of faith in a public health system left in a sorry state by decades of neglect and lack of investment under the neoliberal governments of the past.

To make matters worse, in the context of a fierce political battle from which the centre-left leader Andrés Manuel López Obrador emerged victorious, assuming the presidency in December 2018, opposition groups are spreading disinformation that is adding to the overall confusion.

When the current health authorities conducted an assessment of the state of their health facilities in 2019, they found that many of them lacked basic equipment and instruments and had insufficient medical staff.

They also identified more than 300 building sites where new hospitals were never completed and have been left abandoned, in some cases, for as long as 10 years.

When the pandemic broke out, Mexico launched a massive hospital redevelopment drive to equip and adapt existing hospitals and to set up temporary facilities to ensure the availability of sufficient beds, ventilators and trained staff to care for Covid-19 patients. Nearly 1,000 hospitals were equipped to treat Covid-19 patients.

The authorities spent over 3.2 billion pesos (US$150 million, €128 million) on hiring more than 44,250 doctors, nurses and health workers and training a total of over 36,000 people.

The government signed a business agreement with private hospitals, requiring them to make 50 per cent of their beds available to treat patients with non-Covid related conditions, to free up space in the public system. Mexico was keen to avoid the disastrous scenarios seen in countries such as Spain and Italy, which were among the first to be hit by the first wave of the pandemic.

According to Mexico’s undersecretary for health, Hugo López-Gatell, who is in charge of the anti-Covid strategy, not a single patient has been turned away for want of beds or ventilators. In other words, no patient’s fate has been decided by a lack of adequate medical care.

But all these efforts do not seem to have paid off – as yet – amongst a population group that does not believe in the public health system, with fatal consequences, for some.

Obesity and disinformation

In March, the government called on the people of Mexico to observe a period of lockdown, which was not made compulsory, in the knowledge that 50 per cent of the population lives from hand to mouth and has to go out to work to put food on the table.

Mexico’s predicament is further complicated by its own – unprecedented – epidemic of chronic noncommunicable diseases such as diabetes, obesity and cardiovascular disease, attributable to decades of unhealthy eating habits centred on ultra-processed foods and sugary drinks.

Some 73 per cent of the population is overweight or obese.

In 2014, Mexico introduced a tax on sugary drinks to discourage their consumption. The current government has gone further still, taking a stronger measure – front-of-pack warning labels – that has pitted it against the big food and beverage multinationals. The measure, placing black warning labels on products high in calories, fat, sugar and salt, was introduced on 1 October.

People who are overweight, diabetic or have other pre-existing health conditions are at much greater risk of developing serious symptoms if infected with Covid-19. It is estimated that 70 per cent of those who died from the virus in Mexico had one or more comorbidities – pre-existing conditions such as diabetes or obesity.

I have heard the warnings repeated many times: “If you are over 60 years old and you suffer from diabetes, obesity, high blood pressure or heart disease, do not wait, seek medical attention immediately.”

One fatal victim of the virus who did not hear or pay heed to the warnings was 64-year-old Emilio López Santiago, who suffered from high blood pressure, diabetes and was overweight. López Santiago began feeling ill one Tuesday and went to a pharmacy where he consulted two private doctors, one of whom prescribed portable oxygen. On Sunday, his nephew Sebastian López finally took him to the Military Hospital in the state of Mexico. He arrived at midnight and was transferred, with a ventilator, to another hospital, where he died the following Thursday.

When I asked him why he didn’t take his uncle sooner, Sebastian López replied that public hospitals “are a disaster” and that he had heard “they are killing old people there”. López had previously said that he “did not believe” in the coronavirus and what was really happening was that “the government was paying the doctors to kill” the elderly patients in the hospitals.

Miguel Flores, a gardener, told me that his 70-year-old father-in-law fell ill with Covid-19, in Chiapas, but refused to go to the local clinic because “they kill people there”. He stayed at home, saying he would rather die there than go to the hospital. “He was ill for 10 days, he went purple, he didn’t eat,” said Flores, but he pulled through.

I came across another example in May, in the daily newspaper La Jornada Morelos. According to the news item, the people of Xoxocotla, Morelos, did not believe that Covid-19 could kill. Locals had posted messages around the town, signed “Xoxocotla ready for battle”. They read: “Doctors, not one more death. Covid-19 does not kill. Typhoid, dengue and doctors do.”

To examine the reasons behind such reactions, I turned to psychiatrist Juan José Bustamante, former director of mental health at the General Hospital of Mexico. He told me that when people are confronted with Covid cases they experience a range of emotional responses, including “those in which mental disorder prevails in the form of paranoia that is fed, sustained and perpetuated by fake news and disinformation”.

Added to this, he pointed out, is the fear caused by a completely new agent – the virus and its effects – which disrupts people’s lives, over which they feel they have lost control; it is what is known in psychiatric terms as a “loss of self-determination”.

Bustamante, who said his practice had been overwhelmed by cases of patients struggling with grief over the losses suffered during the pandemic, added that being locked down, having to stay at home, is another factor contributing to the development of ideas that have no basis in reality.

The psychiatrist expressed the view that the attacks from opposition forces also contribute to the medical disinformation surrounding the coronavirus and are part of the campaign to undermine López Obrador’s government. And in light of the opposition camp’s not-so-hidden agenda of benefiting from a climate of confusion, he said, “the right wing and the conservatives will continue to attack and to misinform, to generate confusion, especially among the most vulnerable”.

The World Health Organization (WHO) has been pointing to the dangers of the “infodemic” since the pandemic began. “We are not only fighting the virus,” said WHO Mexico, “We are also fighting the trolls and conspiracy theorists who are driving disinformation and undermining the response to the outbreak.”

In September, six former Mexican health secretaries from previous neoliberal governments issued a 14-point proposal. They claimed, “they could end the pandemic in eight weeks”. López-Gatell responded that the proposal lacked any scientific foundation, and that some aspects of it, such as the creation of a death registry, had already been addressed. He also refuted the former health secretaries’ claim that the government has discouraged the use of face coverings.

Several months after the start of the pandemic, the Health Ministry undertook to identify the “excess death rate” – the number of deaths exceeding those recorded in previous years – with the help of the National Population Council and other institutions. The task of carefully reviewing death records is aimed at establishing a death toll closer to the real figure, and responds in part to the accusations of underreporting.

The Covid-19 report presented on 5 October included data on past deaths attributed to the coronavirus on the basis of epidemiological and medical criteria, in cases where they could not be confirmed by a Covid test.

López-Gatell was emphatic in telling reporters not to treat these deaths as if they had happened overnight, that it would be a mistake, false information. It did not, however, prevent El Financiero newspaper from immediately tweeting]: “Mexico breaks record for the number of deaths in a single day” (a tweet subsequently removed). Several other news outlets published similar news in their print editions.

Visibly dismayed, López-Gatell called on reporters to act sensibly, with professionalism and “generosity” in the midst of the pandemic.

And so continues Mexico’s battle, not only against the coronavirus but with enemies on various fronts.

This article has been translated from Spanish.