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Weekly Report - 07 May 2020 (WR-20-18)

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MEXICO: Facing Covid-19 peak

The Mexican authorities estimate that the coronavirus (Covid-19) outbreak will reach its peak in the country this week. The government led by President Andrés Manuel López Obrador insists that it is prepared to overcome the challenges that this will present. But not everyone is so confident amid warnings about a lack of hospital capacity and medical equipment to deal with an expected upsurge in infections and critical cases, which some believe the government is underestimating.

Mexico’s deputy health minister, Hugo López-Gatell, the man who is leading the government’s response to the Covid-19 epidemic in Mexico, has said that the authorities predict that the peak of the outbreak will occur between 8 and 10 May. According to López-Gatell, the authorities have been preparing for this in the past few weeks by increasing hospital capacity, training and drafting in more staff to help out at hospitals, and by procuring additional medical supplies, including personal protective equipment and mechanical ventilators. López-Gatell says that the government has done everything it can, although he has admitted that Mexico’s health system is weak and poorly prepared to deal with such an emergency; and that thousands more people may die from Covid-19 as the outbreak reaches its peak [WR-20-17].

But there are warnings that the Mexican authorities may be seriously underestimating the number of Covid-19 cases in the country; and that there is still a lack of adequate medical equipment across the healthcare system to face the challenging days ahead. The United Nations and the World Health Organization (WHO) have already warned that due to the lack of mass testing in Mexico, the number of Covid-19 cases could be underreported by a factor of nine. This would make the number of infections in the country as the outbreak approaches its peak much higher than the 250,000 estimated by the government. It follows from this that the number of critical cases requiring intensive care in hospitals will also be higher than the government estimates. López-Gatell has estimated that 15,000-16,000 intensive care beds would be needed during the peak, while the current capacity stands at 8,000.

If the calculations are wrong, then there could be many more preventable deaths. The Universidad Nacional Autónoma de México (Unam) projected on 3 May that the actual number of infections in the country currently stands between 176,000 and 265,000. The Unam projection was arrived at by taking the latest official data on confirmed cases and multiplying it by eight, as per the ‘Centinela’ mathematical model based on a minimum number of confirmed tests that the health ministry says it uses to estimate the number of infections. But Dr Malaquías López, an epidemiology professor at Unam, has highlighted that, without mass testing, it is impossible to know exactly how many cases there are and how the virus is spreading. Dr López said that the number of infections could be up to 25 times higher than those reported.

  • Centinela

The Centinela (Sentinel) model is an epidemiological surveillance system used to track the spread of infectious diseases, such as influenza, on which obtaining extensive data is not possible. The model relies on the collection of high-quality data from a small network of sources (hospitals) to make projections about outbreaks. It is recommended by the WHO as an economical alternative to surveillance systems based on extensive testing. But the WHO says that the model “may not be effective for detecting rare diseases”, and critics say it should not be used to monitor Covid-19. Hugo López-Gatell himself has admitted that the model is no longer accurate once an outbreak reaches community transmission stage, as Covid-19 has done in Mexico.  

Meanwhile, Dr Samuel Ponce de León, another professor and coordinator of Unam’s health research programme, has voiced concerns that the medical equipment that the government says it has acquired is not up the task and that shortages are still being reported in hospitals. The government has purchased tonnes of medical supplies from China and opened various procurement processes for essential equipment, including ventilators. But Dr Ponce de León said that the distribution of these supplies has been hampered by inefficient administrative processes, with some equipment sitting in warehouses waiting to be delivered, and that various hospitals have noted that some of the supplies that they have received are damaged or not the correct specification.

Dr Ponce de León partly attributed these problems to the creation of the Instituto de Salud para el Bienestar (Insabi), the new public healthcare entity recently introduced by the López Obrador administration to help improve healthcare provision in the country. According to Dr Ponce de León, the creation of Insabi has altered Mexico’s public healthcare structure by introducing new administrative and operative processes. However, these processes have not yet been consolidated by Insabi, “aggravating the capacity of [Mexico’s healthcare system] to deal with a pandemic such as this one”.

Corruption

On top of these administrative problems, delivery of urgently needed equipment has also been delayed by corruption allegations in the procurement of emergency supplies. In order to expedite the acquisition of emergency supplies, the government approved the implementation of simplified procurement processes, including allowing government entities to award direct supply contracts. Local anti-corruption NGO Mexicanos contra la Corrupción y la Impunidad (MCCI) warned that this would increase the risk of corruption as these simplified mechanisms could easily be exploited by opportunists. On 1 May MCCI published details of an investigation that found irregularities in the awarding of contracts by the social security institute (IMSS) for the provision of ventilators.

MCCI denounced that there was an 85% variance between the cheapest and most expensive ventilator supply contracts awarded by the government between 27 March and 1 May despite the characteristics of the machines being the same. MCCI accused various firms of selling the government ventilators at inflated prices. But the case that grabbed the most attention was that of Cyber Robotics Solutions, which was awarded a contract to provide 20 ventilators for M$31m (US$1.27m), over US$63,000 per unit. This was much higher than the US$35,800 per unit price agreed with another firm that same day.

MCCI pointed out that Cyber Robotics Solutions is co-owned by León Manuel Bartlett Álvarez, the son of the director of the federal electricity commission (CFE), Manuel Bartlett Díaz, a López Obrador appointee and ally. This raised serious concerns about a potential conflict of interest and other potential corruption offences by Bartlett Álvarez or Bartlett Díaz. The Bartletts deny any wrongdoing. But the Secretaría de la Función Pública (SFP), the federal administrative oversight body, announced on 4 May that it would launch an investigation into the Cyber Robotics Solutions contract.

  • Bartlett’s defence

Manuel Bartlett Díaz has denied having any involvement in Cyber Robotics Solutions, insisting that he has no links to his son’s business. León Manuel Bartlett Álvarez has acknowledged that the price quoted in the contract awarded to Cyber Robotics Solutions is higher than that offered by other firms. But he has justified this by arguing that there is currently a global shortage of ventilators, which has pushed up their price, particularly for quick delivery. Moreover, Bartlett Álvarez pointed out that the Mexico City government had purchased ventilators at even higher prices to argue that the price charged by his firm was “reasonable”. 

Government fights its corner

The SFP’s announcement came after López Obrador was asked about the allegations affecting the Bartletts during his 4 May morning press briefing. López Obrador said that the allegations should be investigated by the SFP and insisted that he would not tolerate corruption and that anyone found guilty would be punished. But he also questioned the motives behind MCCI’s allegations and the honesty of its founder, Claudio X. González Guajardo, who he accuses of being a government opponent. López Obrador said that González and MCCI are intent on destabilising his government by trying to undermine its public image.

López Obrador said that the same is true of sections of the press that question the official Covid-19 case data and the government’s handling of the pandemic. He singled out a leading national daily, Reforma, which he alleged was leading a campaign to discredit López-Gatell after it ran a series of reports questioning the reliability of the official Covid-19 infection and death toll figures. López Obrador insisted that his government is controlling the outbreak. But with the official number of Covid-19 deaths topping 2,500 on 5 May, and hospitals around the country, particularly in Mexico City and environs, warning that they are running out of intensive care beds, there is concern that the death toll could rise quickly as the health system struggles to cope with a surge in cases.