April 15, 2020
Though COVID-19 was slow to appear in worrying numbers in Latin America and the Caribbean, the number of infected people in the region is now rising rapidly. Between March 1 and April 1, total confirmed cases of the novel coronavirus in Latin America rose from 5 to 25,500. In the first half of April, that number nearly tripled to 75,200. The US currently has the highest rate of reported COVID-19 cases per capita of any country in the Western Hemisphere, but this may be primarily because it saw its first case weeks earlier. Latin America may still have a similarly overwhelming case load coming its way.
Like in other regions around the world, the impacts of the pandemic are not evenly distributed throughout Latin America and the Caribbean. Infections are concentrated in certain countries and certain areas within countries; policy responses and health care systems differ from country to country, and from region to region within countries.
The majority of confirmed Latin American cases are in just a handful of countries, with Brazil making up more than a third of all reported cases. Looking at the raw number of reported cases can help give us an idea of where the disease is, but looking only at the overall numbers may obscure serious outbreaks in smaller nations. Additionally, Figure 1 makes it clear that some countries have large numbers of total cases per capita, but much smaller numbers of active cases per capita due to recoveries and deaths. Figure 2 presents national data of confirmed active COVID-19 cases per 1,000 people.
As can be seen, measuring confirmed cases in this manner highlights some potentially significant outbreaks that have thus far largely occurred under the radar. The highest overall active rate of infection right now can be found in Panama, which has more than double the rate seen in Ecuador, the Dominican Republic, and Chile, the next most-infected nations. Along with Peru, the outbreaks in Ecuador and Chile suggest that COVID-19 is more widespread on the Western Pacific coast of South America. Accounting for population size also illustrates that there appears to be significant outbreaks in some smaller Caribbean nations as well, with the Dominican Republic, Saint Kitts and Nevis, Antigua and Barbuda, Barbados, and Grenada all making the top ten.
There are reasons to question these numbers. First, even if they all reported in good faith, each nation has its own sets of standards and collection mechanisms for reporting this data, meaning that each nation has differences in how their COVID-19 numbers are put together. Even more problematic, however, is the matter of testing. COVID-19 cases, recoveries, and deaths can only be reported if the virus is first diagnosed through testing, and the availability of testing varies widely. The inconsistency in testing across the region may also prevent us from having an accurate picture of the disease’s spread. Though not all countries in Latin America are reporting their testing numbers, a look at the data reveals that many nations in the region may be drastically underreporting confirmed cases.
To get an idea of which countries are testing more than others, Figure 3 presents tests per 1,000 people for those countries with available data, with darker green illustrating more testing and white illustrating less.
The gaps between testing rates and reported active case rates can shed some light on who is underreporting most. Figure 4 plots tests per million people against active COVID-19 cases with a trendline that indicates how much an additional amount of testing yields in additional cases on average. Venezuela is excluded from this chart because they have recently received large shipments of medical supplies from China which dramatically expanded their testing capacity in just the last week, while their case numbers have remained relatively low; this suggests that it’s unlikely they’ve had a chance to deploy the tests and report back more accurate numbers accordingly.
If a country appears above the trendline, it indicates that it has a higher number of active cases than we would expect for a country in the region given its number of tests; if it appears below, it has fewer cases than would be expected.
This visualization tells us that the high levels of COVID-19 reported in some countries, like Chile and Panama, is in part due to the fact that they have some of the highest testing rates in Latin America. Unlike Chile, however, Panama’s placement high above the trendline indicates that it does in fact have a very serious outbreak on hand. Other countries with above-average cases per test include Antigua and Barbuda, the Dominican Republic, Grenada, Ecuador, and St. Vincent and the Grenadines. Of the countries that have reported their testing rates, Guatemala, Haiti, Honduras, and Bolivia have the lowest. It is no coincidence that these are some of the poorest and most underdeveloped countries in Latin America: testing rates correlate significantly with both GDP per capita and the UN’s Inequality-adjusted Human Development Index. Because the accuracy of coronavirus rates rises with more testing, we can’t be sure how widespread COVID-19 actually is in these countries.
There is another complication: the first cases of COVID-19 appeared at different times in different countries, and there is a clear relationship between how long it’s been since the beginning of an outbreak and how many total cases a nation has had. As such, it’s worth keeping an eye on the last countries to see cases appear, as these are nations likely to witness the most future growth. Examples include Belize, El Salvador, Grenada, Haiti, and Nicaragua.
On a more positive note, a few nations like Costa Rica, Cuba, and Uruguay appear to have handled the crisis fairly well so far, with a low number of active cases per thousand even when taking into account relatively high testing rates and the fact that their first cases appeared over a month ago.
Health Care Systems
Like the reported numbers of COVID-19 itself, health care systems and policies vary significantly across Latin America. Data on these types of metrics can help us get an idea of which nations are most ready to contain and treat coronavirus, and which may be least prepared to do so. Two simple measures of health care system capacity are hospital beds per capita and doctors and nurses per capita, serving as proxies for both basic health infrastructure and the quantity of medical personnel. In Figure 5, these two measures are plotted against one another for comparison, with each nation shaded darker blue the wealthier it is on a per capita basis.
For the most part, wealthier nations in Latin America have both more hospital beds and health professionals per capita than their poorer neighbors, and will thus be able to handle a larger strain on their health care system. Some countries stand out. Argentina, Brazil, Chile, and Barbados have all clearly put major effort into developing certain aspects of their health care system, while Cuba’s system is by far the most prepared in terms of sheer capacity despite Cuba being less wealthy. Panama, the worst-off country in the region right now, has put significantly less investment in health care capacity than other nations of a similar relatively high-income. Dominica and St. Vincent and the Grenadines punch well-above their weight here considering their GDP per capita. Finally, three nations stand out in their unique unpreparedness for a serious health crisis: Guatemala, Haiti, and Honduras. This is especially important to note as the data presented above indicate that these three countries are all among the countries with the lowest testing rates. Not only are the countries particularly vulnerable, but we also have little information about how widespread the virus is within them.
It perhaps comes as little surprise that three of the most vulnerable countries are also three of the most impoverished nations in the hemisphere. Just as people living below the poverty line are most vulnerable, so too are the most impoverished countries. While the countries with the largest outbreaks in raw numbers will likely receive the lion’s share of attention, it is important to keep in mind that small states — including many small island nations — will face significant outbreaks on their own right.