Introduction
On 17 November 2019, the first known case of infection by the coronavirus SARS-CoV-2 was reported. The victim, according to the South China Morning Post, was a 55-year-old man who died in China.
Since then, the world has experienced the rapid spread of the virus and a pandemic set in, with control of the disease lost and health systems collapsing in many countries. National economies faltered as the effects of the pandemic rippled out.
The evolution of the numbers of cases and deaths in selected countries from around the world is shown in Figures 1 and 2.
Figure 1: Cumulative number of cases in some countries of the world
Figure 2: Cumulative number of deaths in some countries of the world
Comparing the countries considered Figures 1 and 2, we can see the United States was the most affected in the numbers of both cases and deaths. Note, in addition, that each country experienced unique characteristics of cases and deaths in their peak periods. This was due to the unique restrictive measures of containment adopted by each country.
On 26 February 2020, the first case of COVID-19 in Latin America was confirmed: a man who had been in Italy and then returned to Brazil. The second country to file a case of COVID-19 was Mexico. This case also involved a man who had recently traveled to Italy and returned.
This article focusses on COVID-19 developments in Latin America. First it assesses the trends in COVID-19 cases and deaths in each of the 20 countries of the region. This made it possible to see that Argentina, Brazil, Colombia, Mexico and Peru were the countries with the highest numbers of cases and deaths. Analysing the cases in relation to total population, however, shows the countries with the highest number of cases were, respectively: Argentina, Uruguay, Costa Rica, Panama and Brazil.
Regarding the percentage of deaths in the population, the five most affected countries were, respectively: Peru, Brazil, Argentina, Colombia and Paraguay. This can be seen in the charts in Figures 3 and 4.
Figure 3: Cumulative number of cases in Latin America
Figure 4: Cumulative number of deaths in Latin America
All countries in Latin America adopted restrictive measures to contain the advance of COVID-19. Thus, given the large number of countries and the availability of data from them, the present study analyses the impact of COVID-19 in the following countries: Argentina, Brazil, Chile, Mexico and Peru.
We outline individual overviews of how health systems work in each of these countries, followed by descriptions of the scenarios at the beginning of the pandemic for each, including their subsequent approaches to mitigating COVID-19. We also look at the advance of vaccination and its consequences.
Evolution of COVID-19 in countries under study in Latin America
Since February 2020, the date of the first case of COVID-19 in Latin America, countries have attempted to control the spread of the unknown virus and to develop containment measures. Each country adopted the measures it deemed effective and necessary for control. Consequently, spikes in cases and deaths occurred at different times.
Argentina
With approximately 45.38 million inhabitants, Argentina was the third country in Latin America to present a first case of COVID-19, which was reported on 3 March 2020.
After the first case, restrictive measures were taken which included limitations of movement on the streets and implementation of remote work whenever possible. Since 19 March 2020, a period in which the country had 128 cases and three deaths, mandatory social isolation was established to contain the spread of COVID-19.
However, on 17 July 2020, the government of Argentina began to loosen the measures and, since that date the number of those infected has increased significantly. The evolution of cases and deaths can be seen in Figure 5.
Figure 5: Cumulative number of cases and deaths – Argentina
Brazil
On 26 February 2020, the first case of COVID-19 in Brazil was reported: a man who had traveled to Italy and returned to São Paulo, the largest state in the country by population. That made Brazil, with a population of approximately 212.60 million, the first in Latin America to have a confirmed case of COVID-19.
Due to the territorial constitution of the country, individual states and municipalities have the discretion to adopt restrictive measures as each sees fit. It did not take long, however, before the disease spread. Figure 6 shows the evolution of the disease.
Figure 6: Cumulative number of cases and deaths – Brazil
Chile
The first confirmed case of COVID-19 in Chile was reported on 4 March 2020. The country has a population of approximately 12.19 million inhabitants.
On 24 March 2020, Chile adopted numerous restrictive measures, such as prohibitions of people from entering and exiting the country and prohibitions of people moving to summer homes within the country, among others.
The advance of cases and deaths in Chile is shown in Figure 7.
Figure 7: Cumulative number of cases and deaths – Chile
Mexico
On 28 February 2020, Mexico recorded its first case of COVID-19, which also involved a man who had recently traveled from Italy. That made Mexico the second country in Latin America to present a confirmed case of COVID-19.
The country began to adopt restrictive measures after that first case. Decisions on the specifics of these restrictions were made in each state and generated numerous layoffs of workmen in various areas during the pandemic period.
Mexico has approximately 128.90 million inhabitants. The evolution of cases and deaths for the country is shown in Figure 8.
Figure 8: Cumulative number of cases and deaths – Mexico
Peru
The first reported case in Peru came on 5 March 2020, and a quarantine period began the following 16 March, with restrictive measures and curfew. On 17 March, the country recorded its first death from COVID-19.
Peru has a population of approximately 32.97 million. In August 2020, it became the country with the highest COVID-19 mortality rate in the world, as infected people were not receiving diagnoses to begin isolation in a timely manner and the transmission rate increased.
To date, although Peru is not the country with the highest number of cases per inhabitant in Latin America, it is the country with the highest number of deaths per inhabitant, with a total of 202,225 deaths as of December 2021, representing 0.61% of the population. The evolution of the pandemic in the country is shown in Figure 9.
Figure 9: Cumulative number of cases and deaths – Peru
Health system in countries under study in Latin America
In this section, we look at how the health systems work in different countries, both public and private, allowing a better understanding of the challenges of each country in the prevention and treatment of COVID-19.
Argentina
The health system in Argentina is divided into public, private and social security sectors.
The public sector covers anyone who wants or needs to use this service. It is completely free and provides care for people who are unable to afford prepaid medicine. In some cases, services that are covered by the public sector in a given region may not be covered in other regions.
The social security sector is dedicated to registered employees, consisting of beneficiaries such as retirees and employees of the armed forces and the legislative and judicial branches.
Private plans, called prepaid medicine or social works, are health plans financed by individuals and/or companies. Private plans include the use of several hospitals and exclusive services.
Private plans suffered several price adjustments throughout 2020, at generally higher rates than inflation. In 2019, prepaid plans made eight adjustments totaling 60.67%. However, due to the global pandemic, in 2020 only a single adjustment of 10% was applied, in December 2020. In 2021, two adjustments were authorised, one of 4.5% and another of 5.5%.
In 2017, the country had a total of 499 beds for every 100,000 people and 4.00 doctors to serve every 1,000 people.
Brazil
In Brazil, there are two types of healthcare systems, public and private. The public one is completely free and financed by public government resources. To receive necessary medical care, a patient just goes to a public health establishment. All Brazilians have access to the public service.
There has been some debate in Brazil about the functionality of its public health system, as it is known for long waiting times for elective surgeries and lack of basic materials, among other problems.
In addition to the public system, there is a private health system, which is strongly regulated by the National Supplementary Health Agency (ANS).
Several health insurances companies and/or plans provide private healthcare services in Brazil. These services are financed by fixed monthly payments or premiums, or by the full payment of the assistance expenses incurred.
Even before the pandemic, the Brazilian private health market had already shown an increase in the number of beneficiaries. It was intensified by the COVID-19 pandemic, according to research by the Institute for the Study of Supplementary Health (IESS).
Private health service can be contracted by individuals as well as by class entities, unions or companies, and covers a list of minimum procedures defined by the ANS.
In 2017, Brazil had a total of 209 beds for every 100,000 people and 2.17 doctors per 1,000 people.
Chile
In Chile, the health system is divided into public and private sectors, represented by Fondo Nacional de Salud (FONASA) and Instituciones de Salud Previsional (ISAPREs), respectively.
Unlike most countries that have a free public system, the Chilean public system is funded with a percentage of the beneficiary's salary. It is believed that, for the system to work, it is necessary to charge a percentage, so all wages are discounted to provide for the assistance coverage.
There is also the collection of co-participation fees on the value of consultations, exams and other procedures. This percentage is variable according to the salary of the beneficiary.
Beneficiaries who choose a private system are no longer discounted by the public system and start paying the percentage of salary to the private system. In addition, they pay co-participation costs for medical care items in general, such as consultations and exams, among others.
In 2017 Chile had 211 beds for every 100,000 people and 2.44 doctors for every 1,000 people.
Mexico
Mexico also has both public and private health systems.
The public health system is regulated by the Mexican Institute of Social Security (IMSS), and is divided into mandatory and voluntary systems. The mandatory system is composed of registered workers, while the voluntary system is composed of self-employed workers or those in the public system.
For people who do not have any resources or who are unable to contribute part of their salaries to the system, the IMSS-Solidaridad programme provides them healthcare at no cost.
The private health system is composed of people who choose to pay for the service through health plans. Even people enrolled in IMSS can choose to purchase a health plan in order to enjoy more personalised services.
In 2017, Mexico had 99 beds per 100,000 people and 2.38 doctors for every 1,000 people.
Peru
In Peru, as in the other countries, healthcare is provided by both public and private sectors. The central regulatory entity is the Ministry of Health (MINSA).
The MINSA has some subsectors, including Integral Health Insurance (SIS) and Social Health Insurance (EsSalud) among others, administered by the Ministry of Labour.
Although public, the free healthcare service in Peru requires registration as a worker, with some kind of proof of such status.
The private sector has two subdivisions, with-profits and nonprofit. The part that makes up the nonprofit sector is a set of civil associations, such as volunteer firefighters.
The part that makes up the with-profits private sector is composed of private insurers, private clinics and others.
In 2017, Peru had 159 beds for every 100,000 people and, in 2016, 1.30 doctors for every 1,000 people.
Impact on the health sector of Latin American countries under this study
Health markets were impacted not only by an increase in events and claims related to the diagnosis and treatment of COVID-19, but also by the suspension and reduction of the demand for elective care that resulted from the preventive measures imposed, as well as by the need to offer more teleconsultation, the financial effects of the suspension of annual adjustments and changes in technical provisions. These factors vary by country, according to the summary in Figure 10.
Figure 10: Main impacts on the health sector in each country
In general, the measures adopted were similar. The suspension of elective procedures generated reductions in the claim ratio for 2020 and suspensions or postponements of annual adjustments in several countries. However, the postponement of elective procedures in 2020, including hospitalisations, had the side effect of generating pent-up demand for procedures that were eventually carried out in 2021, thus increasing claim ratio and expenses at that time. In addition, high-cost treatments related to COVID-19 were still being performed.
Vaccination
The countries had different vaccination periods and different types of vaccines. Mexico and Chile were the first Latin American countries to start vaccination, 24 December 2020.
Figure 11 shows the evolution of vaccination in the five Latin American countries under study.
Figure 11: Advance of vaccination, in relation to the total population
In the table in Figure 12, it can be seen that Chile and México were the pioneers in the vaccination efforts among the countries analysed, starting on 24 December 2020. Both countries provided the same type of immunisation.
Each country provided a vaccination plan and a type of immuniser, but throughout the vaccination period these countries were adopting more than one immuniser. In addition, we can verify that all countries analysed now have 50% of their populations fully vaccinated.
Figure 12: Vaccination table
| ARGENTINA | BRAZIL | CHILE | MEXICO | PERU | |
|---|---|---|---|---|---|
| Onset of vaccination | 29/12/2020 | 17/01/2021 | 24/12/2020 | 24/12/2020 | 08/02/2022 |
| First available vaccine | Sputnik | CoronaVac | Pfizer | Pfizer | CoronaVac |
| First dose | 82.59% | 77.33% | 89.41% | 62.88% | 72.31% |
| Complete vaccinal scheme | 69.61% | 66.22% | 85.52% | 55.81% | 62.53% |
General considerations
Since December 2019, the world has been experiencing the insecurity of a global pandemic. COVID-19 arrived in Latin America at the end of February 2020 and has since reached every country in the region. Although each country has its own characteristics, it can be observed that the means to contain the advance of the virus were similar among these countries, with the adoption of restrictive measures such as remote work and the suspension of class for people who could adhere to these formats, among other guidelines.
Regarding health systems, these countries were also similar: measures such as the suspension of elective procedures during the most critical period of the disease were adopted in several countries, as well as the suspension of price adjustments in 2020, aiming to minimise the financial impact. Implementation of telemedicine also rose.
At the end of 2020, with the beginning of vaccination, death rates began to decrease gradually. Currently the vaccination process is well-advanced and some countries have already started to distribute the booster vaccines.
Qualifications
Due to the uncertainty associated with the nature of the sources, actual results may vary. When reviewing such results, it is important to recognise the uncertainty and variability of the data. We believe that the actual information may differ, in any direction, from the results presented in this analysis. However, the results presented herein reflect our best professional judgement based on the information available.
Finally, to carry out the analyses presented in this paper we considered data and information made available on the sites indicated in the bibliographic reference. Our verification of the accuracy of the information did not include a complete audit and any incomplete or inconsistent information may generate incomplete or inconsistent results and conclusions.
1 Our World in Data Coronavirus Pandemic (COVID-19). Retrieved 1 May 2022 from https://ourworldindata.org/coronavirus.
2 Reuters. COVID-19: Global Tracier. Retrieved 1 May 2022 from https://graphics.reuters.com/world-coronavirus-tracker-and-maps/index.html.
3 PopulationPyramid.net. List of countries ordered by population size. Retrieved 2 May 2022 from https://www.populationpyramid.net/pt/popula%C3%A7%C3%A3o/2021/.
4 Argentina.gob.ar (20 October 2020). COVID-19 Pandemic – Ensure Coverage. Retrieved 2 May 2022 from https://www.argentina.gob.ar/noticias/pandemia-covid-19-garantizar-la-cobertura-1.
5 Official Gazette of the Argentine Republic. Legislation and Official Notices. Retrieved 2 May 2022 from https://www.boletinoficial.gob.ar/detalleAviso/primera/242850/20210410.
6 Iander Porcella (3 March 2020). Argentina confirms first case of coronavirus. UOL. Retrieved 2 May 2022 from https://noticias.uol.com.br/saude/ultimas-noticias/estado/2020/03/03/argentina-confirma-1-caso-de-coronavirus.htm.
7 Passion, Fernanda (16 October 2020). With one of the largest isolations in the world, Argentina is the target of "antiquarantine." Brasil de Fato. Retrieved 2 May 2022 from https://www.brasildefato.com.br/2020/10/16/tido-como-maior-do-mundo-isolamento-social-na-argentina-e-alvo-dos-anti-quarentena.
8 Bem Estar (29 December 2020). Argentina begins vaccination against Covid-19. Retrieved 2 May 2022 from https://g1.globo.com/bemestar/vacina/noticia/2020/12/29/argentina-comeca-vacinacao-contra-a-covid-19.ghtml.
9 Bem Estar (23 December 2020). Mexico will begin vaccination against Covid-19 on Christmas Eve. Retrieved 2 May 2022 from https://g1.globo.com/bemestar/vacina/noticia/2020/12/23/mexico-iniciara-vacinacao-contra-covid-19-na-vespera-do-natal.ghtml.
10 Coronavirus Brazil. Coronavirus Panel. Retrieved 2 May 2022 from https://covid.saude.gov.br/.
11 Valor (8 April 2020). Mexico loses nearly 350,000 jobs after restrictive measures by pandemic. Retrieved 2 May 2022 from https://valor.globo.com/mundo/noticia/2020/04/08/mexico-perde-quase-350-mil-empregos-apos-medidas-restritivas-por-pandemia.ghtml.
12 Camila Gianelli Malca et al. (17 November 2021). As Peru became the country with the highest rate of deaths by Covid-19 in the world. Galileo Magazine. Retrieved 2 May 2022 from https://revistagalileu.globo.com/Sociedade/noticia/2021/11/como-o-peru-virou-o-pais-com-maior-indice-de-mortes-por-covid-19-no-mundo.html.
13 Peruvian government. Unique digital platform of the Peruvian state. Home page. Available from: https://www.gob.pe/busquedas?contenido[]=servicios&institucion[]=minsa&sheet=3&sort_by=none. Accessed: Jun 15, 2021.
14 Peru Ministry of Health. Vacuna Covid-19 in el Perú. Retrieved 2 May 2022 from https://www.minsa.gob.pe/reunis/data/vacunas-covid19.asp.
15 ACP. Entidades Prestadoras de Servicios de Salud Prepagados. Retrieved 2 May 2022 from https://acp.org.pe/entrevistas/entidades-prestadoras-de-servicios-de-salud-prepagados.
16 Nethis. Health system in Peru. Retrieved 2 May 2022 from https://bioeticaediplomacia.org/sistema-de-saude-do-peru/.
17 Jacqueline Elizabeth Mayor-Rabanal et al. (2011). Peruvian Health System. Retrieved 2 May 2022 from http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S0036-36342011000800019.
18 Minsa (2020). Situational room. Retrieved 2 May 2022 from https://covid19.minsa.gob.pe/sala_situacional.asp.
19 Agency Brazil (24 December 2022). Chile Begins Vaccination With Pfizer-BioNtech Immunizer. Retrieved 2 May 2022 from https://agenciabrasil.ebc.com.br/internacional/noticia/2020-12/chile-inicia-vacinacao-com-imunizante-da-pfizer-biontech.
20 Brito, Janaína (23 March 2020). Coronavirus: Chile announces new restrictive measures; government enacts curfew. Mercado & Eventos. Retrieved 2 May 2022 from https://www.mercadoeeventos.com.br/_destaque_/destinos-destaque/coronavirus-chile-anuncia-novas-medidas-restritivas-governo-decreta-toque-de-recolher/.
21 Minsa. Ministerio de Salud. Retrieved 2 May 2022 from https://www.minsal.cl/category/noticiasregionales/.
22 Isapres from Chile. Retrieved 2 May 2022 from http://www.isapre.cl/home.
23 Fè La Salye (21 August 2015). Living in Chile - What the health system is like. Fernandalasalye. Retrieved 2 May 2022 from https://fernandalasalye.com/2015/08/21/morar-no-chile-como-e-o-sistema-de-saude/.
24 Veja Saude (18 January 2021). National vaccination campaign for Covid-19 is inaugurated with indefinitions. Retrieved 2 May 2022 from https://saude.abril.com.br/medicina/campanha-nacional-de-vacinacao-para-covid-19-e-inaugurada-com-indefinicoes/.
25 Revista Apólice. Covid-19: Health plan spending reaches higher level. Retrieved 2 May 2022 from https://www.revistaapolice.com.br/2021/08/covid-19-gastos-dos-planos-de-saude-atingem-maior-patamar/.