Three years of pandemic and the Mexican health system remains precarious and inoperative

The Covid-19 pandemic stripped the Mexican health sector bare and exposed it for what it is: a precarious and inoperative system… and three years later the situation is practically the same.

The trail of deaths caused by the coronavirus identified at the end of 2019 (and of which the first case was reported in Mexico on February 28, 2020) revealed that the health system was in critical condition: hospitals in a precarious situation; few and poorly supplied intensive care units; few critical medicine specialists (both doctors and nurses); we did not have a good national system of molecular diagnosis and a very high proportion of the primary care system in the hands of clinics attached to pharmacies, describes the infectious disease expert Alejandro Macías Hernández.

The former federal government commissioner for the epidemiological emergency due to the AH1N1 influenza pandemic that occurred in 2009, states that some of the experiences of the 2009 AH1N1 influenza pandemic were useful, but, “the truth is, we could have done much better, knowing what we had been through”.

“The serious thing is that today it seems that we have not learned (not from the pandemic of 14 years ago) but from the current pandemic, because, whether it was reactivated or there was a new one, we should have a better preparation plan, with better response mechanisms, taking advantage of what we have learned from this pandemic, but the truth is that we are not having it.”

He offers several buttons as proof of this: we do not have a good number of intensive care beds. What we have are more beds with a fan, but that means nothing if they are attended by personnel who do not have the necessary capacity to care for an intensive care patient, since the chances of a patient who gets there surviving are very few.

In addition, we do not have a good primary care system, which means that people, even if they are beneficiaries of institutions such as the IMSS and ISSSTE, do not go to the clinic that corresponds to them, but instead choose to be treated in clinics those enabled next to pharmacies, where patients have generally been overmedicated.

Furthermore, we do not have a national diagnostic system. And that’s just part of a long list of shortcomings that show Mexico hasn’t learned from experience, he says.

On the other hand, it indicates that Mexico, from the six-year terms prior to the current one, was abandoning the production of vaccines and, therefore, sovereignty in the matter.

The figures indicate bad decisions

According to data from the Ministry of Health, as of February 21, 7,430,815 cases of Covid-19 and 332,850 deaths had been confirmed in Mexico.

Data from https://ourworldindata.org indicate that Mexico is the fifth country where the most deaths have been registered. It is only surpassed by the United States, Brazil, India and Russia, except that while Mexico has 129 million inhabitants, which ranks as the tenth most populous in the world, the United States is the fourth most populous with 337 million, Brazil is the sixth with 217 million, India is second with 1,289 million and Russia ninth with 142 million, according to figures from statista.com. Japan, which has 124 million inhabitants, registers 72,000 deaths, while Mexico, with 129 million inhabitants, has 5 times more than that.

This is not counting the fact that there is a dark figure that corresponds to people who surely died from Covid-19, but since they were not tested to make sure they had the disease, they are not included in the records of deaths due to the pandemic.

To get an idea of ​​the real dimension, it would be necessary to take into account the figures for excess mortality from all causes, which is defined as the number of observed deaths minus the number of expected deaths.

According to the Inegi, it is estimated that from 2020 to 2022 there was an excess mortality of 650,602 people, of which 316,745 occurred in 2020, another 317,620 in 2021 and 16,237 in 2026.

On the other hand, in September 2019, in his first government report, President López Obrador reported that in the public sector in Mexico there were 1.8 doctors in contact with patients for every 1,000 inhabitants. For the fourth report, presented in September 2022, the number increased to just 1.9.

Something similar happens with other indicators. The number of nurses per 1,000 inhabitants went from 2.5 to 2.6; the number of censusable beds per 1,000 inhabitants remained exactly the same, at 0.7, while the number of outpatient consultation units per 100,000 inhabitants went from 17.3 to 15.5, that is, there was a decline of 1.8.

The National Survey of Occupation and Employment 2021 of the Inegi says that the number of people employed as doctors for every 1,000 inhabitants in the country is 2.4, a value higher than the average of two doctors for every 1,000 inhabitants of the countries of Latin America and the Caribbean , but lower than the average value of the Organization for Economic Cooperation and Development (OECD), which is 3.5 doctors per 1,000 inhabitants

According to the Secretary of Health Jorge Alcocer Varela, Mexico has a deficit of 33,831 general practitioners and 154,786 specialist physicians, to comply with international recommendations.

bumpy reaction

The balance that the pandemic has left so far is not only due to the situation in the Health sector, but also to the public policy decisions that were made, raises the analyst in this area Xavier Tello.

In his opinion, from the outset the decisions to contain it were made slowly and in reaction to the prevention measures already implemented by parents and employers.

The authorities took their time; they waited until the last moment. The authority entered a period of denial of the problem, which brought as a consequence that, as a country, we did not prepare ourselves.

“We cannot say that we had an adequate response, when we were behind in each of the decisions.”

Then, although a spokesperson for the pandemic was appointed, in the person of Undersecretary Hugo López-Gatell, they made him the czar of the pandemic and made all the decisions, which was incorrect, since that is a task of the General Health Council, instance that was relegated.

From there, decisions were made based on what was convenient for the government, such as not using a face mask, simply because the president, Andrés Manuel López Obrador, did not want to use it.

He emphasizes that when the second wave occurred, in Mexico there was an enormous number of deaths of patients in their homes because they were told not to go to the medical units.

On the other hand, the analyst emphasizes, with the argument of respect for the freedom of the people, the confinement measures were not reinforced and the result was that the healthy distance, necessary to contain the disease, was neglected.

Furthermore, the government refused to test. The so-called sentinel method was favored for case detection, instead of carrying out massive tests.

By the time there were vaccines, Mexico was one of the first countries to have access to them, but it was not thanks to the management of the Ministry of Health team, but rather the Ministry of Foreign Affairs because what they were looking for were savings.

The problem then was that we started with the foolishness of involving the so-called Roadrunner Brigades made up of the so-called Servants of the Nation in the vaccination strategy, which was not efficient.

Faced with this situation, local authorities as well as the governments of Mexico City and Jalisco began to implement much better organized macro-vaccination centers, which in the long run proved to be highly efficient.

When asking the experts if three years after the start of the pandemic, Mexico has a better health sector, Xavier Tello regretted that this is not the case and stressed that this was influenced by the fact that the pandemic arrived just a few days after the federal government it had made the decision to eliminate Seguro Popular and replace it with Insabi, which failed.

Meanwhile, Alejandro Macías Hernández responds: “I don’t think we have improved, at least so far. Yes, I think we can improve but so far we don’t see where. You don’t see a path to a better healthcare system yet.”

This situation, emphasizes the specialist, poses a dilemma: either we improve that or we will be in serious danger, not only in terms of the health of the population, but also for the attack of a future pandemic.

diego.badillo@eleconomista.mx