Bolivia reacts to COVID-19: First panic, then policy

It has been just seven days since the Bolivian Ministry of Health confirmed the first two case of the novel coronavirus disease, COVID-19, in the landlocked South American country, on Tuesday, March 10. The announcement, and the attempts of two patients to seek treatment in the lowland city of Santa Cruz de la Sierra set off a wave of panic in that metropolis, marked by (as best I know, globally unprecedented) protests by doctors, health workers, and neighbors seeking to deny treatment to the infected individuals. Cooler heads prevailed, and treatment sites were eventually proposed. Channeling the panic, several national legislators proposed criminal penalties for either blocking treatment or arriving and failing to quarantine.

Meanwhile, the small highland city of Oruro experienced community transmission of the virus, which now has seven cases (one of them is linked to travel from Italy). Oruro then led a wave of departments and localities in taking community-wide measures to prevent the spread of the virus. Oruro department’s “quarantine” measures are scheduled to last from March 16 to 31.

As of March 17, Bolivia has twelve cases, including four in Santa Cruz department and one in Cochabamba. A patient who died in El Alto was reported as a suspected case, but this claim was negated by the ministry of health.

Blockaded from treatment: A medical nightmare in Santa Cruz

Health workers, with their union banner, blockade the doors of the Japanese hospital in Santa Cruz against the entry of a COVID19 patient.
Map: San Carlos is located 59km west of Montero

On Wednesday and Thursday, March 11 and 12, an infected woman was turned away from at least seven medical facilities in Santa Cruz Department. She contracted the virus abroad and flew to Bolivia via Madrid and Miami, arriving on March 7. After being hospitalized in the town of San Carlos, she was urged to leave by public pressure. On Wednesday, March 11, she sought treatment in the departmental capital, Santa Cruz de la Sierra, Bolivia’s most populous city. There, doctors and other health personnel organized en masse to deny her entry in the San Juan de Dios, Japonés, El Bajío, Francés and Fortaleza hospitals. Neighbors of the District 10 Integral Health Center began their own vigil to keep her out. She ended the day being cared for in the open yard of the departmental government palace.

The following day she was relocated to a public health clinic. El Deber reported,

“After entering the clinic icongnito [with regional government officials,] the patient was installed in one floor. She was the only one on that level. After learning of her case, the [clinic’s] health personnel and the neighbors closed the doors with a padlock and remarked that they would not permit the personnel who brought the patient to leave, otherwise they would be taken out with the [sick] woman. The center was closed to other patients and panic was instilled in the neighbors and the staff.”

Here the son of this unfortunate woman describes her experience:

Fortunately, the Municipality of Santa Cruz and the Colegio Médico (a doctors’ union) stepped up to offer facilities for centralized coronavirus treatment in the city. The municipality proposed the as-yet-unopened Quinta municipal inside the Parque Autonómico. The national government joined in the bidding to repurpose facilities for COVID-19 isolation, offering the Miltary School campus in Warnes (a town north of Santa Cruz) that had been used as an “anti-imperialist” training center by the government of Evo Morales. Residents there immediately put up a blockade in protest.

The Santa Cruz departmental Health Secretary called for urban hospitals to step up: “It’s not possible that we don’t have somewhere to intern [COVID] patients. We can’t take the risk of improvising when we have health centers and public hospitals.” The national health ministry warned doctors of their professional and legal obligations to provide care.

Policy: A fast track to “national quarantine”

Oruro’s lockdown and curfew, announced on March 13, went into effect at 3pm on Monday, March 13. By that day, citywide lockdowns were alos approved in the city of Sucre and the department of Potosí. Oruro and Potosí banned transport in and out their departments. Cochabamba banned public gatherings and imposed restrictions on travel.

At the national level, the crisis prompted the MAS-IPSP leadership to work with interim president Jeanine Áñez on response measures. Áñez annouced the following nationwide restrictions:

  • Working hours, which generally include a midday break period are shifted to eight hours of continuous work (horario continuo) from 8:00 a 16:00 (4pm).
  • Interdepartmental travel is restricted.
  • Meetings and parties of more than 100 people are prohibited.
  • Bars, dance clubs, and night-time businesses are closed until March 31.
  • All schools and universities are suspended.
  • All tariffs on imports of medicine or apparatus that fight the spread of the virus are eliminated.
  • Travel restrictions are imposed on passengers arriving from China, Iran, and affected countries in Europe.

On the night of March 17, the government escalated its response to a “national quarantine,” issuing Supreme Decree 4196. Under it:

  • Everyone must stay in their homes between 5pm and 5am.
  • Paid leave will be provided to safeguard the health of ill people, pregnant women, elders and small children.
  • Commercial facilities may operate from 8am to 3pm.
  • Public transport is restricted to 5am to 6pm, except for long-distance transit designed to supply goods to markets.
  • Beginning 12am on March 21, all international flights, land transport, and boat transport are suspended through March 31.
  • All “gatherings and social, cultural, sporting, religous and other activities that imply the agglomeration of people” are prohibited.
  • Cases of extreme necessity for travel are excepted.

Full text of Supreme Decree 4196.

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