Whenever I Throw Away a Mask, I Think of Venezuela and I Freak Out

https://www.nytimes.com/2020/03/24/opinion/venezuela-coronavirus.html

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ÁVILA, Spain — In this small city about an hour northwest of Madrid, the streets are deserted, the emergency rooms are on the brink of collapse, and anxiety and fear are everywhere. It all feels very familiar.

In 2017, I was living in Mérida, a city in the Andes Mountains of northwestern Venezuela, where I was a resident doctor. The country was racked by near daily protests that often turned violent. I would be overcome with worry whenever I stepped out to walk what felt like the longest mile to the hospital where I worked. I’d wonder, “Will this be the day the country crumbles?”

I now treat critically ill patients in an advanced life support ambulance. Our mobile intensive care unit winds down formerly traffic-clogged streets, now silenced by the lockdown. Early on it became clear that if we didn’t do something to prevent the spread of the virus, we would soon be overwhelmed. My unit has already nearly depleted our supply of disposable protective equipment. Every time I throw a used mask in the trash, it takes me back to my time in Venezuela and I freak out.

Spain now has the second-highest number of Covid-19 infections in Europe. Its health care system is ranked among the best in the world, and the population is among the healthiest. And yet the pandemic has brought the country to its knees and tested the credibility of its democratic institutions.

What will happen in a country like Venezuela, where hospitals have already collapsed, and institutions treat people as a latent threat that must be monitored and dominated at all times? Just in February, there were an average of 26 protests a day, largely fueled by a lack of basic services such as water.

On Sunday, President Nicolás Maduro announced that there were 77 confirmed cases of coronavirus in the country, and claimed the infected were all “imported” from other countries like Spain, the United States, Italy and Colombia. He also declared that 135 people had been tested and that “two million more tests” would be carried out this week.

But it’s unlikely that a country in the throes of a deep economic crisis, with 3.7 million undernourished people and a health care system that’s been practically incapacitated by decades of poor management and corruption, would be able to manage the coronavirus. “These are the conditions for a perfect storm,” Dr. José Félix Oletta, a former minister of health, said earlier this month. “We could have a huge problem.”

The virus will ravage an already devastated system. Hospitals can’t serve the current population even under normal conditions. They are overcrowded, dirty and lack basic equipment and medicines. When I was doing my residency in Mérida, I often had to bring my own bottles of water in order to be able to wash my hands or face during shifts. Finding a working, clean bathroom was a challenge. In 2019, at least 50 percent of I.C.U.s reported significant shortages of medicine and supplies.

Just two weeks ago, 70 percent of hospitals didn’t have the tests to diagnose Covid-19. And there are only two centers authorized to carry out the diagnosis of the virus using molecular tests. One is at the National Institute of Hygiene in the capital of Caracas, and the other is the University of the Andes in Mérida, where I studied, which has the capacity to perform 20 tests a day. Testing kits, provided by China, will be transported to these centers alone — increasing the time required to obtain results and making the monitoring of the infection more difficult in a country of around 26 million people. (Since 2016, nearly six million Venezuelans have left the country because of its economic collapse and political instability.)

According to the W.H.O., the Venezuelan health system has just eight hospital beds for every 10,000 inhabitants. Unofficial figures — official ones are not published — indicate that there are only 84 intensive-care beds nationwide.

Even before the pandemic, it was not uncommon to tend to patients in chairs or on the floor. Many spent days lying in makeshift beds we lined up in corridors, and would desperately beg to be given a room. In Venezuela, power failures caused 79 deaths even before the terrible national blackout on March 5, 2019. The situation has not improved since then. Doctors have performed surgeries in the dark, using cellphone flashlights. Patients who need artificial ventilation sometimes have to be manually ventilated by their families.

When Venezuela confirmed its first cases of the coronavirus on March 13, Mr. Maduro did not hesitate to impose quarantines and curfews in many parts of the country. The government further limited the purchase of gasoline and required people to wear face masks to take mass transportation (where it still exists), though the World Health Organization recommends that only the sick, or those tending to them, should do so. The near-complete dearth of information has generated rumors and uncertainty among a population that believes little or nothing of what its rulers say.

The Venezuelan government has imposed a total quarantine. But for many people that’s simply not possible. In a population already plagued by hunger, where you have to go out to earn a living and search for food, quarantine is an unaffordable luxury. No one with an empty stomach is going to care about an invisible enemy. Some fear that the regime will use the crisis as a pretext to further tighten control over a society already in the grip of a humanitarian crisis.

To mitigate the catastrophe, the unimpeded entry of humanitarian aid, the publication of epidemiological data and the distribution of equipment, supplies and medicines in hospitals are paramount.

Otherwise, for a country that seemed to hit rock bottom long ago, there may be worse to come.

Astrid Cantor, @Megarockerita, is a Venezuelan medical surgeon currently working in Ávila, Spain. She writes for Caracas Chronicles and Cinco8.

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