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‘It’s Not the Virus’: Mexico’s Broken Hospitals Become Killers, Too ‘It’s Not the Virus’: Mexico’s Broken Hospitals Become Killers, Too
(about 1 hour later)
The senseless deaths torment doctors and nurses the most: The man who died because an inexperienced nurse unplugged his ventilator. The patient who died from septic shock because no one monitored his vital signs. The people whose breathing tubes clogged after being abandoned in their hospital beds for hours on end.The senseless deaths torment doctors and nurses the most: The man who died because an inexperienced nurse unplugged his ventilator. The patient who died from septic shock because no one monitored his vital signs. The people whose breathing tubes clogged after being abandoned in their hospital beds for hours on end.
In Mexico, it’s not just the coronavirus that is claiming lives. The country’s broken health system is killing people as well.In Mexico, it’s not just the coronavirus that is claiming lives. The country’s broken health system is killing people as well.
Years of neglect had already hobbled Mexico’s health care system, leaving it dangerously short of doctors, nurses and equipment to fight a virus that has overwhelmed far richer nations.Years of neglect had already hobbled Mexico’s health care system, leaving it dangerously short of doctors, nurses and equipment to fight a virus that has overwhelmed far richer nations.
Now, the pandemic is making matters much worse, sickening more than 11,000 Mexican health workers — one of the highest rates in the world — and depleting the already thin ranks in hospitals. Some hospitals have lost half their staff to illness and absenteeism. Others are running low on basic equipment, like heart monitors.Now, the pandemic is making matters much worse, sickening more than 11,000 Mexican health workers — one of the highest rates in the world — and depleting the already thin ranks in hospitals. Some hospitals have lost half their staff to illness and absenteeism. Others are running low on basic equipment, like heart monitors.
The shortages have had devastating consequences for patients, according to interviews with health workers across the country. Several doctors and nurses recounted dozens of preventable deaths in hospitals — the result of neglect or mistakes that never should have happened.The shortages have had devastating consequences for patients, according to interviews with health workers across the country. Several doctors and nurses recounted dozens of preventable deaths in hospitals — the result of neglect or mistakes that never should have happened.
“We have had many of what we call ‘dumb deaths,’” said Pablo Villaseñor, a doctor at the General Hospital in Tijuana, the center of an outbreak. “It’s not the virus that is killing them. It’s the lack of proper care.”“We have had many of what we call ‘dumb deaths,’” said Pablo Villaseñor, a doctor at the General Hospital in Tijuana, the center of an outbreak. “It’s not the virus that is killing them. It’s the lack of proper care.”
Patients die because they’re given the wrong medications, or the wrong dose, health workers say. The protective gloves at some hospitals are so old that they crack the moment they’re slipped on, nurses say. People are often not sedated properly, then wake up and yank out their own breathing tubes, hospital employees say.Patients die because they’re given the wrong medications, or the wrong dose, health workers say. The protective gloves at some hospitals are so old that they crack the moment they’re slipped on, nurses say. People are often not sedated properly, then wake up and yank out their own breathing tubes, hospital employees say.
Adriana de la Cruz, a nurse at Dr. Belisario Domínguez hospital in the southeast corner of Mexico City, said the overstretched and often undertrained work force has made glaring errors — at great cost.Adriana de la Cruz, a nurse at Dr. Belisario Domínguez hospital in the southeast corner of Mexico City, said the overstretched and often undertrained work force has made glaring errors — at great cost.
“People have died because of a lack of medical attention and because of negligence,” said Ms. de la Cruz. “These patients would have a better chance of surviving if we could offer better care.”“People have died because of a lack of medical attention and because of negligence,” said Ms. de la Cruz. “These patients would have a better chance of surviving if we could offer better care.”
The Mexican government spends less on health care as a percent of its economy than most countries in the Western Hemisphere, according to the World Bank, and President Andrés Manuel López Obrador presided over spending cuts even after acknowledging his country had 200,000 fewer health care workers than it needed.The Mexican government spends less on health care as a percent of its economy than most countries in the Western Hemisphere, according to the World Bank, and President Andrés Manuel López Obrador presided over spending cuts even after acknowledging his country had 200,000 fewer health care workers than it needed.
When the epidemic hit Mexico in March, many hospitals sent front-line workers to confront the deluge of cases without any protective equipment or training. Some nurses say they were told not to wear masks to avoid causing panic. Many say they were forced to buy face shields and goggles themselves.When the epidemic hit Mexico in March, many hospitals sent front-line workers to confront the deluge of cases without any protective equipment or training. Some nurses say they were told not to wear masks to avoid causing panic. Many say they were forced to buy face shields and goggles themselves.
The fallout has been severe. About one in five confirmed cases in Mexico are health workers — a greater share than in the United States, Italy or China.The fallout has been severe. About one in five confirmed cases in Mexico are health workers — a greater share than in the United States, Italy or China.
Mexico’s outbreak is growing quickly and shows no signs of slowing. Reported cases and deaths have risen every week for the last couple of months, hitting Mexico City and Baja California, which includes Tijuana, particularly hard.Mexico’s outbreak is growing quickly and shows no signs of slowing. Reported cases and deaths have risen every week for the last couple of months, hitting Mexico City and Baja California, which includes Tijuana, particularly hard.
After a Times analysis found evidence that federal authorities were underreporting fatalities, a top federal health official publicly conceded that the government does not have an accurate count of deaths caused by the virus.After a Times analysis found evidence that federal authorities were underreporting fatalities, a top federal health official publicly conceded that the government does not have an accurate count of deaths caused by the virus.
At Dr. Villaseñor’s hospital, there are so few doctors left that during some shifts, critically ill patients are going eight hours without anyone checking on them, he said.At Dr. Villaseñor’s hospital, there are so few doctors left that during some shifts, critically ill patients are going eight hours without anyone checking on them, he said.
“You hear of one patient dying because he didn’t get the proper care — and then another one and another one — and you try not to become paralyzed,” added Dr. Villaseñor, a rheumatologist who said he had to learn how to suit up to treat coronavirus patients by watching a video on YouTube.“You hear of one patient dying because he didn’t get the proper care — and then another one and another one — and you try not to become paralyzed,” added Dr. Villaseñor, a rheumatologist who said he had to learn how to suit up to treat coronavirus patients by watching a video on YouTube.
As Mexico’s population grew during the last decade, the government kept hospital funding low, devoting less than 3 percent of its national output to health care. World Bank data shows that by 2017, well before Mr. López Obrador took office, only two countries in Central and South America spent less on health than Mexico as a share of their economies: Guatemala and Venezuela.As Mexico’s population grew during the last decade, the government kept hospital funding low, devoting less than 3 percent of its national output to health care. World Bank data shows that by 2017, well before Mr. López Obrador took office, only two countries in Central and South America spent less on health than Mexico as a share of their economies: Guatemala and Venezuela.
“Administration after administration gave lip service to the issue of health, but it never showed up as a priority in the budget,” Judith Méndez, an analyst at the Economic and Budgetary Research Center, said of Mexico’s successive governments.“Administration after administration gave lip service to the issue of health, but it never showed up as a priority in the budget,” Judith Méndez, an analyst at the Economic and Budgetary Research Center, said of Mexico’s successive governments.
The Mexican government did not respond to repeated requests for comment. Local health ministers in Baja California and Mexico City also declined to comment.The Mexican government did not respond to repeated requests for comment. Local health ministers in Baja California and Mexico City also declined to comment.
Patients have filed thousands of complaints with the country’s human rights commission about negligence in hospitals in recent years. And the quality of care only diminished further after hospital workers in Mexico endured some of the nation’s first coronavirus outbreaks.Patients have filed thousands of complaints with the country’s human rights commission about negligence in hospitals in recent years. And the quality of care only diminished further after hospital workers in Mexico endured some of the nation’s first coronavirus outbreaks.
Many countries have struggled with doctors and nurses falling ill, but in Mexico the problem is particularly bad. The government’s data suggests around one in five confirmed coronavirus cases in the country are health workers.Many countries have struggled with doctors and nurses falling ill, but in Mexico the problem is particularly bad. The government’s data suggests around one in five confirmed coronavirus cases in the country are health workers.
“If health workers are getting sick at this rate, bottom line is you risk not having a health work force to look after people,” said Howard Catton, the chief executive of the International Council of Nurses.“If health workers are getting sick at this rate, bottom line is you risk not having a health work force to look after people,” said Howard Catton, the chief executive of the International Council of Nurses.
Ms. de la Cruz, the nurse in Mexico City, said that her hospital initially instructed employees not to wear masks around a patient until the person tested positive for coronavirus.
Updated June 22, 2020Updated June 22, 2020
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
Ms. de la Cruz, the nurse in Mexico City, said that her hospital initially instructed employees not to wear masks around a patient until the person tested positive for coronavirus.
“You waited three or four days to see if the patient tested positive, and in the meantime you got infected,” said Ms. de la Cruz, who noted that 80 of her colleagues have gotten sick.“You waited three or four days to see if the patient tested positive, and in the meantime you got infected,” said Ms. de la Cruz, who noted that 80 of her colleagues have gotten sick.
Some hospitals did prepare early for the virus, which swept the United States and Europe before outbreaks flared in Mexico. In Monterrey, doctors said protocols to shield workers were put in place months ago. Rodolfo Ruiz, an infectious disease specialist, says he feels protected at his public hospital in Mexicali, even as hospital beds fill up.Some hospitals did prepare early for the virus, which swept the United States and Europe before outbreaks flared in Mexico. In Monterrey, doctors said protocols to shield workers were put in place months ago. Rodolfo Ruiz, an infectious disease specialist, says he feels protected at his public hospital in Mexicali, even as hospital beds fill up.
But the missteps in some of the hardest hit cities have brought overrun hospitals to a breaking point, workers say. Doctors and nurses have staged protests outside their hospitals in at least a dozen states, according to local news reports. Some doctors and nurses have refused to treat coronavirus patients.But the missteps in some of the hardest hit cities have brought overrun hospitals to a breaking point, workers say. Doctors and nurses have staged protests outside their hospitals in at least a dozen states, according to local news reports. Some doctors and nurses have refused to treat coronavirus patients.
Rosario Luna, a nurse at the José María Morelos and Pavón hospital in Mexico City, described treating Covid-19 patients with broken heart monitors and faulty suction machines.Rosario Luna, a nurse at the José María Morelos and Pavón hospital in Mexico City, described treating Covid-19 patients with broken heart monitors and faulty suction machines.
Doctors and nurses say that many errors inside hospitals are never investigated, in part because overtaxed health workers are unlikely to lodge complaints against their own colleagues.Doctors and nurses say that many errors inside hospitals are never investigated, in part because overtaxed health workers are unlikely to lodge complaints against their own colleagues.
At Dr. Carlos Mac Gregor hospital in Mexico City, Berenice Andrade, a doctor, said that one internist quit because of the lack of personnel and that only one doctor watched over 54 patients during the weekends.At Dr. Carlos Mac Gregor hospital in Mexico City, Berenice Andrade, a doctor, said that one internist quit because of the lack of personnel and that only one doctor watched over 54 patients during the weekends.
“It makes the care we offer very deficient,” said Dr. Andrade. “The patient’s health is of course affected.”“It makes the care we offer very deficient,” said Dr. Andrade. “The patient’s health is of course affected.”
Five health workers have died at La Raza Medical Center, a public hospital complex in Mexico City, according to a spokesman for the federal health system. This month, one of the hospitals started offering psychological support to workers.Five health workers have died at La Raza Medical Center, a public hospital complex in Mexico City, according to a spokesman for the federal health system. This month, one of the hospitals started offering psychological support to workers.
“It’s not easy knowing that one day you were working with someone and the next, they aren’t there anymore,” said Ivette Díaz, an intensive care nurse, who is 37 and lives with her elderly parents. “I’m scared every day. My alarm goes off and I don’t want to go to work.”“It’s not easy knowing that one day you were working with someone and the next, they aren’t there anymore,” said Ivette Díaz, an intensive care nurse, who is 37 and lives with her elderly parents. “I’m scared every day. My alarm goes off and I don’t want to go to work.”
The hospital has never had enough supplies, she said. Bandages don’t stick to patients because they’ve lost their adhesive. But after her colleagues blocked roads leading into the hospital last month, executives began providing more protective equipment. Still, the masks that they gave out were perforated, because of a manufacturing flaw, Ms. Díaz said.The hospital has never had enough supplies, she said. Bandages don’t stick to patients because they’ve lost their adhesive. But after her colleagues blocked roads leading into the hospital last month, executives began providing more protective equipment. Still, the masks that they gave out were perforated, because of a manufacturing flaw, Ms. Díaz said.
“If here in Mexico they invested in the health sector, if we had adequate materials, things would look very different,” she said.“If here in Mexico they invested in the health sector, if we had adequate materials, things would look very different,” she said.
She spent her day off recently scouring the streets of her neighborhood until she found a local vendor to sell her a batch of masks. She paid $7 for each, a small price for a mask free of holes, she decided.She spent her day off recently scouring the streets of her neighborhood until she found a local vendor to sell her a batch of masks. She paid $7 for each, a small price for a mask free of holes, she decided.