The Costa Rican Formula against the COVID 19 Virus
BBC Mundo, the Spanish version for Latin America for BBC World, released today an article outlining the factors that made Costa Rica the country with the lowest mortality rate of the virus in Latin America.
This is the translated version of the article as it was only published in BBC Mundo and not in the English version of the site. The copyright of the article belongs to BBC Mundo, and you can read the original article here in Spanish.
After spending a terrible night, with fever and severe headaches and shoulders, Henry * did not hesitate to go to the sanatorium the next morning in San José, Costa Rica.
It was March 9, three days after the first case of the new SARS-CoV-2 coronavirus was detected in the country, which to date has left just over 700 infections but only 6 deaths in the Central American nation.
At the government health center, he and his mother, who also had symptoms, were given some basic tests and sent back home.
“They told me that I had a very large throat infection,” he tells BBC Mundo by telephone.
The 50-year-old Venezuelan, residing in Costa Rica, suspected that he had caught covid-19 in his office, as another employee tested positive a few days earlier, after returning from a trip to Europe.
By March 17, Henry went back to the sanitarium to have samples taken. And four days later he received an email: he and his mother tested positive for covid-19.
Despite having some discomfort, and that his mother is at greater risk when he reaches the age of 70, his treatment had to be carried out at home. His wife and daughter were also infected.
Henry assures that they never felt abandoned in the disease, but quite the opposite.
“From March 21 and until about 10 days ago, doctors came here for at least one day yes and one day no ” to closely follow the treatment, explains Henry.
They were visited by health workers from the Basic Teams for Comprehensive Health Care (EBAIS), and their doctor was in contact with the family through WhatsApp messages.
Health workers go to patients’ homes to deliver medicines and verify their treatments.The EBAIS system has been the first line of response to the pandemic in Costa Rica and represents one of the keys that have allowed the country to have the lowest covid-19 case fatality rate in Latin America, experts say.
As the country reaches two months from the first detected case, only six patients have died and as of Wednesday there were only 16 hospitalized out of some 400 active cases.
More than 320 people have recovered from the disease.
“Our best vaccine against covid-19 is to have a disciplined and educated population, and a fairly consolidated health system,” Dr. Luis Villalobos, a public health expert from Costa Rica, tells BBC Mundo.
“We do not spend on the army, but we do spend a lot on health, social security and education, and that has been very important,” adds the also former dean of the Faculty of Medicine at the University of Costa Rica.
A solid health system
The Costa Rican health system was highly fragmented in the 20th century, Villalobos explains, but reforms in the 1990s and 2000s created a solid framework that has enabled it to respond to this pandemic.
Through more than 1,000 EBAIS clinics, which are staffed by doctors, nurses, technical assistants and pharmacists, clinicians are treating covid-19 cases at the detection stage, which is crucial for containing infections.
As in the case of Henry, since a possible case is identified, active monitoring of symptoms is maintained until confirmation . If a patient worsens, then he goes to the hospitalization level.
The Costa Rican Social Security Fund has a dozen hospitals throughout the country’s seven provinces, the country’s Ministry of Health told BBC Mundo.
The most complicated moments in these last two months occurred between March 19 and April 3, when 325 new infections were confirmed. The worst day was March 24, with 60 cases.
The advance of the covid-19 in Costa Rica
The first confirmed case occurred on March 6.
However, since then the progression of the disease has decreased markedly: less than 20 new cases are detected every day (except for two days) and even fewer than 10 in the last days.
Having only 16 hospitalized patients has made almost all of the hundred beds available to exclusively treat covid-19 patients, according to figures from the Ministry of Health.
Artificial respirators, which many countries are struggling to obtain, are about 400 in the health system, and the government announced the acquisition of 300 more.
But only eight people were in intensive care as of this Wednesday.
And having only 6 deaths from covid-19 in almost two months has made Costa Rica one of the countries with the lowest mortality rate from the disease in Latin America, and even in other regions of the world.
The operation of the system is largely due to the fact that Costa Rica is one of the few countries in the Americas (along with the US, Canada, Cuba and Uruguay) that invests more than 6% of the Gross Domestic Product in health .
Having health systems “less fragmented, comprehensive, that handle the information of the people under their care well, and that is well articulated” as in Costa Rica is what other countries should seek, advises Villalobos.
How else has the country been protected?
When the covid-19 case count in Costa Rica reached its first decade, the government made similar decisions to other countries.
Mass meetings, school years, tourism and social activities were suspended and the border was closed. In addition, campaigns to promote work from home, handwashing and social distancing were launched.
Experts and authorities highlight that Costa Ricans have followed the instructions remarkably , unlike other countries.
A Google report based on the location of mobile phones showed that visits to shops and public spaces were reduced by 84%, and visits to beaches or recreational centers, 82%.
“Many have acted up to it. They have understood the historical moment we are experiencing, it is a very delicate moment,” said Health Minister Daniel Salas last week.
Social distancing practices have been respected in public spaces, experts and authorities say.Villalobos agrees in this, who also says that the transmission of information on mobile phones and universal access to drinking water explain part of the country’s protection formula.
“The fact of having intra-household water in practically 100% of the population allows us to make hand washing communication very effective among the population,” he points out.
Walking on “eggshells”
Costa Rica has a population of 5 million, two thirds settled in the metropolitan area of San José, the capital of the country.
This has allowed the authorities to concentrate resources on the most important sources of infection, so that in the rest of the country the demand for health services has not been so pressing.
Minister Salas points out that the Sentinel model favored the early detection of the disease: “It allows us to know what is happening at the highest, most strategic points in the country,” he said on April 23.
“The moment we have an increase in the cases that are in those sentinel units across the country, it immediately alerts us that there is increased circulation of a virus,” he said.
Costa Rica, however, is not without risks.
Opposition politicians have also called for mass tests to be carried out on the population . The nearly 250 per 100,000 inhabitants place the country in the Latin American average.
In addition, the constant movement of Nicaraguans -8% of the population of Costa Rica- has raised questions about how to control the flow of people from the neighboring country, which has taken no preventive measures.
Minister Salas is cautious about the near future, since he warns Costa Ricans that the return to what was normal cannot be accelerated nor will it come in the medium term.
“Most of the population, due to the short time of the presence of the virus in our country, has not been exposed to the virus, has not been infected with the virus. We can have an increase in cases, transmission chains, intensely, in no time, “he says.
The country is walking on a “very fragile eggshell floor,” he warns.