These Countries Have The Highest COVID-19 Infection Rates. This Is What The US Has In Common With Them.

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The pandemic has put the United States in unusual and humbling global company.

Once viewed as a beacon of government competence and a model for public health, the US has fumbled the response to the coronavirus pandemic even more than countries known for widespread corruption, poor healthcare, and ubiquitous poverty — to the shock of many around the world. By many measures, the US is now faring worse than Mexico, Brazil, India, and Russia.

This is not lost on people in those countries, many of whom are watching the situation unfold in the US with shock and bewilderment.

Roxana Sánchez, an economist in Mexico City, has always resented her country’s corrupt presidents and looked longingly at the seemingly upright politics of the US. But these days, as she watches President Donald Trump musing on television about drinking disinfectant, she sees in the US an even more dangerous kind of leader: an ignorant one.

Alexey Raksha, an independent demographer in Moscow, grew distressed this summer as he watched Russians emerge from months of lockdown and promptly begin partying, going to restaurants, and generally ignoring recommendations from public health experts. Coronavirus cases in the country surged. When he turned on the TV, he was shocked to see similar scenes playing out in the US. It looked to him like Russia’s impoverished, remote regions “had a lot in common with states like Florida, Texas, and Georgia, where cases are currently spiking.”

“In the countries where the death toll is the highest, there is no real leadership.”

Nondita D’Souza, principal of a school in western India, watched with dismay as parents in her area threw temper tantrums when schools closed because of the pandemic; she then experienced a jolt of disappointment and recognition as the same kinds of debates playing out in the US.

While these countries seem so different, the response to the pandemic in each place has underscored all the other things they have in common: populist or authoritarian-leaning leaders, officials who have flouted the advice of their top scientists while pushing absurd remedies to fight the virus, and enormous swaths of the population with no safety net to help them stay at home.

“The US is no longer an example for other countries to follow,” said Sánchez, the Mexico City economist. Instead, she said, it has become an example of something else: “In the countries where the death toll is the highest, there is no real leadership.”


MAGICAL THINKING AND CONTRADICTORY MESSAGING

Jam Media / Getty Images

Coronavirus protection candle in esoteric products store in Pachuca, Mexico, April 16.

In all these countries — and others that have emerged as hot spots — top officials initially downplayed the severity of the crisis, fumbled lockdowns, and sometimes even seemed to embrace magical thinking to ward it off.

Mexico’s President Andrés Manuel López Obrador said he carries palm-sized amulets as protective shields against the coronavirus. In Russia, where President Vladimir Putin was largely absent from the country’s response, homemade recipes spread widely, including one for a “miracle drink” of lemon and baking soda to cleanse the body.

Prime Minister Narendra Modi of India proposed banging pots and pans; his followers were quick to circulate videos over WhatsApp suggesting the sound’s “cumulative vibration,” similar to temple bells, would destroy the virus’s potency. Modi also repeatedly extolled the virtue of yoga as a “protective shield” against the virus. Last week, he and several Hindu priests ignored social distancing rules to gather and lay down the foundation stone of a Hindu temple. (Subsequently, a priest who shared the stage with the Modi tested positive for the virus.)

Leaders had waved off the advice of their top scientists, so why shouldn’t everyone else?

In the wake of such messaging, people in these countries have often failed to take the virus seriously themselves. Leaders had waved off the advice of their top scientists, so why shouldn’t everyone else? Especially since, as in the US, many people were told they had to choose between public health and the economy, between catching an illness their leaders have pooh-poohed and putting food on the table.

By April, as the number of infections was multiplying rapidly in Brazil, President Jair Bolsonaro, who called the disease caused by the coronavirus a “little flu,” fired his widely beloved health minister, Luiz Henrique Mandetta. While Mandetta had been urging social distancing, Bolsonaro demanded people return to work.

In Russia, Putin initially ordered a nationwide paid holiday in late March, when there were less than 1,000 confirmed COVID-19 cases, but he quickly sloughed much of the power and responsibility to regional governors. Some of them imposed restrictions on public transport and public gatherings, and citywide lockdowns for those hardest hit; in Moscow, residents were required to download a digital pass to leave home.

But caught off guard, many regional governments were not up to the challenge, and their responses were confusing or lackluster. As a result, many Russians went about their daily lives, flouting or ignoring public health recommendations, such as wearing face masks. News reports described restaurants and bars in Moscow and St. Petersburg as being near full capacity while infections surged; owners complained about the financial hit long-term closures would cause.

Most of the measures were gradually lifted starting in May, when Putin said the country should reopen and people should get back to work. The daily rates of infection surged. Nevertheless, much of the country continued to behave as if everything was fine. A New York Times story published at the beginning of August quoted young Russians who are out partying again at bars without masks because they “want to have a life.”

In Mexico, Hugo López-Gatell Ramírez, the deputy health minister in charge of the government’s coronavirus response, told people to keep their distance, stay home, and wear masks. López Obrador flouted each of these suggestions, continuing to hug people, travel, and go maskless, even in crowded rooms.

One of the only times that López Obrador has worn a mask in public was when he went to meet Trump, who himself has stoked the raging debate over mask use in the US.

In Acapulco, a major tourist port city on Mexico’s Pacific coast, people continued attending weddings and hosting quinceañeras. And it wasn’t just locals — skeptical people from Mexico City who drove to Acapulco to ride out the pandemic in their luxury condominiums have also been throwing parties. The government, despite its lackadaisical and conflicted stance, eventually deployed the Mexican National Guard to break them up.

“It has been a challenge to make people understand that the coronavirus is, for starters, real,” Adela Román Ocampo, the mayor of Acapulco, told BuzzFeed News.

At the same time, when many of these places did finally lock down, they did so without a plan to boost the social safety net.

In India, Modi imposed one of the harshest lockdowns in the world in late March. Some people were confined to their homes for weeks, but the lockdown also left millions stranded without work, unable to make rent, or feed their families and also unable to leave the cities for their hometowns.

This, according to Supriya Sharma, an editor at the Indian news website Scroll.in, is when the trouble began. “Rural migrants were forcibly held back in cities for two months as infections rose. When they were finally allowed to go home, they took the virus from urban hotspots to rural areas across the country,” Sharma told BuzzFeed News over email. “Now, cases are rising in every state, every region of the country — even Bihar and Odisha where the health infrastructure is extremely poor. Frontline workers are fatigued, hospitals are overwhelmed, and the economic crisis means there’s little scope for any more lockdowns.”

There are echoes of all this in what has happened in the US. In April, Trump famously spoke on national television about the possibility of shining a powerful beam of light or disinfectant inside patients to kill the coronavirus. He also repeatedly called for the economy, and later schools, to be reopened, absent what many experts said was a real plan to do so safely. His administration has undercut his own public health experts, as when his aides provided campaign-style opposition research on Dr. Anthony Fauci.

What these leaders have in common “is the inability to navigate ambiguity and the need for certainty, even when it’s baseless” Michael S. Roth, president of Wesleyan University, told BuzzFeed News. “And in a pandemic, that becomes a deadly combination.”


POOR HEALTHCARE SYSTEMS

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A health worker in New Delhi wearing a protective suit takes a nasal swab from a man to test for COVID-19.

Even before the pandemic, public healthcare in these countries was in trouble. Many hospitals suffered from crumbling infrastructure, medicine shortages, and ill-prepared staffers.

In Mexico, López Obrador implemented steep budget cuts shortly after his inauguration in 2018. Doctors, nurses, and patients complained of empty medicine cabinets and delayed surgeries. When the coronavirus hit the country of 126 million, many people stayed away from hospitals, which are perceived as inefficient and even dangerous.

Blanca Imelda, a nurse in a clinic in Culiacán in Sinaloa state, became infected with the virus in late April. Immediately, she told her children: “If I get very ill, I’d rather die at home than over there,” referring to the local hospital. Imelda, 58, said doctors didn’t have the resources to give patients optimal care.

When her son became infected, a doctor told her by telephone to administer hydroxychloroquine. Her son had a bad reaction; Imelda was unable to care for him at home, and she rushed him to the hospital. Staffers told her that he was no longer infected and turned them away. As Imelda hooked him up to an IV at home, she prayed, asking God to spare him. He survived.

In Russia, the healthcare system has been underfunded and in abysmal shape for decades. With the exception of some hospitals in Moscow and St. Petersburg, the country’s two most populated cities, most healthcare facilities are dilapidated and suffer severe shortages of doctors, nurses, equipment, and medication. Moreover, medical staffers work long hours (sometimes 48-hour shifts with just 24 hours in between) for very little money, according to news reports and experts who spoke to BuzzFeed News. Then came the pandemic, inundating already overburdened hospitals and doctors with far more patients than they were used to seeing.

As Imelda hooked him up to an IV at home, she prayed, asking God to spare him. He survived.

Dmitry Seryogin, a paramedic in the city of Oryol, about 225 miles south of Moscow, told BuzzFeed News that early in the pandemic there was a severe lack of personal protective equipment for hospital staffers, leading to medical workers getting infected with the coronavirus. Many doctors and nurses died — but their deaths often went unreported. So Alexey Erlikh, a Moscow cardiologist, cofounded an advocacy group for medical workers that created a “memory list” of Russian healthcare workers who have died of COVID-19 after treating coronavirus patients.

The situation is eerily similar in India, where the number of cases has crossed 1.5 million. Some estimate the country could overtake the US and Brazil with the most cases in the world by early 2021. At present, India has seven doctors and 17 nurses for every 10,000 people. (The global average is 13.9 doctors and 28.6 nurses per 10,000.)

Meanwhile, many people in India have treated medical professionals as a threat, worried that they are carrying the virus. Medics in several parts of the country were harassed, assaulted, and even evicted on suspicion of being infected until the government finally intervened, warning citizens and police to lay off frontline workers.

The US, by contrast, spends more than any other country on healthcare. And yet its system has also buckled. As the Atlantic’s Ed Yong noted, the country has squandered immense resources, leaving citizens and healthcare workers prey to an expensive and ineffective healthcare system. Meanwhile, a history of systemic racism in its healthcare system further endangers already vulnerable sections of the population.


SPOTTY TESTING AND QUESTIONABLE STATS

Sergei Konkov / Sergei Konkov/TASS

An employee of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing scanning passengers' body temperatures with a thermal imaging camera at Pulkovo International Airport in St. Petersburg.

On top of crumbling public health systems and the “magical thinking” approach, these countries have also been plagued by spotty testing; plus, in many cases, faulty or manipulated statistics have made it difficult or impossible for public health officials and epidemiologists to get a handle on the spread.

This has played out in the US ever since the pandemic’s early days, beginning when errors at the CDC led to a severe shortage of tests. Since then, Trump has repeatedly promoted a specious claim that case numbers are high due to the country’s high testing volume, and has even called for slowing down testing. In recent weeks, testing has declined sharply in hot spot states, which has epidemiologists worried that cases are being missed.

In India, the health ministry has wheeled out statistics to boost public confidence. But the country’s testing rate is dangerously low: While more than 2 million tests have been administered, India is still only testing around 4,100 people per million. (The global average is 29,000 tests per million.) Sulakshana Nandi, director of People's Health Movement, a rural health advocacy group, told BuzzFeed News that “huge number of cases are being missed, mainly due to grossly inadequate testing.”

Even the one thing Modi has congratulated himself for — that India has the lowest fatality rate among the worst-affected countries — might be false.

“We are missing COVID-19 deaths in the same way that we are missing cases due to less testing,” Nandi said. “In India, death-reporting by the government has always been a problem. There is a long-standing practice of underreporting specific disease mortality. We have seen that with regards to malaria, tuberculosis, dengue, and many others.”

“In my opinion, the number of cases and deaths may be underestimated in order to calm the population.”

In Russia, health experts and a former government statistician told BuzzFeed News that the number of coronavirus cases and related deaths are being drastically undercounted.

Alexey Raksha, the Moscow demographer, worked for Rosstat, the Russian federal statistics agency, before being forced out early this year for speaking out about flaws in its recording system. He has studied mortality rates throughout the county since the early days of the pandemic and compared them with official death counts. He quickly found inconsistencies, he said.

For instance, the number of deaths recorded in Moscow in April, 11,846, was almost 20% higher than that of the same month last year, and in May the number was 15,713, about 58% higher that the previous year, Raksha said. Yet in April this year, just 658 deaths were attributed to COVID-19, and in May the figure was just 2,757. Reports from the city of St. Petersburg and across the country were similar, Raksha said. That suggests that officials were missing or undercounting deaths.

Russia’s Ministry of Health had reported 932,493 cases and 15,872 deaths as of Wednesday. But based on Raksha’s calculations, the actual number of coronavirus cases in the country “could probably be 1.2, 1.3, or 1.4 million” with the true number of deaths closer to 40,000.

COVID-19 Hall Of Shame

As of August 21, 2020

Brazil
Population: 210 million
Reported infections: 3,501,975
Reported deaths: 112,304

Populist right-wing leader. Universal healthcare but public health expenditure per capita has been declining. Independent media that Bolsonaro deems his enemy.

India
Population: 1.4 billion
Reported infections: 2,905,825
Reported deaths: 54,849

Populist, right-wing leader. A once robust public healthcare system has crumbled under years of neglect, leaving behind a few stretched high-quality public hospitals. Those who can afford it go to private hospitals that have a reputation for price gouging. Almost all media is corporate-owned, and almost all of it kowtows to the BJP.

Mexico
Population: 127 million
Reported infections: 543,806
Reported deaths: 59,106

Populist left-leaning leader (with major caveats). Global healthcare though in shambles (medicine shortages, crumbling infrastructure). Mix of independent and state-funded media.

Russia
Population: 144 million
Reported infections: 939,833
Reported deaths: 16,058

Authoritarian leader. State-provided healthcare. Powerful and obedient state-run media.

US
Population: 331 million
Reported infections: 5,573,847
Reported deaths: 174,255

Populist right-wing leader with authoritarian tendencies who has downplayed and politicized the outbreak. Poorly coordinated federal response on testing coupled with expensive and ineffective private healthcare system. Trump frequently characterizes media coverage of pandemic as fake news.

Source: Johns Hopkins University

Seryogin, the paramedic in Oryol, said he also doubts the official coronavirus statistics, based on what he has seen. “In my opinion, the number of cases and deaths may be underestimated in order to calm the population,” he said.

He added that limited testing is partly to blame for the alleged inaccuracies. He said people are currently only tested for COVID-19 at hospitals when they are diagnosed with pneumonia and that authorities are also not counting deaths as being related to COVID-19 if the person had a preexisting condition.

For the government’s part, Russian Deputy Prime Minister Tatyana Golikova lauded the country’s testing capacity in April. As of Wednesday, it had conducted a total of 17,803,955 tests, according to the Ministry of Health. Moreover, Putin boasted this month of approving the world’s first coronavirus vaccine, although there is skepticism over its efficacy and safety.

And in Mexico, officials admitted that there were 71,314 excess deaths in 20 of the 32 states between March 15 and June 27 — the official COVID-19 death count is just 59,106. The government came under fire in May, after the news media reported that the death toll in Mexico City was more than three times what the official figures claimed.

By July, half the tests in Mexico were coming back positive, a sign that only those who present serious symptoms are getting tested. According to the World Health Organization, countries should not reopen their economies until they get test positivity rates at 5% or lower.

Yet, despite Mexico having the highest percentage of positive tests in the world, restaurants in many parts of the country boast full tables, stores are trying to lure people back with deep discounts, and subway platforms are packed.


ON THEIR OWN

Silvia Izquierdo / AP

Crosses, red balloons, and Brazilian flags are placed in the sand on Copacabana beach in a demonstration to honor the victims of COVID-19, as the country heads to a milestone of 100,000 new coronavirus related deaths, in Rio de Janeiro, Aug. 8.

Mriga Kapadiya, co-owner and cofounder of the NorBlack NorWhite apparel line, is a Canadian citizen of Indian origin who found herself locked down in south India when travel restrictions first hit the country.

Over the last few months, Kapadiya said, she has regularly checked on friends in Toronto, New York, and Los Angeles. The differences were stark.

In Toronto, her friends had “solid government welfare support,” she said, and “a stable income to at least pay rent and create some time and space to think about next steps.”

But in New York, “the lack of government support, physical space, major job cuts coupled with the uprising and political climate, it seems to be extremely difficult on every single level.”

She sees in New York the same thing as in India: People have given up on the idea that the government will keep them safe, fed, or housed. They are on their own to protect themselves from the virus, and to figure out how to make a living as it rages around them.

Emilio Reyes, an antiques vendor in Mexico City, said he can’t rely on his government. When the pandemic first reached Mexico, Reyes said, he underestimated its potential. And as he watched López Obrador zigzag the country — hugging and kissing people during political events in April, with much of the world already in lockdown — Reyes became convinced the virus was nothing to worry about. But then a relative died. Neighbors and close friends soon followed.

“Mexico doesn’t give a fuck,” he said. “The thing about the government helping people? That’s a show.” ●

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