Tough weeks ahead for South America's COVID-19 hot spots

As the global COVID-19 total passed 5 million last week, cases in Latin America—the current epicenter—passed the United States and Europe in number of cases, and though Brazil's total is highest in the region, health officials are worried about an even higher incidence in Chile and Peru, where outbreaks are accelerating.

The global total today climbed to 5,550,399 cases, and 348,447 deaths have been reported, according to the Johns Hopkins online dashboard.

Multiple South American hot spots

The assessment came from the director of the World Health Organization (WHO's) Pan American Health Organization (PAHO), Carissa Etienne, MBBS, MSc, at a media briefing today. She said cases in Brazil increased by 5% last week, with an even higher increase in Chile, at 7%. She said Peru and Mexico both reported 4% increases.

For deaths, three PAHO countries reported the highest numbers of new deaths: the United States, Brazil, and Mexico.

Etienne said modeling projections, which are a useful tool but should not be taken literally, suggest that several countries in Latin America will see increases in the weeks ahead. They reflect a steep increase for Nicaragua and accelerating outbreaks in some Central American countries, including El Salvador and Guatemala. Further increases are predicted for Mexico, Brazil, Peru, Chile, and Ecuador, she said.

Brazil is expected to reach about 1,020 deaths a day by June 22 and about 88,300 deaths by August.

Marcos Espinal, MD, PhD, PAHO's director of communicable diseases, said totals in South America are likely an undercount. "Most countries in South America are not testing at the level they should," he said, adding that increased testing capacity is the only way to have a clear picture of the situation.

He said Brazil's state governments have taken actions, and PAHO stands ready to continue helping Brazil, which recently became the country with the second highest COVID-19 total. "They still have a long way to go," he said.

Impact on noncommunicable disease care

Etienne said one of the most concerning thing about the pandemic is the oversized impact of the disease on people with noncommunicable diseases (NCDs) such as hypertension, cardiovascular disease, and obesity. She said 1 in 4 people in the Americas are at risk for COVID-19 complications due to underlying health conditions.

Compounding the increased risk, stay-at-home orders and fear of visiting health facilities have led to fewer clinic visits and less access to care for people with underlying conditions, Etienne said, which could lead to parallel deaths from COVID-19 and noncommunicable diseases. She called on countries in the Americas to tackle the problem head on by protecting and supporting at-risk groups and ensuring supply chains of drugs to treat underlying conditions.

"It is important to find safe methods of delivering essential clinical care for people with NCDs during the pandemic," she said. "Many countries are quickly scaling up telemedicine, prioritizing scheduled appointments to avoid crowded waiting rooms."

In other developments, at an international donors conference today led by the Spanish government and the European Union, more than 60 countries pledged $3.4 billion to help 5 million Venezuelan citizens who have fled to other South American nations due to the country's economic collapse. "All the actors taking part in this meeting have given testimony to the world of the worst displacement crisis Latin America and the Caribbean have suffered in its recent history," the group said in a statement.

Africa outbreaks show mixed patterns

Africa's case total recently passed 100,000, and while cases increased 15% last week, countries are reporting different trends. Currently, 25 are experiencing community transmission, and 15 are battling clusters, the WHO's African regional office said yesterday in its weekly update. The seven countries reporting the steepest increases last week include Comoros, Mauritania, South Sudan, Central African Republic, Ethiopia, Madagascar, and the Democratic Republic of the Congo. However, the three countries with the most cases are still South Africa, Algeria, and Nigeria.

Angola last week reported its first infection in a healthcare worker, and so far, 2,007 have been infected from 32 of Africa's countries.

In other developments, South Africa today announced that churches can reopen in June, with gatherings limited to 50 people, part of gradual loosening of restrictions, Reuters reported.

In other global COVID-19 developments:

  • The United Kingdom announced today that the experimental antiviral drug remdesivir, developed by Gilead, will be available to patients who meet certain clinical criteria, similar to emergency use measures approved by the United States and Japan.

  • Saudi Arabia today announced that mosques can reopen for Friday prayers with certain restrictions starting May 29, part of gradual loosening of restrictions. The country's curfew will be lifted in phases and is slated to end on Jun 21 everywhere except Mecca, Reuters Haj and Umrah pilgrimages are still banned until further notice. Elsewhere in the Middle East, Holy Land churches reopened to worshipers and visitors today, part of scaled-back restrictions by Palestinian Authority and church officials.

Wuhun, China's former epicenter, has tested 6.5 million people since May 14 in an effort to identify asymptomatic carriers and prevent another wave of illnesses, following the recent detection of a cluster in a residential housing area, Xinhua, China's state media, reported yesterday.

As of May 24, testing had identified 206 asymptomatic cases, Caixin, a Beijing-based media group, reported. Health officials have used pooled samples to test in batches, and labs are processing about 46,000 tests a day, the New York Times reported.

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