In Chile’s fight against COVID-19, a lot has gone right: from a public health system bolstered by decades of investment, to early negotiations that helped make Chile a world leader on vaccinations.
But with that success, the government allowed an “almost-over” narrative to take hold, bringing Chile to the current state, marked by worrying surges in cases. Chile also missed opportunities to leverage its impressive public health infrastructure to strengthen other interventions—like contact tracing and risk communication.
Javier de la Maza, MD, MSPH, a pediatric emergency physician and assistant professor of Health Communication at Pontificia Universidad Católica de Chile, still sees many reasons for optimism—in Chile’s empowered civil society engaged that advocates for public health interventions, and in a new wave of medical and public health leaders unafraid to demand accountability from the government.
De la Maza, who is also the co-founder and executive director of Ars Medica—an online community to support medical professionals—gives an overview of how Chile has weathered the pandemic in this latest installment of GHN’s COVID Country Dispatches series.
Highs and Lows
After months of massive protests, with people across Chile demanding to remove the constitution the military regime imposed in 1980, public health officials reported the first COVID-19 case. Our first peak in cases hit around June of 2020—our worst time last year. Then, cases gradually decreased, and the pressure on the health care system began to ease a little until another rise in November. And just recently, we were hit with the highest number of new cases per day—about 9,000.
What Went Right: Vaccines
We are fortunate that our government started conversations early—it’s rumored that negotiations started as far back as April of last year—with different vaccine developers, giving us an important advantage. We launched our vaccination campaign by the end of December 2020, prioritizing frontline workers. The initial rollout was slow because the first shipments of Pfizer vaccines were small, but vaccinations gained traction after Chile approved the use of the Chinese CoronaVac vaccine.
The strength of Chile’s public primary care network across the country is one reason we’ve been so successful in vaccinating so many people so quickly. We started building our public health care system, based in primary care centers and rural health centers, in the mid 1950s—so the infrastructure that we have today is the result of decades and decades of investments.
But what’s a little bit sad, or frustrating, is that we didn’t leverage that infrastructure to coordinate an effective contact tracing system and promote non-pharmacological interventions early on. Also, our government failed at keeping the standards of transparency and accountability that you need in times of crisis, eroding trust and creating barriers to comply with public health measures. We have a very conservative president and politicians who believe the Chilean people have no agency and that they should follow their guidelines because they know best.
And yet, we also have a very empowered civil society that is constantly advocating for sound public health interventions to control the pandemic. Even though the government has been very rigid, it makes me proud to see the rise of new and influential voices shifting the narrative towards public health.
The Chilean "Dr. Fauci"
The Chilean Medical Association (Colmed), for example, has been instrumental in demanding accountability from the government. Colmed’s president, Izkia Siches, is the first woman—and youngest person—to be elected president of the body; we were actually classmates in medical school. Early in the pandemic, she was seen as one of the most trusted sources of information and a leader in the response. She introduced a more open and participatory approach, building up a network of collaborators, including the country’s main public health schools, scientific groups, and other key stakeholders. Without their advocacy, the response arguably could have gone worse.
Messages that Missed the Mark
Misinformation is a challenge. Many people still have distorted beliefs about the pandemic, or don’t have the level of knowledge that they should regarding how COVID is transmitted. Risk communication is a key component of emergency preparedness and response. However, the government hasn’t even considered doing assessments to understand the population’s knowledge, attitudes, and beliefs regarding COVID and improve their messaging. I specialize in health communications so that’s kind of my thing, and I think that’s a missed opportunity.
Most people get their information from the traditional news media, which is very aligned with the government’s agenda. And the government hasn’t applied best practices in their risk communication. Take Chile’s paradox of being recognized as one of the countries with the highest vaccination rate, at the same time that cases were rising dramatically. That probably can be traced to the false sense of security conveyed by officials, who grew overly optimistic when they started to see that vaccination was going well. This allowed an “almost-over” narrative to take hold, lowering people's risk perception when the message should’ve reinforced personal protective behaviors.
The Mood of the People
I think that people are tired, just exhausted with this whole thing. Working in pediatric emergency care, I see a really worrying level of exhaustion and burnout in health workers. Even though we’ve expanded capacity and increased ICU beds to numbers that seemed impossible a year ago, it has taken a toll on health workers. They have been really courageous, working relentlessly to ensure patients receive the care they deserve. But the cost, I think, is going to be huge with regard to mental health, with PTSD. I see it in my everyday conversations.
Bulwark against Burnout
That’s why my work with Ars Medica has been an especially rewarding experience this last year. It's dedicated to nurturing the personal and professional growth of medical students, residents and physicians from all over the world—and the need is greater than ever now.
The Hardest Things to See
From a personal perspective: The pandemic’s unintended consequences for children and adolescents—looking at my own kids and all the other kids missing out on school and having to deal with this terrible crisis. I do think that it’s not all bad, though; perhaps this generation will develop a special resilience. So I’m not completely pessimistic, but the impact has been huge. I see it at home.
In the emergency department: We care for a lot of immigrant and migrant families and people with scarce resources. You hear their stories, how they have to live all in the same room—making physical distancing impossible when one family member gets infected—and you feel that suffering, and it’s rough. We’re still a country with a lot of inequity and a lot of misery. People who rely on informal jobs to make a living—they’re suffering a lot. And that has been hard to see.
Professionally: Knowing that there are evidence-based strategies and tools that could have been applied to mitigate the impact of this terrible pandemic, if only the political will had been there. To see all the missed opportunities and mistakes that could have been prevented is frustrating. And the cost is people losing their lives or loved ones, or facing chronic sickness and complications after surviving Covid. It’s been a lot.
Hope for the Future
What gives me hope is my people. When I returned from the US, a few months before the pandemic, going from a big place like Hopkins back to my old hospital and neighborhood was a huge contrast. At some point, I was feeling very hopeless about the future, and thinking that we have a long way to go. But then, in October of 2019, social unrest broke out in Chile over economic injustices, igniting protests and ultimately bringing us to the period of social transformation that we’re now living, and that fills me with inspiration. Regardless of their education level, or the resources that they have, Chile’s people are very courageous, and they have an amazing history of solidarity.
I also find hope through the new generations. I started teaching health communication recently, and you wouldn’t believe the spectacular ideas and the critical thinking from these undergrads. Because of them, because of my people, I’m hopeful about the future.
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