Healthcare workers dressed in full protective gear interview a resident during a house-to-house campaign against the spread of coronavirus, in La Paz, Bolivia. Photo / AP
Bolivia was mired in political turmoil when the pandemic hit. The response was chaotic. And the surge in deaths that followed was among the worst in the world, according to an analysis by The New York Times.
So many people were dying that the government's numbers couldn't be accurate.
Calls to pick up bodies were inundating Bolivia's forensic office. By July, agents were gathering up to 150 bodies per day, 15 times the normal amount in previous years, said the country's chief forensic official, Andrés Flores.
The demand on his office suggested that the official tally of Covid-19 deaths — now more than 4,300 — was a vast undercount, Flores said. But with limited testing, scarce resources and a political crisis tearing the country apart, the extra lives lost were going largely unrecognised.
New mortality figures reviewed by The New York Times suggest that the real death toll during the outbreak is nearly five times the official tally, indicating Bolivia has suffered one of the world's worst epidemics. The extraordinary rise in death, adjusted for its population, is more than twice as high as that of the United States and far higher than the levels in Italy, Spain and the United Kingdom.
About 20,000 more people have died since June than in past years, according to a Times analysis of registration data from Bolivia's Civil Registry, a vast number in a country of only about 11 million people.
Tracking deaths from all causes gives a more accurate picture of the pandemic's true toll, demographers say, because it does not depend on testing, which has been very limited in Bolivia. The mortality figures include people who may have died from Covid-19 and from other causes because they couldn't get health care.
"This is a very cruel situation that we're living through," said Flores, who heads the Institute of Forensic Investigations. "We've been left completely exposed."
With a bare-bones health system, a decentralised government and poor infrastructure, Bolivia struggled to contain infectious diseases such as dengue even before the coronavirus arrived, said Virgilio Prieto, an epidemiologist at Bolivia's Health Ministry.
But its ability to respond was undermined by a contested election that led to the ouster in November of the then-president, Evo Morales, a socialist. An interim president, Jeanine Añez, a conservative, stepped in with a promise to govern until elections could be held.
Since then, Añez has announced that she is running for the office — and asked the electoral board to postpone the new vote, saying the pandemic made it unsafe for the population to go to the polls. The rescheduling of the vote from May to October has enraged opposition groups, who see it as an attempt by the caretaker president to cling to power.
"She is not recognised as a legitimate leader, which makes it extremely difficult to coordinate a complex response that the pandemic requires," said Santiago Anria, a Bolivia expert at the Dickinson College in Pennsylvania.
Añez's decision to run for president herself antagonised the opposition lawmakers and regional officials on whom she depended to mobilize health care resources, said Anria, leading to a disorganised, ineffective effort.
Her response was also bogged down by corruption scandals, including the arrest of her health minister in May after investigators accused him of using money from international donors to buy hospital ventilators at twice the real cost.
Añez defended her approach to the outbreak, saying that her decision to enact a swift lockdown avoided an even greater loss of life. She also blamed Morales' party for mismanaging the health care system during its 14 years in office and stifling her plans to boost public spending in the pandemic.
"We did more in three months than what was done in the history of health care of this country," she wrote in a Twitter post this month.
More than 100 road blocks by labor unions and Morales' supporters have paralysed an already weakened economy, leaving the government with fewer resources to import urgently needed medical supplies. The shortages of oxygen and other equipment caused by the road blocks resulted in the deaths of at least 30 patients, the government said in a report to the Organization of American States.
As hospitals ran out of medicines and coronavirus tests, Morales' allies in Congress passed a law to allow the medical use of a bleaching agent, chlorine dioxide — an unproven and potentially dangerous coronavirus treatment popular among Bolivians.
"The pandemic has found us in a very precarious situation, with an inexperienced government and elevated political tensions," said Franklin Pareja, a political scientist at the San Andrés Major University in La Paz. "This political standoff has a cost in lives."
In Bolivia's political center, the La Paz region, five times as many people died in July than in past years, according to the data, a rate comparable with Madrid's during its worst month. In the tropical plains region of Beni, more than seven times as many people died as normal, a number surpassing Bergamo, Italy, during its peak.
Although Bolivia's official statistics show a severe spike in mortality starting in July, the closure of government offices during a lockdown in April meant that almost no deaths were registered that month. Officials at Bolivia's Civil Registry, which issues death certificates, warned that at least some of the deaths that occurred in April could have been registered in later months, potentially skewing the mortality rate.
The scale of the mortality spike, however, is confirmed by Bolivia's overwhelmed crematories, cemeteries and body collection agencies.
The spike in deaths had collapsed Bolivian hospitals and forced local authorities to expand their crematories and open new cemeteries. In La Paz's municipal cemetery, residents and hearses had to line up outside the entry last week for a chance to bury their loved ones.
In Bolivia's capital, Sucre, local health authorities said they had to stack up dozens of bodies in morgues, hospitals and even the local university until they were able to install a new crematory oven to meet the demand. And in the central city of Cochabamba, families had to keep bodies of their loved ones at home for days because local funeral parlours and crematories could not handle the increase.
"The health system is saturated," said the Health Ministry's chief epidemiologist, Prieto. "We don't have enough capacity, equipment or the intensive care units required."
Despite the crisis, some regional governments, under pressure to restart the economy before the elections, are reopening gyms and restaurants, feeding fears that mortality rates will continue to rise. The Health Ministry estimates that the country will only reach the peak of the pandemic in September.
And in the meantime, the population will continue to bear the burden of Bolivia's ineffective response.
When Josué Jallaza, a 24-year-old taxi driver in Cochabamba, fell sick with coronavirus symptoms, his family called three times for a doctor, but no one ever came. After he fainted, his family took him to a hospital, "but they didn't want to admit us," said his brother, Marcelo Jallaza. "They threw us out like a dog."
They then took him to a private clinic, where "a doctor came out, looked into his eyes, and said, 'He's already dead. We can't do anything,'" said Jallaza.
The family took the body home and spent four days trying to bury it. After pleading in tears with cemetery officials, they were finally granted a grave.
Written by: María Silvia Trigo, Anatoly Kurmanaev and Allison McCann
Photographs by: Federico Rios
© 2020 THE NEW YORK TIMES
Susie Wiles will be the first woman to be chief of staff in the White House.