The Getsemaní neighborhood, a somewhat more authentic tourist option a few blocks from the glamorous walled city of Cartagena de Indias, started this 2020 well positioned in the lists of the most desirable places to visit in the world. A little further north, booming Barranquilla was preparing to host the long-awaited annual meeting of the Inter-American Development Bank (IDB) in March. But those good omens were shipwrecked amid the health emergency. Both the tourist jewel of colonial architecture and the largest city in the Colombian Caribbean have felt the ravages of the coronavirus in a region that has been overwhelmed by infections. The data on excess mortality in recent months, studied by EL PAÍS, reflect that deaths during the pandemic multiply the number confirmed by covid in the Caribbean departments.
The excess mortality analysis has become a key tool to assess the impact of the epidemic around the world. Colombia is no exception: on August 6, the National Administrative Department of Statistics (DANE) published its estimates of the number of deaths in the first half of 2020, comparing them region by region with the average for the same period of the five years previous. This exercise allows us to discern where and to what extent the epidemic has impacted without relying on epidemiological detection systems, which focus on confirmation through a diagnostic test that detects infection. In any epidemic, and particularly in one of this volume, there are cases to be detected. It also has an indirect impact on other aspects of health (for example, saturating services or delaying treatments). This is how the comparative metric becomes an essential complement to gauge its impact.
Five departments in Colombia concentrate most of the excess estimated by DANE until June 27: Atlántico (capital: Barranquilla) and Bolívar (capital: Cartagena de Indias) bring together more than 4,000 deaths from natural causes of which would be foreseeable for this period. In the next group are Bogotá, Magdalena (capital: Santa Marta) and, on the Pacific coast, Valle del Cauca (which contains Cali): around 400 each. But the concentration of impact in the Caribbean is evident on the map, totaling around 5,000 in all its administrative departments.
If we focus on the three major departments of the Caribbean, the Atlantic results in the greatest differentiated excess, with growth that began to be noticed in early May and that at the end of June was still looking for its peak.
The pattern in Bolívar, determined above all by the dynamics in Cartagena de Indias and its metropolitan area (which concentrate most of the population in a very considerable density, outside the tourist areas), is similar at its inception but less steep in its process, although it does draw a sustained plateau of excess deaths that correlates with the form observed by confirmed cases of the epidemic in the city.
In Colombia, the government of Iván Duque decreed a national quarantine at the end of March. By May, when the country was getting ready to move to a new phase that relaxed the so-called mandatory preventive isolation, the Caribbean already concentrated three of the places that most concerned the authorities: Cartagena, Barranquilla and Soledad – which are part of the same area metropolitan. Santa Marta is added to them as the other great city on the north coast, and together they have more than 3 million inhabitants.
Barranquilla, with a more robust hospital capacity, and Cartagena, famous for a deficient network, have alternated the lights. The explanations are varied, and are not limited to social indiscipline. In both cases, there are surveys from the National Consulting Center that suggest a low perception of risk. In March, when the confinement was just beginning, more than half of Barranquilleros and Cartagena considered that the worst part had passed. Social distancing was largely not followed, local administrations were timid in applying their own actions, complementary to those indicated by the Ministry of Health, and fines were an insufficient mechanism.
On the social front, the very high levels of informality –especially in Soledad and Cartagena, where a quarter of its inhabitants live in poverty– make it difficult to comply with the confinement measures. The call motorcycle taxi – Riding as the second passenger of a motorcycle – is very popular and has been identified as a dangerous transmission space. "There are cultural factors that unfortunately do not help, also the very overcrowding in which many people live in very small spaces," Health Minister Fernando Ruiz explained to this newspaper in May. The north coast is also known for its high levels of mistrust of institutions, as well as being prone to fake news chains with all kinds of conspiracy theories, which alarm health authorities and make their work difficult.
In Cartagena, the virus circulated in the main market square, Bazurto, and they had to intervene, as well as close six popular neighborhoods in the city. In Barranquilla, they had to suspend Transmetro, the mass transportation system, for several days and set up sanitary fences for 14 days throughout June and July, among others. In both cases, the occupancy of Intensive Care Units is down today, and they seem to have passed the most critical moment. But the bill, the data hints, has been higher than suspected. By looking to the rest of the Caribbean, Montería, the capital of Córdoba, has had late ICU admissions that have resulted in high mortality rates, and the authorities are especially concerned about the impoverished and desert department of La Guajira, at the extreme north of the country, due to its porous border with Venezuela, which makes any epidemiological control difficult.
Lags and adjustments
We cannot yet say conclusively what that extra cost has been: the defining feature of the data for any epidemic is that it is provisional until it is exhausted. But the still photos that we are taking from different angles of the phenomenon help us to get an idea of what the country is doing.
Thus, when we compare the excesses of deaths due to natural causes in the first semester with the cases that, in theory, have been detected so far by means of a covid diagnostic test in each department, the differences in the Caribbean region again attract attention. While Valle del Cauca or Bogotá counted deaths from covid above the estimated excess, the comparison is the opposite in Atlántico, Bolívar and Magdalena, but also in Cesar, Córdoba or La Guajira.
It is thanks to the fact that the Ministry of Health and DANE offer differentiated and updated statistics that we can carry out this exercise, which does not speak of permanent disparities of criteria but in fact offers a window in the way in which the effects of an epidemic are counted. The DANE data do not distinguish if those 2,650 deaths more than those expected in Atlántico are due to covid or another disease, for example. Similarly, the 1,527 deaths confirmed by a diagnostic test in the same region do not include all the cases in which such a test was performed late or could not be performed. Lags are critical to understanding discrepancies. That is why the DANE also offers a value of "suspects" (which goes until July 19 in this case) in its report. "The suspects are not necessarily attributed to covid," explains epidemiologist Silvana Zapata Bedoya. For these and other cases, designated committees must "confirm the cause, and this takes time." Hence the lags.
In any case, it is clear from the data that these differences are not equally distributed throughout the Colombian territory. The question is to what extent this is simply due to the fact that the epidemic was at its peak in those months, precisely in the Caribbean cities, slowing down the death count due to saturation of the instruments, and to what extent there are different causes that explain this saturation, some of them parallel to those that turned the coast into an epicenter.
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