17/4/2020 Senior Mexican Health Official Questions How Deadly Coronavirus Really Is - WSJ

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https://www.wsj.com/articles/senior-mexican-health-of icial-questions-how-deadly-coronavirus-really-is-11587133043

LATIN AMERICA

Senior Mexican Health Official Questions

How Deadly Coronavirus Really Is
Hugo López-Gatell, who leads country’s coronavirus response, says virus could be as lethal as flu; health
experts say health system unprepared for spread

Mexican Deputy Health Minister Hugo López-Gatell said only 0.5% of Mexico’s population will get
sick enough from the virus during the entire pandemic to show any kind of symptoms.
PHOTO: JOSE MENDEZ SHUTTERSTOCK

By David Luhnow and Santiago Pérez

April 17, 2020 10 17 am ET

MEXICO CITY—The man in charge of Mexico’s response to the coronavirus pandemic says he
isn’t convinced that the virus is any more lethal than an ordinary influenza outbreak, but he still
worries about its capacity to overwhelm the country’s hospital system given the speed of its
transmission.

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17/4/2020 Senior Mexican Health Official Questions How Deadly Coronavirus Really Is - WSJ

“I don’t know yet. The WHO says it could be 10 times that of influenza, but I think we need to see
more evidence,” Mexico’s deputy health minister, Hugo López-Gatell, said in an interview with
The Wall Street Journal, referring to how deadly the virus may be.

Critics say that Mr. López-Gatell’s boss, President Andrés Manuel López Obrador, has
consistently played down the risk of the pandemic. Health experts say they fear the Mexican
government is underestimating the potential impact and leaving the health-care system
unprepared for the eventual demand for hospital beds and critical-care items like ventilators.

“I think most people would agree that some of these assumptions are overly optimistic,” said
Julio Frenk, Mexico’s former health minister and president of the University of Miami. Dr.
Frenk said he estimates that Mexico’s health system is only a few weeks away from being
overwhelmed.

Mr. López-Gatell, 51, said he estimates the virus will eventually infect roughly two-thirds of
Mexicans, the level at which enough people have developed immunity that further spread
becomes more difficult. Left unchecked, the virus would run its course in as little as six weeks,
overwhelming the health system, he said. But with social distancing measures, it could take as
long as a year or more, similar to the H1N1 influenza pandemic in 2009, which first emerged in
Mexico and which Mr. López-Gatell also experienced as a health official.

But, he said he also estimates only 0.5% of Mexico’s population will get sick enough from the
virus during the entire pandemic to show any kind of symptoms. And 80% of those cases, he
said, are likely to be mild. He said the vast majority of people infected by the virus would show
no symptoms.

Mr. López-Gatell’s assumptions would suggest a death rate for Covid-19, the disease caused by
the virus, that is similar to or even lower than the flu, which is typically about 0.1% in the U.S.
While many experts have said it is too early to definitively determine the death rate for Covid-
19, most estimates put it far higher than that.

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17/4/2020 Senior Mexican Health Official Questions How Deadly Coronavirus Really Is - WSJ

Health workers test people at a drive-through coronavirus testing station in Monterrey, Mexico
PHOTO: DANIEL BECERRIL REUTERS

“I’ll repeat: 0.5% of the population will have some kind of symptoms out of the total Mexican
population. [The great majority] will develop immunity without ever knowing they were
infected,” said Mr. López-Gatell, who holds a doctorate in epidemiology from Johns Hopkins
University.

Several health experts say Mr. López-Gatell’s numbers are unrealistic. In Italy’s Lombardy
region, for example, 0.6% of the population have already gotten sick. Lombardy is one of the
hardest hit regions in the world, but the outbreak there is far from over.

“I think those estimates are ridiculously low, especially given Mexico’s late and incomplete
response to the virus,” said Jaime Sepúlveda, the executive director for the Institute for Global
Health Sciences at the University of California San Francisco and a former deputy health
minister in Mexico.

Mr. López-Gatell said he is basing his assumptions on the experience of Hubei, China, the
province where the virus first emerged in late December of last year and where an estimated
0.1% of the population got infected enough to get sick.

But several experts said basing predictions on China is problematic, including doubts about
China’s numbers. The Communist regime was able to implement a total lockdown that stopped
the virus largely in its tracks. Mexico may have far less success, however, and end up looking
more like Lombardy or New York, said Mr. Frenk, the former health minister.

While Mexico and China have relatively young populations, Mexico has a far higher percentage
than China of people at risk of falling seriously ill with the coronavirus, including those with
hypertension, diabetes and obesity, Mr. Frenk said.

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Projections about how many people might get infected and sick are important because they
help countries know how many intensive-care beds they might need, for instance. In the case of
Mexico, Mr. López-Gatell estimates the country will need to supply—over the course of the
pandemic—hospital beds to some 95,000 people and intensive care to 31,700.

Mr. López-Gatell’s estimates of the numbers of people needing hospital services might be
reached within a month or two instead of a year, said Rafael Lozano, the director of health
systems at the Institute for Health Metrics and Evaluation at the University of Washington.

“It’s far better in these situations to prepare for a worse outcome rather than something overly
optimistic,” said Mr. Lozano, who is finishing a predictive model for how the pandemic may
play out in Mexico in coming months and the demand for hospital use.

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Carlos del Río, an epidemiologist at the Emory Vaccine Center in Atlanta, agreed. Mr. López-
Gatell’s “numbers may be right, but within two or three months,” he said. “The speed of
transmission of this thing is unlike anything I’ve ever worked on.”

Mexico had 6,297 confirmed cases as of Thursday, a relatively low rate that can partly be
explained by a lack of widespread testing. In the Americas, Mexico is ahead of only Guatemala,
Venezuela and Bolivia in the number of tests per capita it has conducted. The U.S., for instance,
has conducted more than 3.2 million tests, while Mexico has tested about 45,000 people,
according to official figures.

Mr. López-Gatell readily admits that the likely number of cases at the moment is at least eight
times higher, and currently around 56,000.

The number of deaths attributed to the virus in Mexico is picking up speed and stands at 486,
with 74 people dying on Tuesday alone. Already in some parts of the country, like the border
city of Tijuana, hospitals say they are full or nearing capacity.

The governor of Baja California state, Jaime Bonilla, said doctors and nurses in Tijuana and
Mexicali were “dropping like flies” after getting infected by a wave of Covid-19 patients in the
past 10 days.
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Dr. Eduardo Reza, 39, an emergency-room doctor at a hospital in Monclova, a city of a quarter
million people in the northern border state of Coahuila, was infected with coronavirus in late
March after treating a patient with Covid-19. The patient spent three days in the emergency
room, eventually infecting some 20 people on the hospital staff, he said.

Since then, three doctors and the hospital’s administrative director have died, and there have
been 116 confirmed coronavirus cases in Monclova.

Dr. Reza said he believes Mexico is in for a difficult time. “I think we will be overwhelmed,” he
says. “Looking at the number of people with the virus, there won’t be sufficient space in the
hospitals.”

As the virus began to spread in Mexico in early March, Mr. López Obrador continued to hold
rallies, hug supporters and tell Mexicans they shouldn’t be afraid to go out to restaurants.
Under pressure from Mr. López-Gatell, the president eventually relented and began telling
Mexicans about the need for social distancing.

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Mexico as a whole has imposed among the least restrictive measures in the Americas. The
government has yet to urge citizens, for instance, to wear surgical masks. In early March, Mr.
López-Gatell resisted closing schools and other steps because he said there was no evidence of
local transmission of the virus. But authorities were only testing people who had traveled
abroad, meaning they would miss the first cases of local transmission.

“They caught themselves in circular logic,” said Mr. Frenk. “López Gatell is a very well-trained
epidemiologist. I respect him intellectually. However, I think in this case there’s been an
attempt to rationalize the initial flaw—which is a political leader minimizing and trivializing
the threat represented by pandemic.”

Mexico closed schools and universities in mid-March, secured supplies of protective equipment
and is working to boost the number of ventilators to about 15,000, Mr. López-Gatell said. The
government also reached a deal with private hospitals to provide services such as C-sections,
ulcers or endoscopies so that more than 3,000 beds at public hospitals could be used for Covid-
19 patients.

Mr. López-Gatell said the timing of hospital demands would depend on how quickly the virus
spreads and the effectiveness of social-distancing measures. With current measures, he

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