World Report

Understanding Mexican health worker COVID-19 deaths

An Amnesty International report says that more health workers have died in Mexico than
anywhere else. David Agren explores why.

Less than 3 weeks after Mexico
recorded its first COVID-19 case, staff
from a Mexican Social Security Institute
(IMSS) hospital blocked a Mexico City
road, demanding medical supplies and
In a press conference, Mexico’s Direc­
tor of Epidemiology José Luis Alomía
said that Mexican health-care workers
with COVID-19 had a mortality rate
of 3·8%, lower than that of the gen­
contracts”, said Penman. “That affects
a lot of things in terms of job security
and access to sick leave.”
Soto said that unions representing
health workers were keeping quiet on
For more on COVID-19 among
Mexican health workers see
https://www.paho.org/en/
documents/epidemiological-
alert-covid-19-among-health-
workers-31-august-2020

personal protective equipment (PPE).
At least 70 protests have followed,
according to a report by six former
health secretaries, with medical staff
eral population. Alomía said that
1410 health-care workers had died,
almost half of whom were doctors.
issues of workplace safety, preferring
to please the government rather than
address members’ demands. Some
protest leaders, he said, have had their
For Carissa Etienne’s comments
on Sept 2 see https://www.paho.
org/en/documents/weekly-
press-briefing-covid-19-
directors-opening-remarks-

decrying shortages of supplies and “97 632 Mexican health-care jobs terminated by their employers or september-2-2020

tests, along with a lack of hospital
infrastructure and even proper training.
“We didn’t even have access to
a single test. Now we have some”,
said Rafael Soto, an IMSS nurse and
spokesperson for the National Union
of Health Workers, an organisation
formed during the pandemic to
improve labour conditions. He said that
more equipment has arrived since the
protests started, but it is poor quality.
The COVID-19 pandemic has heaped
misery on Mexico, with more than
70 000 deaths, a tally surpassed only by
the USA, Brazil, and India. The country
has pursued a strategy of not testing
widely or contact tracing, but instead
monitoring hospital capacity to inform
the relaxation of restrictions.
97 632 Mexican health-care workers
were infected between Feb 28 and
Aug 23, according to the Pan American
Health Organization. On Sept 2, the
organisation’s director Carissa Etienne
said that a survey found that nearly half
of Mexican health workers were not
provided PPE at work.
A Sept 3 report from Amnesty
International said that more Mexican
health-care workers had died of
COVID-19 (1320) than in any other
country. The USA ranked second with
1077 deaths and the UK third with
677. The Mexican health secretariat
did not dispute the figures, but called
the comparison with other countries
unfair because none used the same
method for recording deaths.
workers were infected between
Feb 28 and Aug 23...”
“[Health-care workers] get less
seriously ill and die less than the
general population”, Alomía said. “If
these two indicators were above what
we see in the general population, we
might think that it’s a risk to be a health
professional in Mexico. But it’s not.”
Brenda Crabtree Ramírez, a physician
and infectious disease researcher at
the National Institute of Medical and
Nutritional Sciences Salvador Zubirán,
said that preliminary results of a
study using Mexico City data showed
that health-care workers were dying
of COVID-19 at a lower rate than
that of the population as a whole.
Mexican health-care workers were
infected at much higher rates than
their counterparts in other countries,
however.
Madeleine Penman, a researcher with
Amnesty International, said Mexico is
“keeping a very disaggregated register
of the numbers on health worker
deaths. In the Americas, not all countries
are actually counting the deaths of
health workers with the same detail
that Mexico is.” She said that Brazil is
undercounting its health worker deaths.
Health-care workers, nurses, and
researchers offered varying explanations
for Mexico’s numbers, but working con­
ditions are often mentioned. “A lot of
people in the health sector workforce
are basically working on informal
have been sanctioned by their unions.
Physicians in Mexico routinely have
multiple jobs—often a position in
a public institution, augmented by
private practice—which compounds
issues of stress and exhaustion.
Salaries in Mexico’s top public hospitals
seldom top £1000 monthly, with most
physicians earning substantially less,
according to interviewees.
Daniel Tovar, an emergency medicine
physician treating COVID-19 patients
in Matamoros on the US border, said
“I earn what a medical assistant would
make in the United States...That’s why
we work two or three jobs, in addition
to giving classes”.
Continuing education for physicians
can also be lacking. Crabtree recalled
treating a physician with a cough, fever,
and diarrhoea, who waited a week to
seek treatment and con­tinued seeing
patients. “It never crossed his mind this
was COVID-19”, she said.
Doctors themselves are often
not pictures of health, many physi­
cians have noted. “We’re an obese
country with many diabetics and
people with hyper­ t ension” said
Álvaro Martínez de León, an internal
medicine specialist in Matamoros,
where he said three physicians died of
COVID-19 in early September: two were
obese and one had hypertension. “We
have many people with these illnesses
in the medical community”.
David Agren

www.thelancet.com Vol 396 September 19, 2020 807