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How Chile Ended Up With One Of The Highest COVID-19 Rates

A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country — 13,000 cases for every 1 million people.
Marcelo Hernandez
Getty Images
A nurse protests Chile's handling of the coronavirus pandemic. The country now has the highest per capita infection rate of any major country — 13,000 cases for every 1 million people.

Chile looked as if it were well prepared to deal with the new coronavirus.

It's a rich country — classified as high income by the World Bank. Life expectancy is roughly 80 years — better than the United States'. It has a solid, modern health care system, and when the outbreak began spreading, officials made sure they had plenty of ventilators and intensive care beds at the ready.

But the virus exploited the cracks in Chilean society. The country now has the highest per capita infection rate of any major country — 13,000 cases for every 1 million people. That's more than 10 times the rate in neighboring Argentina and twice the rate in Brazil.

Like many well-to-do countries, Chile saw its first cases of COVID-19 among its elite — people who'd recently traveled to Europe and the United States. That was in April. The government quickly rolled out a plan to provide testing and treatment. Health officials quarantined hard-hit neighborhoods. Residents had to apply for a pass online before they could go out of their homes even to buy groceries. In late April, things were going so well that Chile was starting to talk about reopening.

"And then May started bringing more cases and more cases. Currently we have, in my opinion, more cases than we are able to handle," says Thomas Leisewitz, a physician in Santiago. Leisewitz is a professor at Pontificia Universidad Católica de Chile and heads up strategic development at Red de Salud UC Christus, a nonprofit Catholic health care network.

Since May, the number of cases has been rising steadily, with the country recording at one time 5,000 to 6,000 new cases a day in June. The virus spread out of the affluent parts of Santiago to low-income neighborhoods where many residents don't have the luxury of being able to work from home.

And the high numbers are not just a reflection of an efficient testing infrastructure. Chile's per capita testing rate is lower than most European nations' and almost half the rate in the United States.

So how did this particular virus come to spread incredibly rapidly in wealthy, well-prepared Chile?

Andrea Insunza, a journalist in Santiago, says the reason is something unrelated to the virus itself. That something is social inequity.

"In Chile, there are two countries," says Insunza, who runs the center for investigative journalism at Universidad Diego Portales. "There's a country for people like me. I have a good education. I have a good salary, and all my social security is privatized."

By this she means she has access to high-quality private hospitals and clinics.

But there's another Chile.

"And that Chile is poor and you depend on the public health [system]," says Insunza.

Last October, violent street protests erupted in Santiago over a fare hike on the subway of 30 pesos, or less than 5 U.S. cents.

The protests became about far more than the price of a subway ride. Chile is one of the most unequal countries in Latin America, according to the World Bank. The elite, the top 10%, controls more than half the country's wealth. And while extreme poverty has been driven down significantly over the last decade, the social unrest in October centered on the frustrations of lower- and middle-class Chileans who view their economic opportunities as unfairly limited.

Insunza says part of the frustration is driven by the elite often not even seeming to recognize their privileged lifestyles.

"Santiago, it's a very segregated place," Insunza says. "You can actually live your whole life and don't see poverty. Never."

Chile's initial plan to deal with the coronavirus outbreak — which at first affected mainly the elite in Santiago — failed to recognize that the affluent have maids, gardeners and cooks who might also get infected.

The country's response went well in those early weeks. Case numbers were holding steady. The fatality rate was low.

Then the virus started spreading in lower-income neighborhoods and quickly got out of control.

"One thing that's interesting about Chile is that it probably has more state capacity in a technical way than any place in Latin America," says James Robinson, a professor at the University of Chicago and co-author of Why Nations Fail. He has written extensively about Latin America and, in particular, Chile.

"It's good at raising taxes and building roads and infrastructure," he says. "And there's not much corruption and things like that, but it's also a very polarized place."

Robinson says large segments of the public don't trust the state. They are wary of cooperating with government, which may be part of what has hindered Chile's response to the coronavirus outbreak.

In June, the health minister stepped down over his handling of the crisis and discrepancies over the case numbers he reported domestically, which were lower than the counts given to the World Health Organization.

President Sebastián Piñera caused an uproar last week when he attended the funeral of his uncle along with more than 30 other people, while the government's coronavirus rules allow only 20 people at funerals.

Despite the government offering cash support and food to people who've lost work because of the lockdowns, Robinson says many Chileans feel that the system is stacked against them. And that's impeding the country's ability to tackle this virus.

"There's a real problem with the social contract in Chile," he says. "And the way they tried to manage this thing just seems to have sort of exacerbated a lot of those problems."

Chile has now extended lockdowns to more areas and put in tougher limits on movement to try to rein in the surging outbreak. In Santiago, residents who are not deemed essential workers are only being allowed to leave their houses twice a week, including trips for grocery shopping.

The regional office of the World Health Organization, the Pan American Health Organization, predicts that cases will continue to rise in Chile at least into the middle of July.

Copyright 2021 NPR. To see more, visit https://www.npr.org.

Jason Beaubien is NPR's Global Health and Development Correspondent on the Science Desk.
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