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Little Uruguay, Not Many Dead
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Uruguay is a small country on the eastern coast of South America between Argentina and Brazil. Mostly European in demographics, it was long considered the Switzerland of South America because, fearful of the usual local tendency towards dictatorship, it shared power in a plural executive, was early in separating Church and State, in giving votes to women, allowing divorce, and generally being sensible. It has low corruption, high press freedom, a democratic tradition which survived a 70s lapse into military dictatorship, and no terrorism, a good standard of living, and an excellent standard of beaches. In fact, think of a 400-mile beach with an excellent farm attached. In truth, it also has a fine capital city of Montevideo where half the population lives, which gives it a high population density; and Punta del Este, the continent’s premier beach resort, which helps draw in 4 million tourists a year. Agriculture and tourism are major sources of income.

The interest lies in how this country, with only 3.45 million citizens in an area larger than England, has coped with coronavirus, given that it knows with reasonable certainty that the entry point was Montevideo airport on or about 6 March, and is a society in which most people know each other, or at least can trace connections pretty easily. Three arrivals at the airport spread the disease. Two took a 6-hour bus ride north on 8 March, and one already infected lady on 7 March attended a society wedding with 500 guests, and kissed, conversed and danced with enough of them to infect a reported 44 people.

Half of Uruguay’s cases can be traced to that party. One of those infected, a young woman, went to work and infected a male colleague in her office, and that young man passed it on to his mother, a friend of mine, who later recounted her illness in detail. It was over 3 weeks before she felt fully recovered.

The socialite who flew in denied having any knowledge of her infected status, though she had been in Milan in January and fallen ill afterwards, but she was not screened at the airport. She was later reported for having received family visitors while in quarantine. Folklore songs have been composed about her, none of them flattering. Contact tracing has been done on the wedding event but detailed reports are not yet available.

What has happened since?

Coincidentally, on first of March the ruling Left-wing coalition gave way after 15 years to a Centre Right coalition of traditional parties, the more rurally-inclined one celebrating by getting many of its farmers to attend the inauguration on horseback in full gaucho regalia, a spontaneous innovation which was a joy to behold. With only a week’s notice, the newly installed government took advice, and soon went into lockdown. (This had been started progressively the moment cases were announced, with universities, schools, public theatres and cinemas introducing various distancing measures immediately, though the airport was not finally closed till 20 March). Kids at public schools already had a personal computer, so distant learning was already established. Health officials traced contacts, and used widespread testing. Uruguay had had the wit to ensure that the Pasteur Institute, looking for a South American location for a new centre, chose Uruguay (because an ex-president remembered that Uruguay had excused France a post-war bill for meat, and deserved something in return), so test systems were on hand.

The government designed an app so that information could be disseminated by WhatsApp and a system for border control, so that if any flights came in they had advance notice of names and health status.

Currently, Uruguay has had 737 cases and 20 deaths. Here are some comparative rates (rates per million, not percentages).

Brazil death rate 79
Argentina death rate of 8.5
Uruguay death rate of 5.8

Uruguay has been 13 times safer than Brazil, where the President is against lockdowns though many state leaders are for it; and a bit safer than Argentina, which also went into lockdown. Brazilian contacts tell me that compliance has been variable, and much lower among the hard-pressed poor, despite welfare payments. Argentine contacts say that compliance was mostly good, and it remains to be seen if it holds up.

By the way, Uruguay is not a culture in which deaths could be covered up. At most, there seem to be 3 degrees of separation. News travels fast, and family connections are strong, so a body on the street would soon have a crowd at a distance sending social media announcements.

How come Uruguay has few cases and very few deaths? As discussed, Uruguay does not have many airline connections with the countries of origin of the infection, and by March the big holiday season influx of tourists was over. The health service is good, and there are strong professional medical links with the US and also with Europe. The new government maintained progress on transition tasks but concentrated heavily on the threat. Social distancing was observed, and the minority of infractions related to walks on the beach or in parks, which is less dangerous. Given that the transfer of power between sharply contrasting political coalitions (ex-terrorist Tupamaros leaving power, landed gentry and business owners taking power) had been peaceful and even convivial, there was a sense of national unity.

Uruguay even took time out to help some cruise ships with Covid patients on board, who had been refused docking in other countries, treating them and then letting the whole lot get into buses to take flights out. To the great surprise of the cruise passengers, who had been refused a berth at other countries, Uruguayans came out at night to clap and cheer them on their way home.

In the last few weeks, before agreeing to lift lockdown, it started up the construction business under strict distancing protocols, and monitored the workers in a large sample of workplaces. Not a single one tested positive. Equally, they let rural primary schools open, finding that they could do so without further outbreaks. They have worked carefully, testing each step of the way.

They have also been conducting research, some of which is already published. A local research group has done some backward tracking on the first cases encountered world-wide, showing it was active earlier than publicly stated.

It is too early to make a final judgment about which countries have done best. The debate will be about which of them got the biggest dose to begin with: airport connectivity and entrepot status. Then some debate about population density, and the age structure. Is Africa doing well because of previous experience with Aids and Ebola, or is it just that it is a very young continent? Did Uruguay benefit from being far away in airline terms from China, and having completed most of its summer tourism by mid-February?

Comparatively, it is wise to have airports which do not connect directly with airports in countries with the infection, nor with other countries which themselves have direct flights to sources of infection. Closing airports is probably the best thing that any country could have done in this pandemic and, though costly in itself, by far the cheapest. It would also have saved most lives. British planners found that option offensive, perhaps on the grounds of it being simple and effective. Early on, they washed their hands of it.

Uruguay is a tantalizing case: if it had closed its airports on 1st March it would most probably not have had any cases.

• Category: Science • Tags: Coronavirus, Disease, Uruguay 
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