MORELOS, Mexico — Elías Alejandro Albarrán Coria had been back home in Zacatepec, a mid-size sugarcane town in the state of Morelos in central Mexico, for less than a day when his neighbors started to insist that he leave. He’d touched town on Sunday, February 2, at Mexico City’s airport on a flight from Shanghai, where he’d spent the better part of a year studying Mandarin and had chosen voluntarily to return home to avoid the advancing Coronavirus contagion. And while he took precautions by isolating himself at home, and presented no symptoms of the virus, which had not yet officially appeared in Mexico, other residents of Zacatepec panicked, demanding not only that he leave town, but that his mother, principal at a local elementary school, refrain from going to work.
The first confirmed case of Covid-19 appeared in Cuernavaca, the capital of Morelos, on March 16, roughly three weeks after the first potential cases were identified in the country, brought to the city by an Italian visitor who reported himself almost immediately upon arrival. But by then, the fear that has accompanied the virus around the globe had already established itself. It has yet to dissipate.
In the first weeks after the pandemic reached in the state, demand for tests skyrocketed, said Dr. Daniel Madrid, Morelos’ Director of Coordination and Supervision, the technical branch of the state Secretary of Health, though at the time the prohibitive cost of tests meant administering them statewide would have cost more than five times the secretary’s annual budget. In some state hospitals, said Dr. Madrid, as many as 40% of frontline workers took leave because of pre-existing conditions that made them especially vulnerable to infection. Meanwhile, demand for protective gear outpaced availability. In one state hospital, Dr. Madrid said, a supply of 2,000 PPE kits was used up in a single day.
As the single largest private supplier of donated protective equipment in Mexico, Direct Relief is not only working to protect frontline workers but also to fight panic, a grave danger for treating the virus and stemming its spread. On June 30 alone, Direct Relief delivered more than 10,000 masks, as well as gloves, surgical gowns, face shields and other protective gear, sponsored by the Coca-Cola Foundation, to three hospitals in Morelos, the first step in an ongoing effort to ensure that hospitals throughout Mexico’s under-served provinces remain equipped to combat the current crisis. It’s part of the latest wave of shipments that will distribute up to 1 million masks to more than 150 hospitals across Mexico in response to Covid-19.
Morelos, due in no small part to its proximity to Mexico’s capital city, is particularly vulnerable. According to Dr. Madrid, fully 75% of the state population over the age of 20 is overweight, some 35% have been diagnosed with hypertension, and 15% with diabetes. Only one of the state’s 10 hospitals has a CT scan, which can make diagnosis challenging. Beyond that, the city’s proximity to the capital, the primary focal point for contagion nationwide, leaves the entire state vulnerable to infection. “A significant number of the houses in Cuernavaca are weekend homes of people from the city,” said Dr. Madrid. “So instead of decreasing mobility, the beginning of the quarantine ended up increasing mobility because people from Mexico City came here to ‘self-isolate,’ but really, they came here to go to parties.”
Federal guidelines did not allow for the closing of highways or state borders, though some residents urged the Morelos state government to do just that. Instead, state health institutions had spent the previous months bulking up their capacity to the best of their ability, surveying available hospital beds in state hospitals, and setting up centers to treat Covid-19 patients at state-run hospitals. In the indigenous community of Axochiapan in the state’s southwestern corner, a large group of residents attempted to block the hospital’s opening, even going so far as threatening to burn it down before it could accept any infected patients, said Dr. Madrid. Not long after, that hospital received its first Covid-19 patient, the leader of those protests. He died within a week.
Now, several months into Mexico’s crisis, exhaustion is as critical a problem as fear for healthcare workers and residents alike.
The Mexican Institute of Social Security, or IMSS, a hospital in Cuernavaca, has seen some 1,300 Covid-19 patients since mid-March when the city’s outbreak started, and currently has around 70 patients under supervision on the three floors currently devoted to Coronavirus infections. Relatively few staff members took leave from the hospital – no more than 10%, said hospital director Dr. Delia Gamboa Guerrero.
“Doctors from all of our teams have been helping to deal with Covid-19 patients because if they didn’t, we wouldn’t have the personnel to handle it,” she said. “So the problem now is that people are tired, they’re exhausted.”
Though the IMSS hospital has never surpassed 85% occupancy, said Dr. Gamboa, “the beds aren’t everything: there are medication and tools that sometimes run out, even when you have space.” Among those tools are certified protective gear, increasingly challenging to get as both larger cities, like the neighboring capital, and larger countries, like the United States, consume the necessary equipment in enormous quantities.
Indeed, according to Dr. Madrid, the fact that Mexico’s hospitals have at no point been saturated is largely due to gaps in the country’s medical system. “A patient that, under other circumstances, might survive for a month in another hospital, here, no – their case will complicate more quickly.” High mortality rates, in other words, keep hospital beds empty.
The state’s first IMSS hospital, surrounded by sugarcane fields on the outskirts of Zacatepec, has been especially hard hit, with mortality rates of 50% among Covid-19 patients and some two dozen hospital workers infected (one among them has died, a young assistant nurse who passed away less than a month ago.) At the height of the pandemic in May, said Dr. Marco Antonio Bermudes Espinosa, the hospital’s clinical director, the Covid-19 team would see nine deaths daily. “There was a death and then maybe 20 minutes later another death and 20 minutes after that another,” said Dr. Bermudes. “Some days there were lines of people outside,” said Fabiola Cabrera Santana, the hospital’s head of nurses.
While hospitals in Cuernavaca face the same difficulties as urban hospitals everywhere – namely dense populations and high mobility – in the region surrounding Zacatepec, communication has been the primary struggle. Residents in the neighboring community of Xoxocotla, continued to run their weekly outdoor market and local businesses even as large numbers of people fell ill. Many residents died in their homes or took the bodies of loved ones to an unlicensed crematorium. Others waited too long to seek medical help, said Nurse Cabrera, “and they would die at the entryway; they wouldn’t even make it inside.”
For now, said Dr. Bermudes, the situation appears to be under control. Deaths are intermittent and usually of much older patients, and there are no major holidays on the horizon to spark another outbreak. Still, for doctors here at the IMSS hospital in Zacatepec, the ongoing crisis has become an endurance game, a daily struggle to remain on your feet, to continue treating new cases as panic in the general population fades to anger and frustration as they wait to resume their lives. “We’ve learned a lot,” said Nurse Cabrera in the afternoon that her team received its PPE delivery from Direct Relief. “You learn to channel your fear and your pain and you learn–” she shrugged “–well, you learn to survive.”
– Michael Snyder is a freelance journalist based in Mexico City. His work has appeared in the New York Times, the Los Angeles Times, The Believer, and The Nation, among others.
– Felipe Luna is an independent photographer, reporter, and editor based in Mexico. His work has been published in Bloomberg, El País, the Los Angeles Times, the New York Times, among other media outlets.
