Joan Didion famously wrote, “We tell ourselves stories in order to live”. In time, we will need poets and writers of the imagination to look through the looking glass – and tell us the stories of this strange, upside-down world. We will need more than a vaccine and a rebooted economy to heal us. The painting above by San Miguel artist Andrew Osta was created before the covid crisis, but he sees it as foreshadowing social distancing.
We not only tell ourselves stories in order to live we trust that those whose task it is to lead us through this pandemic with the least amount of death and economic suffering will tell us stories based on the truth about what we face. To get to the other side of a pandemic leaders must have the ethical and political will to counter the pressures of larger countries, foreign companies and political foes. More to the point, scientists cannot serve politicians with little understanding of the enormous consequences at stake when there is no reliable data to plan for even the least bad outcome.
We have been told several times that the numbers of COVID patients were reducing enough to begin a slow “opening up” only to see soon after this opening that we are in the red or dangerous zone according to the state and yellow according to the federal government. Red of course means we should resume strict social isolation. As I write this on a Sunday morning, I hear a church singing hymns that appear to be coming from behind closed doors. Recent experience has demonstrated that there is probably no greater risk of passing and catching COVID than singing in a choir in a closed space.
In my newsletter of June 4th I focused on the unpredicted debacle that still rages in Mexico City as evidence of how little our leaders know, how slim their grasp on events or the worst case scenario is, or that they are deliberately distorting reality. The most charitable view of our leadership is that they simply found themselves caught unaware by the old and decrepit health infrastructure inherited from the past party. The most recent poll published by the well-respected Spanish language public health journal mentioned in my last newsletter, Nexos places the toll as of July 3 at 22,705 excess deaths in the capital at the end of June. Officially, CDMX officials have only confirmed 6,642 deaths from coronavirus.
In that newsletter I passed over the issue of limited and inadequate COVID testing (this is antigen testing I am referring to) without fully explaining why it could and indeed did lead to the situation we find ourselves in two months later. For those of you who carefully watch the government statistics purporting to give us meaningful information about what percentage of the population have COVID based on how many positive antigen tests are being reported may forgive themselves for finding these figures profoundly confusing. Whether deliberate or simply based on inadequate information systems, distortion of information and a lack of transparency inevitably leads to a distrust of our leaders and in Mexico distrust seeds civil unrest.
The average person would have no idea as to the true meaning of those figures because why would any of us understand the complexities about monitoring a disease much less a pandemic? The conclusion is not intuitive. Every well-educated person including health professionals whom I asked what the numbers meant said “there must be a lot of virus”.
The fact is when nearly every third symptomatic person is tested for COVID is positive as is the case in much of Mexico, it only means far too few people are being tested. All the major authorities like the CDC and the WHO recommend a high level of testing among asymptomatic people as we discover more about the disease. Tragically, as we saw in Mexico City it also means our leaders most likely have no handle on how many people are really infected especially when so many cases are asymptomatic and the disease lasts far longer than previously thought. For example, see below for the countries that used random and abundent testing as a means to track their epidemic:
Australia, South Korea and Uruguay have a positive rate of less than 1% – it takes hundreds, or even thousands of tests to find one case in these countries. These are the countries who most likely have reached the other side of the pandemic.
The World Health Organization has suggested a positive rate of around 3–12% as a general benchmark of adequate testing.
Mexico as of today July 6th fell below India as the least tested country in the world.
Despite the early praise for Mexico’s choice of a cost effective sentinel system of surveillance, it is now obvious to many authorities including the World Health Organization that Mexico was not a good choice for using sentinel centers surveillance. WHO Recommended Surveillance Standards WHO/CDS/CSR/ISR/99.2 (https://www.who.int/csr/
We need to know how many people without symptoms are infected in order to plan an adequate response and to manage any kind of opening of the economy. What tentative attempts Mexico has taken to open up society and more especially the economy are not based on a solid knowledge of the impact of the pandemic and in fact the last opening coincided with a sharp rise in the numbers of cases of COVID and lead to further outbreaks.
I am once again focusing part of this newsletter on how little information we have about the path of the pandemic here in Mexico. I am doing this because I am asked more times than I can count what I think is going on. When will we see a decrease in COVID and if we do will it return? When can we leave our homes? As discussed above we are still at a stage where little is known about the impact of the pandemic in Mexico. Just because many of us are health workers and most have worked in other epidemics, we have a hard time following the distortions generated by complex political and economic interests …not only Mexico’s but the United States and Canada as well.
The fact is we are alive now and what we do every hour and every day matters. I realize that people cannot live without food, shelter and most especially hope. The brief openings, however damaging to the health of the community do bring albeit brief, a sense of the world as we knew it and will know again. Stay in touch with friends. Get outside when the crowds have dispersed. Exercise, eat well and when the world feels like it is really closing in call us and we can help.
Below for those of you who venture out despite the orders to shelter in place I have a chart that rates the risk of various activities we may be tempted or forced to engage in. The single most important message for everyone is to wear well-made masks when in public and wash your hands as often as you can after any possible contact with the virus and of course keeping social distancing of 6 feet. We are beginning to realize the highest risk of catching COVID is to be around aerosolized spray such as when someone sneezes or coughs. Fresh circulating air is also important. Remember the highest risk is being around people with the disease who may or may not know they are infected.
ALERT from The Center for Disease Control
Highly toxic methanol is being found in commonly available hand sanitizers. Because we use so much of the cleanser including using them on children, it can have the same effects as drinking methanol: blindness, hospitalization and death. If you or someone you know is experiencing nausea, vomiting, headache, blurred vision, blindness, seizures or a coma, a trip to the emergency room is urgent as the effects can be treated in early stages.
Methanol is not an acceptable active ingredient for hand sanitizers and must not be used due to its toxic effects.
The CDC is doing an ongoing investigation of all hand sanitizing products and will continue to let us know what to avoid. Part of the problem is methanol is mixed into the alcohol and cannot be detected outside of a lab or at the onset of neurologic effects. A clue that a product might contain methanol is when it says “Approved by the Federal Drug Agency”. No hand sanitizer is approved by the agency.
The link below lists Mexican products on shelves in Mexico and indeed here in San Miguel (and possibly your bathroom)
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Thanks to those concerned about Mexico all over the world, at least two funding campaigns have been very successful
Front line workers around the world including Mexico are facing an unprecedented workload in overstretched health facilities, and with no end in sight. They are working in stressful and frightening work environments, not just because the virus is little understood, but because in most settings they are under-protected, overworked and themselves vulnerable to infection. Many have died.
Joey Merrifield, a nurse practitioner is distributing N95 masks, face shields, etc to Centro de Salud (Covid testing site), IMSS, Hospital General and the Covid Hospital and Covid Mobile Unit.
In addition, she is buying medical masks, thermometers and other items for “home health kits” for low income Mexican COVID patients and their families
To make a donation, CLICK HERE
Community Mask Project organized by Jessica Frick
you will find information on high quality inexpensive or free masks.
English Mask Order Site: CLICK HERE
Sitio de Pedidos de Cubreboca en Español: HAGA CLIC AQUI
Announcing Sheila Sawyer, a great addition to the advocacy team of Be Well San Miguel
We are very pleased to have found someone with extraordinary medical skills, the result of years of impressive training and experience. I won’t put her full bio here but you can find it on the web site and on the civil list. In short SMA now has a patient advocate with eleven years of acute care nursing experience in one of the toughest public hospitals on the East Coast. She also trained and worked as an epidemiologist and went on to complete an MBA at Boston University. After many visits over the years she and her husband have decided to settle in San Miguel. Sheila can be reached at 415 163 3258. Her email is oemac@comcast.net. She is now available to see clients on her own. Sheila uses both Sawyer and Lees as a last name.
Sue Leonard is still very much working with us from Seattle and is available by virtual and phone communication. You can reach her at her Mexican number
415 103 3952. Her email is unchanged and is Sue@bewellsanmiguel.com.
Home Health Care for COVID Alliance managed by Be Well San Miguel
Finally, we would like to reassure those of you asking about home health care for COVID. We are in negotiations with the same group I mentioned last month although I had their official organizational name wrong. They are called Biotechlab Análisis Clinicos. They are a group of highly skilled paramedics, nurses, and doctors working under the leadership of General Director Lic. Dulce Perales. They have access to many maximumly equipped ambulances and will go into homes and help with home health care at any stage of the disease. They also provide COVID testing sent to Mexico City with a turn-around time of 2 days. They come to your home and do the testing at prices competitive with any walk-in testing clinics in town. Sheila is a key source for oversite of the quality of the program with assistance from Dr. Emilio Ramirez and myself. Prices for care will of course be more expensive than common home care as the staff is fully equipped with hazmat suits and come to your door with a paramedic and well-equipped ambulance where they can carry out many of the functions of an Emergency Room short of intubation.
What we can do for you
For those of you who want more direction about how to manage any and all questions about COVID, are dealing with the stress of isolation, need to find the least contagious site for getting routine medical care, need referrals to excellent specialists and where they are working, or have questions about testing ,we can help. If you become a member of Be Well San Miguel we are available 24/7, can put you in touch with our partner Dr. Emilio Ramirez in any urgent setting, or help you write advance directives legal in Mexico. We will be offering home health care for COVID as well as home health care for any routine needs such as post-surgery support.
We follow the trends of the epidemic as well as they can be discerned. We are wrestling with not only the reported figures but also looking at the juncture of societal and economic pressures the pandemic forces upon Mexico. We are keeping up with the flood of information about possible treatments, approaching vaccines and most of all any new information that can help you prevent exposure. We are a team of clinicians who have a wealth of information to share.
We take appointments virtually and if you are having trouble setting up systems such as Zoom, Skype, Facetime we have technicians that can help.
For more information about this email update contact Deborah Bickel at deborah@bewellsanmiguel.com