(This article was first published in Spanish in Contra Corriente.)
On March 11th the World Health Organization (WHO) declared the outbreak of Coronavirus Disease 2019 (Covid-19) a pandemic;that same night Honduran authorities reported the first two cases in the country. Nine days later, the government of Honduras had reported 24 confirmed cases. Currently, the entire country is under a state of emergency, which includes the suspension of constitutional rights, until March 29 (at which point the government will announce new measures).
Fear of the virus adds to the growing distrust of President Juan Orlando Hernández’s government, which has already presented multiple cases of corruption. Citing both the health emergency and related social crisis, the National Anticorruption Association (CNA) released a statement claiming that the coronavirus epidemic could create “the perfect circumstances” for corrupt acts.
The National Congress of Honduras on March 13 approved a package of over 10 billion lempiras ($420 million dollars) as part of the Special Law for Economic Stimulus and Social Protection against the Effects of Coronavirus. This is the same Congress that currently has representatives involved in legal processes for embezzlement of public funds and has barred the CNA from providing oversight of the Special Law funding.
On March 15 Contra Corriente submitted a public information request regarding the approved budgets, and today we denounce the fact that the system did not accept the requests and informed us they would not be able to respond until staff had returned to the office. The lack of a clear protocol for access to information in these times can create even more distrust of the government’s management of the crisis.
Since the government declared Covid-19 a national emergency on February 10, government authorities in both the executive and legislative branches have approved a series of economic packages totaling 11.32 million lempiras ($454,000 dollars) in order to manage the crisis. However, the Special Law for Economic Stimulus and Social Protection against the Effects of Coronavirus, which has been heralded as the primary economic aid measure, does not allow for the immediate use of all the funds to address urgent shortages in the country’s health system.
This law provides for special direct contracting authorization for public works, goods, and services, although it does not specify how many contracts are allowed for, nor the time period for executing them. President Hernández, in a press conference announcing the third case of Covid-19, thanked “a large majority” of members of congress who approved the law that he had sent to the legislature weeks before. Of 128 representatives, 69 voted to approve said bill.
“With this measure, the health system will generate around 10 thousand new jobs over the next five years and build 11 hospitals, 17 clinics, 27 health centers, and 40 primary care centers around the country,” declared Hernández.
Suyapa Figueroa, president of the Medical Association of Honduras (CMH), told the media the law’s objective is not to create mechanisms to bypass the State’s limited measures of control. “It is not necessary to legislate for direct contracting in a state of emergency, given that the Law of Public Administration and the Law of State Contracts already exist to regulate that specific kind of contracting,” explained Figueroa.
Although the law appears to give the go ahead for any type of procurement or contracting free of regulation by other institutions, on March 11 the National Office of State Contracting and Procurement (ONCAE) released a statement announcing the launch of a tool to make procurement processes more transparent in line with the president’s emergency declaration.
Ministro de #Copeco @gabrielrubip, muestra los avances de la instalación de la Sala de Aislamiento Temporal, que se habilitará para la atención de ciudadanos asintomáticos que necesiten estar bajo vigilancia y monitoreo por #COVID19 y que no puedan autoaislarse en sus viviendas. pic.twitter.com/a4joCKU7ey
— COPECOHONDURAS (@COPECO_HONDURAS) March 18, 2020
Businesses already registered in the Supplier Registry can record their products in the Emergency Electronic Catalog PCM-005-2020, the tool for government institutions to order materials needed to deal with the crisis. The catalog, established by ONCAE and distributed through the online platform Honducompras, consists of 53 products—from disposable masks to high-flow mechanical ventilators—offering suppliers a way to affiliate themselves to specific materials. The Honducompras platform also includes each public institution’s purchase order. Recently, there have been several inconsistencies in the purchase of these materials.
The Customs Administration of Honduras submitted a purchase order for 500 boxes of antibacterial hand sanitizer, each containing six gallons, for a total of 2.2 million lempiras. Each gallon of hand sanitizer cost the government 750 lempiras, even though the government itself had set the maximum value of a 500mL bottle of gel at 80 lempiras ($3 dollars), meaning the maximum price of a gallon should be 606 lempiras (over $24 dollars). In total, the Customs Administration is paying 432,000 lempiras ($17,320 dollars) more than what is stipulated in the catalog.
The Customs Administration purchased these supplies from YIP Supermarket, a registered supplier offering products substantially more expensive than another supplier selling the same box at 710 lempiras ($28 dollars), according to the Honducompras website. In another case, Customs purchased two thousand boxes of disposable masks from Central American Healthcare Products at an approximate cost of 1.2 million lempiras ($48,000 dollars). Each box contains 50 masks, and the state is paying almost 12 lempiras (fifty cents) per disposable mask. Among pharmaceutical suppliers in Honduras, the maximum price before the coronavirus crisis was 3 lempiras (ten cents) per mask.
Although the government had defined price limits on antibacterial hand sanitizer, it did not limit the price for other materials, which has resulted in a significant increase for the average consumers who have tried to obtain these materials in the midst of a health crisis. The presidentially appointed Minister of Economic Development, María Antonia Rivera, agreed in a press conference to determine a maximum price for the sale of certain products considering the health emergency and understanding they “could be used by the population without violating their rights.”
The Missing Ventilators
The president’s private secretary, Ricardo Cardona, told media outlets this Monday that the presidential aircraft had gone to the United States to bring back materials for treating Covid-19. However, he did not specify which materials were acquired, the cost, nor their location. The plane landed, without public knowledge, in New York City, where it remained at the Steward International Airport until March 18.
When the communications director for the Presidential Palace was questioned about the trip, the response was that it was not, in fact, the president’s plane that had left the country. The director later admitted to not having information about the trip, and finally said that the trip was to purchase 140 mechanical ventilators, 140 respirators, and 90 mechanical mucus suction devices.
According to photographs that the Presidential Palace’s communications office sent to the press, the ventilator purchased was a Breas model VIVO 65 with an approximate market value of five thousand US dollars. According to specialists, this model is not meant for the treatment of Covid-19 patients in a critical state who need assisted breathing equipment.
Doctor Gaspar Rodríguez, a specialist from the Honduran Social Security Institute, explained that the ventilators needed are those that allow for totally assisted ventilation for treating lung complications; the ventilators purchased by the government do not meet these specifications. Even the epidemiologist Roxana Araujo, spokesperson of the National Risk Management System (SINAGER), admitted that the ventilators were purchased without following the necessary specifications, and the ex Minister of Health, Elsa Palou, has mentioned that there are only 100 such machines in all of the country’s public and private health centers.
This newspaper sent an email to the company that distributes these ventilators to confirm the purchase made by the Honduran government, but at press time has not received a response.
Regarding the purchase of ventilators inadequate for treating patients in the critical stages of Covid-19, President Hernández admitted the information is true and that the worldwide stock of equipment for treating the most advanced stage of the disease has run out. “The Health Secretary told me that, together with the Banco de Occidente’s trust, they had contemplated purchasing respirators for patients who are in the most critical stages of intensive care, and the process has moved forward normally, but suppliers around the world are saying, ‘Look, we cannot sell them now because there are governments who hoarded all of this equipment for the countries where they are produced,’” said Hernández. He also assured that technicians are working to repair several ventilators already in the possession of the health system.
Hernández pointed out that in the second phase of the illness, when someone with mild Covid-19 can advance to a critical state, “it is in this intermediary stage that these machines can also be useful.” He also stated that an Air Force plane brought 4,200 test kits for the emergency and that the government had requested a donation or sale of 100,000 more kits from China and Taiwan.
In the electronic ONCAE catalog created for the national emergency, two companies offer to provide mechanical ventilators to whatever institutions need them. These products were entered into the catalog after March 11, two days before the approval of $420 million US dollars for the
The Situation in Hospitals
International media reported that in Italy, 2,629 doctors and nurses had been infected with coronavirus, more than double the figure reported in China. Italy has also reported at least 24deaths among healthcare professionals. This is due, in part, to a shortage of personal protective equipment.
According to the Global Health Security Index, developed by Johns Hopkins University, Honduras is one of the countries in Latin America least prepared for a pandemic. Only Venezuela has worse healthcare conditions, according to the index.
The situation in Italy could repeat itself even worse in Honduras, despite the extraordinary budgets and costly purchases of hand sanitizer and masks to avoid spreading Covid-19 within government institutions. Doctors from several health centers around the country claim that they have not received the materials they need to respond to the emergency. In addition, last Tuesday the Honduran Medical Residents Association (ASOHMER) and doctors in their rotational internship announced in a press release that they would stop working in hospitals around the country.
The press release claims these doctors have not had access to N95 masks, even while treating patients categorized as suspected coronavirus cases. “It is not as if we do not want to help the Honduran population, because we do, but we also have families and we have to protect our lives,” said Marco Elvir, coordinator of the Medical Social Service at the National Autonomous University of Honduras (UNAH).
Likewise, the Student Commission for Microbiology Social Service at UNAH released a statement in which they demanded that materials be stocked in all areas in order to comply with biosecurity measures, considering they are the ones who take samples that are sent to the National Virology Lab, which confirms suspected cases of Covid-19. To date, neither one of these student groups has had their demands for protective equipment and other supplies met.
Doctor Ligia Ramos, member of the Medical Association of Honduras, supports the young medical professionals’ decision to stop attending to patients, since they receive low salaries that do not allow them to even buy their own equipment. “[The government] should give the materials they have to the hospitals that already exist. If they can’t manage with the hospitals we already have, what are they doing building more? Stop fooling around—they only want to steal. The problem is already at our doorstep and we need to strengthen the health system now,” she said.
The University Hospital School (HEU) suspended walk-in consultations but is still allowing patients with previously identified chronic illnesses to pick up their medications. Residents and interns are still receiving patients in the emergency room after meeting with authorities from the Medical Sciences Department, who promised they would provide all the equipment necessary. Contra Corriente attempted to contact Doctor Jorge Valle, Dean of the Medical Sciences Department, to discuss how he would improve this situation, considering Covid-19 cases are on the rise and medical personnel are invaluable. At the time of publication, we have not received a response from Dr. Valle.
Meanwhile, the Health Secretary designated specific health centers in the Central District for treatment of the pandemic disease: the Peripheral Hospitals in El Hato and El Sitio, as well as the Cardiopulmonary Hospital (known as “el Tórax”) and the San Felipe Medical Specialties Hospital. Anyone with acute respiratory symptoms and fever should seek attention only in these facilities. “We must remember that the General Governmental Budget is not distributed equitably, since the majority goes to Defense and Security, leaving health and education behind,” said Jorge Letona, president of the UNAH’s Medical Defense Organizations Group.
Crisis Management
Last Wednesday, a video of a situation report from COPECO circulated on social media, although COPECO stated on its Facebook page that the video was false and later erased the publication after seeing that larger media outlets had already published the information. The situation report in question stated that up until March 18 there had been 105 suspected cases in the country, of which only 31 had received medical attention.
A medical student doing her social service in the Cardiopulmonary Hospital, who prefers to remain anonymous, mentioned that not all patients with symptoms received a test for Covid-19 since there are only 50 test kits available. The hospital does not want to run out of kits, so doctors are prioritizing testing for patients who have had contact with a positive case or have recently traveled to an area with community transmission, making them a probable vector.
COPECO announced they had set up a temporary isolation room in one of the Olympic Village gyms. This space is for asymptomatic patients who have had contact with confirmed Covid-19 patients and who cannot self isolate in their own homes, in order to avoid overwhelming healthcare facilities.
#COPECO Minister @gabrielrubip demonstrates the progress of the Temporary Isolation Room, which will be used for attending to asymptomatic citizens who need to be under observation and monitoring for #COVID19 and who cannot self isolate in their homes.
This situation led residents of surrounding neighborhoods to protest, claiming the area does not comply with health standards and was not designed for the purpose of providing medical care. The residents believed that the sports complex was being converted into an improvised hospital. However, the National Sports Facilities Commission’s (CONAPID) director, Armando Váldez, indicated that the residents had nothing to fear given that the only patients present in the facility are 21 people who recently arrived from Nicaragua without symptoms and who are under observation in case they start to present symptoms.
This measure, however, has just recently been applied. A report by COPECO indicated that at least through March 13 the country had received five buses full of migrants deported from Mexico and three flights from Texas with more than 300 Hondurans. None of these people were put in isolation upon their arrival.
On Thursday afternoon, Juan Orlando Hernández announced that he had come to an agreement with the country’s two private telephone companies to allow their customers to access certain government websites with the aim of keeping citizens informed. In addition, users will be allowed 50 messages and 5 phone minutes per day free of cost. A government message sent through these companies’ networks announced, “TOTAL CURFEW. Movement is prohibited. No entry or exit of the city is permitted. Coronavirus is lethal. STAY AT HOME.”
Honduran authorities say that the end of the curfew will depend on how the situation evolves over the next few weeks, as well as on the analysis of World Health Organization (WHO) and SINAGER experts. For now, authorities cannot say for sure whether 14 days of forced isolation will be enough to deter the spread of the virus. In a statement to the media, President Hernández said, “The dimension of this situation is beyond expectations, and any previous measure or prediction had not anticipated what has since happened in other countries around the world. Therefore, we must work off the worst-case scenario, which means thousands and thousands of infections and, unfortunately, we will also have people die of the disease. It’s not easy, but that’s how it is.”
*Translated by Brendan Fields
