The streets of Guatemala City appear almost normal. On the first weekend of eased coronavirus restrictions, the Sexta Avenida, which is lined by shops and restaurants in the City’s historic center, was filled with people returning to shopping and strolling, while others took to the roads across the country to visit loved ones and travel to the beaches 130 kilometers from the city, leading to the first major traffic jams in four months.
Yet according to the Guatemalan government’s new health alert system, Guatemala City and many other municipalities remain on the highest alert level due to the pandemic. The country is opening even as it continues to suffer from the impacts of the COVID-19 pandemic. Since March, Guatemala has registered over 51,500 confirmed cases of COVID-19, resulting in over 2,000 deaths.
Cases have been on the rise, with nearly 13,000 cases confirmed in the last two weeks, as well as 344 deaths. Experts and public health officials are afraid that the premature reopening of the economy will lead to an explosion of the virus across the country.
“Relaxing measures in the middle of an increase of cases and deaths, without fully enabling the five temporary hospitals, and having the national, departamental, and regional hospitals saturated, means we will have more mobility, an increase in cases,” Lucrecia Hernández Mack, congressional representative with the centrist Semilla Party and former Health Minister, told El Faro. Following the first cases, the Giammattei administration announced the construction of five field hospitals to treat patients infected with coronavirus. “We are going to see an increase of cases in the rest of the country. The response has been fatal.”
A week prior to the opening, the Giammattei administration announced on July 26th that the country would begin the slow opening of the economy after over four months of restrictions to prevent the spread of COVID-19. The easing of measures permits public buses to begin running with decreased capacity, businesses and shopping centers to open, and religious groups to begin holding services.
The opening comes as the Health Ministry began to implement a Health Alert System in each municipality to permit the opening of the country. Similar to the system in Mexico, Guatemala’s alert system denotes the risk of infection by Red, Orange, Yellow, and Green. But as Hernández Mack points out, unlike the Mexican system, there is no clear division of what ministries are responsible for guaranteeing the enforcement of the restrictions associated with each level, and little methodology based in public health to denote the levels.
According to Hernández Mack, only public transportation has clearly articulated structures for reopening.
“For the rest [of the sectors] no one knows who is responsible for guaranteeing they comply,” Hernández Mack said.
While Guatemala was one of the countries with the quickest responses aimed at containing the spread of the virus in March, the months since have seen an approach plagued by a lack of testing, accusations of corruption, and general incompetence stemming from the Giammattei administration’s centralized response. The fact that the panorama of the impacts of the virus are not fully recognized means that the country’s already overwhelmed health care system is poised to face greater pressures. The lack of clarity and establishment of rules for reopening mean that chaos could be on the horizon.
“We do not have reliable data,” Hernández Mack said. “But we know [cases] are increasing rapidly. Supposedly the relaxing of measures should occur when they are lowering, but we are on the maximum alert and the measures are being relaxed.”
For doctors on the front line, the new measures are reminiscent of the last time restrictions were relaxed.
“The cases have been increasing a lot,” Doctor Zagreb Zea, who has worked for 16 years in the Guatemalan public health care system and is the current president of the Roosevelt Hospital directive council, said. “At the beginning, the measures were good in March and April. But after April, we saw the first spike as people began to leave [their homes]..”
Though Guatemala’s health care system has been overwhelmed by the pandemic, has long suffered from lack of funding.
“With Covid, we have uncovered the neglect that has been for years on the part of the previous governments,” Doctor Zea said. “And the disinterest in [supporting health care]. If the pandemic happened in 2024, the excuse would be the same: ‘We were not prepared;’ ‘It was a collapsed health care system,’ and ‘he other governments didn’t leave a quality healthcare system.’”
According to the World Health Organization, Guatemala has one of the lowest rates of investment into the public health system in Latin America. The country also has one of the lowest ratios of doctors to population in Latin America, with only 0.4 doctors for every 1000 citizens.
Furthermore, until last year, doctors in the public health care system were insufficiently paid for their work. After a struggle led by medical staff, they managed to gain an increase in pay in 2019.
The virus has hit Guatemalan doctors and medics hard. Since March, at least 31 medical professionals from both the public and private hospitals have died as a result of the virus.
“There is frustration with everything happening right now with [the health] emergency and the government,” Doctor Zea said. “But there is also sadness for all our colleagues who have lost loved ones and for those colleagues we have lost. But we are not tired physically or mentally.”
The uphill battle to treat an unprecedented swell of patients in a neglected health care system has exhausted doctors and medical personnel. But they remain dedicated to treating the patients who arrive at public hospitals.
At the beginning of the pandemic, the Guatemalan congress approved over US$2 billion in loans for the response to the pandemic. The approval made US$83.5 million available to the 5 temporary hospitals built to treat COVID-19 infections and the Specialized National Hospital in Villa Nueva. However, in over four months, the Health Ministry has only utilized 15 percent of the temporary field hospitals’ budget, all while the families of patients must pay for medicine, oxygen, and other medical necessities.
Nor are the temporary hospitals fully operational: they have far lower capacity than the administration had stated, and over half of the contracted doctors and nurses at the Parque de Industria temporary hospital in Guatemala City have not been paid.
On multiple occasions doctors have pleaded with the Health Ministry to come and observe the conditions they are working under, but according to Doctor Zea, they have not arrived.
“And there are only three blocks between the Health Ministry and the Roosevelt Hospital,” he said.
As the country continues to deal with a collapsed health care system, the true scope of the virus remains difficult to grasp. There have been long-standing issues getting an accurate number of cases due to significant disparities in the country’s testing. At one point, Doctor Edwin Asturias, who heads Guatemala’s Presidential COVID-19 Response Commission, claimed that the number of cases could be as high as 100,000.
Efforts have been made to expand testing. On July 30, Doctor Asturias praised the country in a tweet for reaching 5000 tests in a single day. Since then, the number of tests performed per day has fallen significantly.
As of August 1st, Guatemala has performed over 160,000 tests since March. Of those, the vast majority have occurred in the central region of the country, including the departments of Guatemala, Sacatepequez, and Chimaltenango. The department of Guatemala alone accounts for over 60 percent of all tests.
According to the data, over half of Guatemala’s 340 municipalities have performed less than 200 tests, with several performing as few as only one to three. Yet in spite of this, many of the municipalities do not fully know the state of the pandemic within the communities.
“There are municipalities that are beginning to be affected,” Hernández Mack said, “but there is nowhere to get tested.”
In spite of the problems and obvious dangers, the country has begun to reopen. The easing of measures comes after the Guatemalan business community - including the Coordinating Committee of Agricultural, Commercial, Industrial, and Financial Associations (CACIF) - and some Evangelical and Catholic groups began lobbying the presidency and Congress.
“The President gave in to special interests groups,” Hernández Mack said.
But the measures also come after the government’s relief efforts largely failed to reach those most affected by the measures to contain the virus, especially in the informal economy.
“None of the programs meant to help the people arrived,” she explained. “The people had to go out with their white flags to search for work, because if they don’t, they won’t survive.”
Across Guatemala people began to take to the streets holding white flags as a sign of need, a practice also seen in El Salvador.
While some municipalities, an Evangelical association, and the parts of the Catholic Church, announced that they would not renew public transportation or hold services due to the continued threat of the virus, the countrywide response has been one that has subordinated the public healthcare system to the will of the executive branch.
In regards to the crisis, Doctor Zea said, “I think this government is incompent.”