COVID-19 in Colombia and Venezuela: Two Sides of the Coin

Over the past two years the world and its different regions, including Latin America, have been suffering from the enormous burden and impact of the COVID-19 pandemic, which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Colombia and Venezuela have been greatly affected.^1,2 Despite sharing historical and cultural roots and similarities, each nation has entirely different sanitary conditions, especially regarding infectious, tropical, and reemerging illnesses, including vaccine-preventable diseases. Such differences have increased especially during the past two decades.

Major infectious diseases in Colombia, such as tuberculosis, HIV, and malaria, are under reasonable control. Malaria, in particular, has significantly decreased during the past decade.³ Conversely, in Venezuela, all of these diseases are rising, especially malaria, which is shifting the country from being the former leader in vector-borne disease control to the nation with the highest morbidity in the Americas.⁴ Vaccine-preventable illnesses, such as measles, diphtheria, mumps, pertussis, and hepatitis A, show a similar picture, with high vaccination coverage in Colombia and sustained outbreaks across multiple years in the past decade in Venezuela.⁵

In addition, the risk and occurrence of imported cases of these diseases in Colombia, Brazil, Ecuador, Panama, and other countries in Latin America and beyond also increased because of critical Venezuelan migration in the region.^6–8 The arrival of COVID-19 to Latin America has compounded existing health crises in Venezuela. The COVID-19 pandemic has required different surveillance, diagnostic, and management approaches as well as marked differences in the national vaccination plans. Therefore, the COVID-19 crisis in these two Andean countries shows two different sides of the coin.

After the first case in Latin America, reported in Brazil on February 25, 2020, multiple countries in the region rapidly detected SARS-CoV-2 or COVID-19 cases.⁹ In Colombia, initial cases were noted on March 6, 2020, and in Venezuela, on March 13, 2020.¹⁰ Going further, as the pandemic emerged, Colombia was a country with high international air traffic. Alternatively in Venezuela, even before the pandemic, there were significant decreases in the number of international flights, as many airlines left the country and discontinued regular flights to the capital Caracas and other cities. Additionally, Venezuela suffers from long and profound political and economic crises, which contributed to truncating internal mobility because of fuel and electricity shortages and a high percentage of poverty.^4,7 Differences in international travel and population mobility likely promoted the rapid spread of COVID-19 in Colombia and a slower spread in Venezuela. It is important to note the paradoxical benefits of the airline crisis and economic challenges in Venezuela.

Furthermore, it was suspected from the beginning that the surveillance and reporting of COVID-19 cases in Venezuela were not accurate, similar to gaps in data collection of multiple other notifiable communicable diseases that were not publicly available. This is in contrast with Colombia and other countries, where the leading epidemiological indicators are online (www.ins.gov.co). Thanks to the long history of public health surveillance for tropical infectious diseases, Colombia has managed the challenge of implementing the key recommendations for COVID-19 surveillance promoted by the World Health Organization via Colombia’s National Institute of Health.¹¹ In addition, Colombia rapidly established molecular diagnostic laboratories and was the first to have the reverse transcription–polymerase chain reaction (RT-PCR) test for SARS-CoV-2 available in Latin America. As of October 13, 2021, Colombia had collected 16.5 million samples by RT-PCR for SARS-CoV-2 and 9.5 million samples by antigen testing (available in all the country departments) and had installed 21 laboratories across the country with genome-sequencing capacities. In Venezuela, by November 2020, the molecular diagnosis was available at only five public reference laboratories, limiting the country’s diagnosis capacity.¹²

Another critical aspect to consider is the capacity of the hospital network in these two countries and how it has adapted to deal with the current pandemic. When cases escalated in March 2020 and patients required hospitalizations, Colombia had 43 935 hospital beds and 5346 beds in intensive care units (ICUs). This capacity increased up to 83% in the case of ICU beds in August 2020, turning Colombia into the Latin American country with the highest number of ICU beds per 100 000 inhabitants at that time. Moreover, to support adequate attention to critical COVID-19 patients, Colombia acquired 6313 ventilators and trained 45 000 health care workers in the management of intensive care patients.¹³ Unfortunately, the situation across the Venezuelan border was dramatically different. At the pandemic’s beginning, Venezuelan authorities reported 23 000 hospital beds and 1200 ICU beds for COVID-19 patients, although more realistic estimates reported by health care workers indicated only 80 ICU beds in the entire country.

The Venezuelan government designated 46 hospitals to respond to the crisis. According to the authorities, these hospitals were fully equipped, but this was denied by health workers of these same health centers, indicating that half of them could not meet aseptic and antiseptic conditions and lacked equipment such as gloves, masks, and soap. Besides, 30% and 40% of the facilities reported water and electric services problems, respectively.¹⁴ Regarding vaccination, Colombia began its program in March 2021, Venezuela in June 2021. Up to October 2021, only 36% of the Colombian population have been fully vaccinated with five different available vaccines, whereas only 22% of Venezuelans were inoculated with three vaccines available (Figure 1).

FIGURE 1—

COVID-19 (a) Cases per Million Over Time, and (b) Proportion of People Fully Vaccinated: Colombia and Venezuela, 2020, 2021

Source. Johns Hopkins University CSSE COVID-19 Data. Note. The inserted boxes list vaccines used in each country.

Lastly, it is important to mention that Colombia has been coping with the humanitarian migration crisis generated in Venezuela before the pandemic. This included a national plan in cooperation with national and international organizations to integrate Venezuelans into the national COVID-19 response through health care access disregarding their migratory status and their inclusion in economic support programs. The plan included the application of biosecurity protocols in human corridors established at the Venezuelan frontier; attention to irregular status immigrants through emergency mechanisms offered by local authorities; the strengthening of cooperation programs to provide housing, shelter, and food to refugees and migrants; and the enrollment of vulnerable migrants in governmental assistance programs with a particular focus on border departments.¹⁵

The differences in the COVID-19 situations and responses between Colombia and Venezuela show us two sides of a coin. Colombia has managed so far with international aid and the effort of national health authorities and health care workers to adapt its health system and meet the demands of this crisis. Meanwhile, the situation in its neighboring country has been exacerbated by a government in denial of its internal political and social crises. Reaching conclusions about a more exact state of the situation would be risky, as accessing accurate statistics about the COVID-19 pandemic seems impossible. Hopefully, both countries will collaborate more closely in a future health crisis.