Thread by @davidluhnow

Thread: Brazil is ranked number two in the world lists of Covid fatalities, behind the USA. But that is almost certainly wrong. Mexico is almost surely number two. And in this story, we explain why. wsj.com/articles/29-fa… via @WSJ

Mexico is failing to accurately record the majority of those who die from Covid. How do we know? Because the surge of excess deaths in 2020 in Mexico was roughly 2.4 times the official Covid toll. On Dec 12, excess deaths were 274,486 compared to Covid toll of 113,704.

Some of the additional deaths, of course, may not be Covid but from people who put off treatment for chronic disease, for instance. But health experts say the majority of those were likely killed by Covid. Other countries have a far smaller gap between excess deaths and Covid.

In Brazil, excess deaths for last year were 200,270 by Nov 21. The Covid toll by that date was 168,989, a far smaller gap than Mexico. That means Brazil is likely doing a far better job accurately counting its Covid dead.

A big difference is testing. Mexico carries out fewest tests in the Americas. It has only done 3.6 million tests during the entire pandemic. Brazil has done nearly 29 million. Mexico's coronavirus czar @HLGatell says widespread testing is a waste of time and resources.

And in Mexico, to be counted as a Covid death right away, you need a positive test result from gov't approved labs. The government doesn't count test results from private labs. To get an official test, you need to be at a selected public hospital and meet checklist of symptoms.

In October, the government said it would loosen its criteria, saying you could be added as a Covid death if a government medical committee reviewed the case file and made a determination. You can imagine how long that takes, and why it only accounts for a tiny % of Covid tally.

That means many, many Mexicans are dying from Covid and not being counted. Many are dying in their homes, terrified to go to public hospitals. Others are dying in hospital without a test.

We found one family just north of Mexico City where 29 of 34 members got Covid. Two died. None met the criteria to be entered as a Covid case or fatality. "It feels like, for our government, we don’t exist, and what we went through didn’t happen.” says one family member.

So getting back to the Brazil comparison. Brazil had 200,000 additional deaths by Nov 21. Mexico had 274,000 20 days later. Assuming a similar % of total excess deaths are caused by Covid, and it's almost certain Mexico has a higher Covid toll than Brazil.

A luminary of Mexican epidemiology, Jaime Sepulveda Amor, said he believes Mexico's limited testing and strict criteria was a deliberate strategy to keep the official Covid toll low. "What has happened in Mexico is not just a scandal, it's criminal," he says.

Government officials say that is not the case. They point to increased testing in recent months and say they used criteria that were already in place to monitor influenza. That begs the question why they didn't change that strategy.

Whatever the cause, the strategy has indeed kept Mexico's official Covid toll below that of Brazil. For the town of Coyotepec, though, the lack of testing meant local authorities didn't pick up on the epidemic until after it swept through the town and the Cristobal family.

Many in towns like Coyotepec were left to fend for themselves. Doctors feared treating patients. So a dentist stepped up. People feared going to public hospitals, so they stayed home until they started turning blue. By the time they got to hospital, it was too late.

The local priest, Father Mendoza, says the stigma of Covid is so bad that some local families bribed doctors to put a different cause of death on certificate. He says the real number in Mexico may never be known. "It will take generations to digest the impact of this tragedy."

P.S. The @WSJ did a global study on excess deaths. You can read that piece here: wsj.com/articles/the-c…

P.P.S. Many smart analysts in Mexico have studied excess deaths. @LaurianneDsp and @mariorz have done great work on Mexico City, and @netocervantes98 has done great work at a national level. His work is here: proyecto.li/acerca-de