Photo: Kennyjo

Why COVID-19 Numbers Stay So Low in Venezuela

Almost one year after the start of the pandemic, Venezuela reports remarkably lower figures than its neighbours, but that’s due to the government’s unwillingness to scale up diagnosis

Back in June, the Venezuelan opposition and Nicolás Maduro’s Ministry of Health announced an agreement to use part of the Venezuelan assets retained abroad to acquire COVID-19 antigen tests, to strengthen the country’s limited diagnostic capacity. The agreement was universally welcomed but, unsurprisingly, Maduro’s government has failed to live up to its promises.

Around 340,000 tests were sent by the Pan American Health Organization (PAHO) in October as part of the negotiation but, as of January 21st, only 3,000 have been used, according to official PAHO figures reported by Bloomberg. Similarly, while the original agreement indicated that tests would be distributed to 27 different hospitals around the country, the government exclusively dispatched them to their public ambulatory clinic network, known for their nonexistent accountability and opaque handling of epidemiological data.

Despite not being as precise as molecular tests (such as those based on the polymerase chain reaction technique, or PCR), antigen tests can detect proteins produced by SARS-CoV-2 within a week after symptom onset, and are generally considered useful for the diagnosis of symptomatic cases. They’re also considerably cheaper, can be performed virtually anywhere without the need of specialized equipment, and give results in about 30 minutes. These qualities make them an ideal alternative in countries where scaling-up PCR testing capacity is unfeasible. In India, for instance, the introduction of rapid antigen tests allowed almost a million people to be tested in a single day, back in August.

This opacity is openly exploited by Maduro and his propaganda apparatus, as demonstrated with the government’s recent offer to provide oxygen cylinders to the Brazilian city of Manaus

But more tests invariably mean more COVID-19 cases, a price the Venezuelan government seems reluctant to pay. 

While Venezuela still holds one of the lowest number of cases in the continent (123,245, and 1,142 deaths as of January 23rd), the real magnitude of its testing efforts remain obscure. The country has allegedly run over 2 million tests, but most of these have been rapid antibody tests, which are different, and less sensitive than antigen-based ones. According to Bloomberg, the country has only done 485,000 PCR tests, about 18 per 1,000 people. 

The figure in Colombia, for instance is ten times higher.

The fact that the Venezuelan government has used less than 1% of the antigen tests it received in October, indicates not only its chronic incapacity to stick to negotiation terms, but also its little interest in scaling up diagnostic capacity.

While it’s true that the daunting scenes witnessed in other countries have not been replicated in Venezuela, mathematical models show that while the country reports some 300 new cases every day, the estimated number is probably between 1,200 and 3,500. Low testing capacity is therefore helping the government keep the number of reported cases artificially low.

The absolute lack of public epidemiological data in the country, including general mortality figures, and the number of daily reported cases of respiratory infections, also mean that the true magnitude of the COVID-19 pandemic in Venezuela is virtually impossible to measure, as there’s no baseline to compare the current situation with. 

This opacity is openly exploited by Maduro and his propaganda apparatus, as demonstrated with the government’s recent offer to provide oxygen cylinders to the Brazilian city of Manaus, where health services have nearly collapsed. Just six months ago, reports of patients looking for these cylinders flooded Venezuelan social social networks, as these are a rare commodity in most national hospitals.

The government’s lack of accountability regarding its handling of the tests, as well as the $11 million debt it holds with PAHO, also jeopardize the acquisition of COVID-19 vaccines via the organization. 

The Children’s Cardiology Hospital in Caracas and the Russian Gamaleya Institute are, however, carrying out a large phase III clinical trial with the Sputnik V vaccine, and expect to recruit 2,000 volunteers in the Venezuelan capital. This strongly suggests the vaccine will be eventually distributed in the country.

Now, despite evident politicization and a reckless initial approval, the Russian vaccine seems to be similarly effective as other available alternatives, although detailed results have not yet been published in peer-reviewed journals. Argentina, which leads regional vaccination efforts, has already applied over 200,000 doses of the vaccine without any evidence of major adverse reactions. 

And for those stuck in Venezuela, Sputnik V is still better than no vaccine at all, given Maduro’s reluctance to allow the arrival of alternatives.

Juan Carlos Gabaldón

Medical doctor from Merida, currently studying Medical Parasitology at the London School of Hygiene and Tropical Medicine