COVID-19 in El Salvador: an end-of-year second wave of cases?

A little less than nine months ago, the novel coronavirus arrived in El Salvador as part of the pandemic’s worldwide inexorable spread.   The country had a wave of infections, hospitalizations and deaths which threatened to overwhelm its healthcare system during June and July before subsiding after the first week in August.   As the year nears an end and the country approaches Christmas parties and family gatherings, the number of cases is again beginning to gradually increase across the country.   

According to the official statistics on the El Salvador’s COVID-19 website at, there have been 40,551 confirmed cases of the virus in the country and 1168 persons have perished from the disease.  There are 2432 active cases as of today.   These statistics only include those cases and deaths which have been confirmed by a test administered by the government.  There are 4189 suspected active cases (persons with symptoms which have not been confirmed with a test).

For a detailed analysis of nine months of government data, see the reports (in Spanish) of Fundación Ungo at this link.   

There are a few challenges in evaluating these numbers.   El Salvador has not expanded its testing capacity beyond 2500 tests per day since mid-May, and the government has refused to release data regarding who has been tested and the protocols for determining who will be tested.  It is acknowledged by all involved that there has been a significant undercount both of positive cases and deaths.   

Despite the limitations imposed by the testing limits, there is no doubt that the country passed through a large wave of hospitalizations and deaths during the summer which then subsided in August through September.  In the past month, however, cases have begun to rise again.

Daily new confirmed cases of COVID-19
sharp spikes in September and October reflect testing changes and not progress of disease)

Unlike some other political leaders in the Americas like Donald Trump, Jair Bolsonaro and Andrés Manuel López Obrador, Salvadoran president Nayib Bukele actively promotes wearing masks and other public health measures.    The president no longer tweets the daily statistics of the progression of the disease in El Salvador, but there is still plenty of public health messaging around the virus.   

The economy has largely been reopened since September, and incoming international flights were no longer restricted after the first week of October.   (A negative COVID-19 test is required of all arriving international passengers).   

The president and the Legislative Assembly have ceased fighting over lockdown measures.  Instead, the conflict between branches of government comes from the unwillingness of Bukele and his government to provide data on how it has been spending the billions appropriated by the Assembly for dealing with the pandemic.  In addition, the country's attorney general has commenced investigations into corruption in government contracting related to the pandemic.

Anecdotally, on a recent trip to El Salvador in mid-November, much of the activity in the country felt like it had returned to normal.   The traffic congestion in the capital city was at its normal high levels. Stores and restaurants were open.   San Salvador was illuminating its giant Christmas tree with a fireworks display.  Temperature checks on entering commercial and government offices were routine.   Hand sanitizer was prevalent.   Mask-wearing was much more common than in the Midwest of the United States.

The country’s COVID-19 hospital, the Hospital El Salvador, now occupies the space formerly used by the capital city’s convention center.  Despite early promises, the third phase of Hospital El Salvador remains far from complete, yet it is not clear that it was ever needed.   

Bukele has declared that the country will obtain sufficient vaccine to vaccinate 100% of the population (though vaccinations will be voluntary).  He announced an agreement to purchase 2 million doses of the vaccine developed by AstaZeneca and Oxford University.   The agreement was confirmed in a press release from AstraZeneca which stated that availability would be in the first half of 2021.

The country will also have access to vaccines through COVAX, a global program sponsored by the United Nations to make vaccines available to lower and middle income countries.     The government has falsely claimed that it will be one of ten countries to get priority access to vaccines through COVAX.   In fact, it is quite clear that one of the goals of COVAX is to have all participating countries get access to vaccines on the same basis and in the same proportions.  COVAX also must compete with wealthy countries in purchasing doses of vaccine, and so far is reported to have procured promises for 700 million doses for its 189 participating countries.  In El Salvador's favor is a strong nationwide program of universal vaccinations, so it understands how to reach the public once the vaccine arrives in the country.     

As El Salvador heads towards Christmas and end-of-year vacations and family gatherings, there is still risk of a resurgence of the disease.  The risks come from large gatherings of family and friends, from crowded stores and shopping centers, and from people letting down their guard with COVID fatigue.  The chief of infectious diseases at the Rosales national hospital stated in a recent interview that end of the year family gatherings could be the accelerator for a second wave of infections in the country, a fear shared in countries throughout the world.  Unlike northern countries, however, El Salvador is not heading into a winter season where everyone remains indoor in sealed spaces where the virus lingers in the air.   The ability to have buildings and homes open to the outside air is a natural aid to reducing virus spread.    

 Bukele recently tweeted that El Salvador had been the best in the region at managing the pandemic, and, while that was a deceptive retweet of a paid placement by his government, the country and its citizens have certainly gotten better in controlling the spread of this disease.  The desire to celebrate with family and friends will be the next big challenge for the country before people are able to start rolling up their sleeves and getting shots of vaccine.