Two years of COVID in El Salvador - the unknowns

As we reach the second anniversary of the pandemic impact of COVID-19 in El Salvador, the Salvadoran public continues to wholeheartedly approve of the handling of pandemic by Nayib Bukele's government.   That approval is driven both by concrete actions such as the early acquisition of vaccines, consistent public health messages, and hospital improvements, as well as by the sophisticated government public relations machinery telling the public how well the pandemic was being handled.           

Verifying those claims with actual data is much more difficult, however.  The Ministry of Health has declared as confidential, and not subject to disclosure under the public information law, a wide variety of data regarding the pandemic and the government's response.

What we know -- the official COVID 19 case count

The official count of confirmed cases of COVID-19 in El Salvador as of February 27, 2022 is 156,364.

What we don't know -- the actual number of COVID 19 cases

The actual number of cases of COVID-19 in El Salvador is many times the official total.  COVID cases are undercounted everywhere in the world, but the undercount is greatly exacerbated in El Salvador by the fact that El Salvador limited its daily COVID testing to approximately 2500 tests per day and only reported in daily totals the positive cases found in those 2500 tests.  This limited testing continued until January 18, 2022 in the midst of the Omicron wave when the country increased its daily testing to an average of approximately 4650 tests per day.  Suddenly the country was reporting almost twice as many positive cases per day, and at the same time the Ministry of Health said it was delivering 10,000 medicine kits daily to persons who had called the Ministry's phone hotline with COVID type symptoms.  

The government testing is not aimed specifically at symptomatic persons.  Instead, an announcement is made the night before listing 5 or 6 locations where mobile testing sites will be, and anyone can approach for one of the limited number of PCR tests. Other than these mobile testing sites, the government does not disclose what other groups of persons it is testing.

Although private labs conduct thousands of additional antigen and PCR tests daily, the government does not gather or report their results.

The government also does not disclose any additional information about these confirmed positive cases, such as ages and genders of those infected, or how many were breakthrough infections.

Finally, El Salvador does not disclose hospitalization rates for those infected with COVID.    Although the government dashboard lists "active" cases by levels of severity, there is no indication whether these levels correspond to persons who are hospitalized or in intensive care and how many persons are admitted to Hospital El Salvador which treats only COVID patients.

What we know -- the official death count

The official death count from COVID-19 during the two years of the pandemic as of March 15, 2022 is only 4,104.

What we don't know -- the actual number of deaths

The actual death count is unknown because of the way El Salvador decided to report deaths.  Only if someone died after having a COVID PCR test from the government laboratory confirming the diagnosis is the death included in the official death toll.  This is so even if the person died in Hospital El Salvador while being treated for COVID.

Death statistics found on a government website for Hospital El Salvador (and then suddenly erased after they were disclosed) showed that 3218 persons had died during from January-September 2021 out of 9774 admitted, for a mortality rate of roughly 1 in 3 in this hospital which treats only COVID patients.  Using other data found before it was erased produced an estimate of 4291 persons dying in Hospital El Salvador in just 2021, 187 more than the "official" death toll for the entire two years of the pandemic. 

A study in the Lancet found that El Salvador had one of the highest levels of undercounting COVID deaths in Latin America.

What we know -- the number of vaccine doses administered

El Salvador has the following levels of vaccination for its population of more than 6.3 million.

These vaccination rates put El Salvador in the middle or slightly below average among countries in Latin America:

What we don't know -- who received the shots

El Salvador's government has shared no information about the populations which are unvaccinated or have received their first, second and third doses of vaccine.   What percentage of the most vulnerable elderly population is still unvaccinated?   What is the break down in vaccination rates between rural and urban groups?  What are the barriers in expanding vaccination?  What percentage of unvaccinated persons have already had at least one case of COVID?

What we know -- the pandemic is not over

The pandemic is still affecting El Salvador with new cases every day.

What we don't know -- what has happened in recent weeks

In December 2020, Nayib Bukele tweeted that detailed, daily information was "vital" for those who study the evolution of the pandemic in the country.  A year later, however, the Salvadoran government turned, without explanation, to only updating its COVID-19 dashboard every two or three weeks.  As this post is being written on March 17, the website has not been updated with case totals since February 27, 2022, and similar patterns of failure to update have existed since the beginning of the year just as the Omicron wave was starting to pick up steam.

This meant that on January 7, 2022, when Nayib Bukele tweeted that there had been 4 consecutive days without a death from COVID-19 in El Salvador, the population was unaware that the Omicron wave had already started a large surge of infections within the country.  There may be a public relations strategy behind this.   First, reporting a surge in cases was inconsistent with a series of Bukele tweets at year end about empty hospitals and zero deaths.   Second, reducing the number of updates reduces the number of days that local media have new information to write about the pandemic, at a time when the government had priorities other than COVID-19.  

What we know -- the government spent a lot on publicity praising its own efforts.

The government has spent a ton of money on slick publicity surrounding its COVID-19 efforts.  

What we don't know -- how much did all that cost. 

Exactly how much has been spent on publicity as opposed to treatment and prevention?

What we know -- there were serious reports of purchasing fraud

There is significant evidence of corruption in the procurement of pandemic related materials by the government.   Much of it is summarized here.

What we don't know -- will anyone go to jail?

Nayib Bukele had the Attorney General replaced and his lead corruption investigator resigned and fled the country.  There have been no indications of active investigations by the attorney general or prosecutors who replaced them.


Charly Boqueron said…
the special conditions under the pandemic served to exhibit the true corrupt nature and intentions of el salvador's president, his government and his political party. from the violations to the constitution and basic human rights to the deliberate fear inducing propaganda, the use of government institutions and public money to fund their political campaign, bribe officials from the opposition and hand out direct government contracts to his own mafia subordinates; the pandemic proved ripe and irresistible to manipulate the population and undermine the country's legal system, rule of law, civil liberties, etc. and all for what? just to amass more power and more money for the self indulgence of the president's egotistical craving of popularity and recognition that has the country on the edge of financial, institutional and social collapse. nayib bukele has proven to be more corrupt and more harmful to el salvador's insterests than any previous corrupt president from the past. so much for the new ideas. :/