The rapid spread of covid-19 across the world has taken the scientific and medical community by surprise.
Brazil was the first country to confirm a case of covid-19 case in Latin America on 26 February 2020, followed by Mexico and Ecuador. To date, all 33 countries in Latin America have been impacted by covid-19.
Currently, Latin America has one of the highest urbanization rates in the world, with unequal access to public services such as adequate housing, water, and sanitation.  Countries from Central and South America are also experiencing migration challenges with moving populations fleeing conflict.  The lack of universal health coverage and the presence of mainly private for-profit healthcare services places substantial restrictions on efforts to control the outbreak and on the management of testing and contact tracing.  Furthermore, several countries including Venezuela, Chile, or Ecuador have recently experienced political shifts and economic decline. This combination of inequality, lack of governability, and debilitated public services is leading to high numbers of cases and death rates. Urgent and effective action is required.
Many countries in Latin America reacted quickly to the emerging threat at the start of the regional outbreak. The mobilization of medical personnel, equipment, and significant public health measures has slowed transmission in countries like El Salvador, where very strict draconian measures were put in place a week before any cases were registered in the country. Countries like Ecuador, Colombia, Peru, Chile and Argentina began with less intense physical distancing measures, such as avoiding public gatherings, which soon ramped up to include school closures and international flights restrictions. However, political leaders in Brazil and Mexico have trivialised the pandemic, delaying action and allowing their citizens to pay the price.
In Latin America, there are more than 700 distinct native communities representing more than 45 million people, distributed from Panama to Chile. [5,6] Travel restrictions within and between towns and cities might intensify the difficulties of access to healthcare services for indigenous and rural populations, pushing them to seek self-isolation as a precautionary response to inaccessibility and poor healthcare.  High-complexity healthcare services, such as the ones needed for patients with acute respiratory stress syndrome, are located almost exclusively in urban settings. Limited mobility, without active search efforts, might sentence isolated populations to a silent death.
Accessing testing is also limited in rural settings throughout the region. The acquisition of diagnostic testing kits is especially difficult when they have to be imported from countries experiencing their own health crises, such as the USA or China. Currently, in countries like Ecuador, Colombia or Peru, the demand for laboratory components exceeds the capacity for supply with laboratory employees working around the clock.
The public health response to covid-19 should focus on containing positive cases, strengthening surveillance and contact tracing within the community. A serious additional challenge in responding to covid-19 is protecting medical staff from infection and properly isolating patients.  In China, the United Kingdom and the United States of America, difficulties in supplying personal protective equipment (PPE) have been reported.  Shortages of personal protective equipment (PPE) in Latin American countries has been more severe, with poor industrial capacity limiting the production of these vital resources.  Doctors and health personnel across the region have refused to work due to lack of protection, despite the recommendations from the Pan American Health Organization (PAHO) to ensure sufficient access to protective equipment and supplies.
In addition, the coronavirus pandemic has placed an unmanageable burden on public services, including funeral infrastructure. Ecuador was the first country to experience a collapse of funeral services. Morgues, cemeteries and funeral homes in Brazil, Peru and Mexico are now also beyond capacity.
In 2019, Latin America experienced the worst dengue epidemic in recent history.  More than 3 million confirmed cases were reported, almost 20% more than the previous record breaking figures from 2015.  The high burden of many endemic and neglected tropical diseases in the region, including dengue, chikungunya, Zika, yellow fever, filariasis, trachoma, schistosomaisis, leishmaniasis and onchocerciasis, has already exerted a lot of pressure on already weakened health systems.  Malaria resurgence is also challenging the region, with more than 400,000 new malaria cases registered in Venezuela in 2018 alone. 
The evolving covid-19 pandemic combined with decades of high prevalence of infectious and neglected diseases, as well as increasingly higher rates of chronic related maladies, such as diabetes and cancer, will pose enormous pressure on historically weakened public health services and politically unstable countries. A vigorous, coordinated and integrated effort is required for the region to withstand not only the health crisis, but also the resulting unprecedented economic impact of the pandemic.
Esteban Ortiz-Prado, Director of the One Health Research Group at Universidad de las Americas, Quito, Ecuador
Aquiles R. Henríquez-Trujillo, Principal investigator, One Health Research Group at Universidad de las Americas, Quito, Ecuador
Alex Lister, Operations Management Director, University Hospital Southampton NHS Foundation Trust
Gabriel Cevallos-Sierra, Associated Researcher, One Health Research Group at Universidad de las Americas, Quito, Ecuador
Rachel Lowe, Principal Investigator at the Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene & Tropical Medicine, London, United Kingdom
Competing interests: None declared
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