After a long period in which Costa Rica seemed to have managed to contain the spread of the COVID pandemic in the country, cases are now on the rise following the relaxation of the previously enacted containment measures.
Up untill now Costa Rica was indeed a case study and a positive exception in Latin America, due to its ability to tame the virus with one of the lowest fatality rates in the world due to COVID-19, even though the Minister of Health Daniel Salas, and the Executive President of the Costa Rican Social Security Fund (CCSS), Gabriel Macaya, had repeatedly insisted on saying that the result "is fragile".
There are several reasons that explain the country's success in managing the crisis so far before the relaxation of restrictive measures.
The first one is that the authorities reacted very quickly and with complete transparency, warning the population that the country would face a potentially catastrophic situation if health security measurements were not followed. The first case was reported on March 6. Three days later, mass assemblies were banned and it was instructed that anyone who could do so should work from home, in both the public and private sectors. In the following days, national parks and beaches were closed and the entry of foreigners was strongly restricted; all educational institutions were closed, the national soccer championship was suspended, restaurants and nightclubs were closed, and the movement of vehicles was restricted, among other measures.
The second one is that crisis management has been in the hands of health specialists, who have acted according to scientific criteria. The president, Carlos Alvarado, only appears in public to address issues when it is strictly necessary and he has not tried to use the emergency to gain political advantage. The Minister of Health, who appears almost every day on television, has become a respected, admired figure and, above all listened to. (In a meme that went viral, the image of a woman and the following text appeared: "Dr. Salas is the only man who can tell me to stay home and I obey him.") The result is that, in a way, the majority of the population expresses confidence in the way the authorities are managing the situation.
A third factor, resulting from the previous one, is that the population in general understood, accepted, obeyed and put into practice the guidelines to avoid contagion. On social networks, the activity of citizens is intense, calling for everyone to stay home, wash their hands and maintain social distancing; not to let your guard down and to take care of each other. The president publicly recognized that the vast majority of the population has been disciplined and supportive.
And the fourth factor is the existence of a robust and consolidated institutional system that, for almost 80 years, has brought preventive and curative health to all corners of the country. It is not by chance that Costa Ricans enjoy one of the longest life expectancies in the world, even higher than the United States of America. The health system includes dozens of hospitals and clinics across the country, well-equipped and with highly qualified health personnel. But different authorities highlighted that an important key for containing the epidemic was the existence of 1053 “Basic Teams for Integral Health Care” (EBAIS) that cover the entire country. Each EBAIS is in charge of a relatively small region that allows for a very direct and personal relationship with people. Their work was complemented in this crisis by the use of technology: an app that already existed a long time ago, called the Unique Digital Health Records (EDUS) that was modified in a way so that each person could indicate if they have had symptoms. If so, the system alerts the corresponding EBAIS that sends medical personnel to the person's home. If they are found to have the virus, they receive medical attention at home, along with everyone else living there, giving them a daily follow-up. This is the reason why most of the infected people have not required hospitalization. In the beginning of June, in a country of 5 million habitants, EDUS had been downloaded by more than 2.2 million people. On the other hand, when dealing with a virus that requires constant hand washing as a first line of defense, and unlike many other countries in Latin America, around 98% of the population has access to drinking water. The authorities indicate that this has been a key factor in the prevention of infections.
The difficult reopening
At the beginning of June the country is executing a careful and gradual process of lifting restrictions that includes opening restaurants and cinemas to 50% of their capacity, resumption of the soccer championship without the public in the stadiums.
The situation in Nicaragua, where the WHO indicates that "community outbreak" is already taking place, has an effect like a Sword of Damocles on Costa Rica's efforts to keep the epidemic under control. The alarms were set off on June 3 when 52 new cases were reported; the highest number reported since the start of the crisis. More than half were identified as “foreigners”, so on that day very strict measures were re-instated on the borders in an attempt to prevent the entry of sick Nicaraguans seeking health care in Costa Rica.
The economic situation
While the country is cautiously optimistic about pandemic management, the economic forecast is shady. The crisis surprised Costa Rica in the middle of a delicate fiscal situation - with a deficit equivalent to 6% of GDP - and with a high unemployment rate of around 12%. The authorities now estimate that unemployment already exceeds 20% and that 45% of small and medium-sized companies have been closed. It is estimated that at the end of the year the deficit will be over 8% of GDP. To ease the short-term situation, the government decided to borrow from international organizations such as the Inter-American Development Bank (IADB) and the International Monetary Fund (IMF), which aggravates the weight of total debt that already existed before the crisis with around 60% of GDP. At the end of May Moody´s lowered the country's risk rating.
But every crisis brings opportunities. Given multiple statements from transnational companies and governments in different parts of the world about the need to reduce dependence on supply chains from China, the Minister of Foreign Trade, Dyalá Jiménez, announced that Costa Rica is formulating an aggressive and ambitious plan to attract investments to the country for the manufacturing and high technology sectors, considering that the country can offer political stability, solid rule of law, highly trained talent, 13 free trade agreements - which includes an Association Agreement with the European Union – and also a trustworthy public health system, so that companies can transfer their operations to the country. Also, the country will undoubtedly benefit from the fact that it succeeded in being admitted to the Organization for Economic Cooperation and Development (OECD).
In the first three months of the crisis, Costa Rica achieved solutions that place the country among the most effective in the world for pandemic control but as Minister of Health warned day after day, the results were fragile. As current surge in new infections is witnessing Costarican should not let the gard down.