Uruguay has attracted international media and press due to the management of the pandemic, with 2417 total confirmed cases, and 51 deaths of COVID-19 by 16 October 2020. Entering the 7th month of the new SARS-CoV-2 in the country, Uruguay currently has the record of 341[1] active cases in all the territory. This number is significantly low when compared to other Latin American countries such as Brazil, Argentina and Colombia. Some international articles claim that “Uruguay is winning against covid-19”[2], “containing” could be a more appropriate word, as the communication campaign of Uruguay’s Health Ministry says, “if we think we won, then is when we lose”

There is no place for triumphalism or lessons to give, because the variables that define the “luck” of each country are unique and there isn’t a “one size fits all” approach. However, in this article I highlight some aspects of the management of the pandemic in Uruguay that could explain the good results (so far). Giovanni Escalante, representative of PAHO/WHO in Uruguay stated “Uruguay has a comparative advantage over other countries due to its institutional strength, democratic and civic tradition with significant credibility in its leaders, a strong presence of the State in fields such as health, social welfare, education system and regulation capacity of the private sector”[3] .

A small country of 3.5 millions in South America, Uruguay looks like an oasis in the region, with Argentina and Brazil as neighbors where sadly the COVID-19 is out of control. The “new normal” life in Uruguay functions with essential services open, public transportation and hospitals operating at normal capacity and schools and universities open for in-person classes. Masks are strongly encouraged in all public spaces and protocols of hygiene and social distancing are applied.

The new president of Uruguay, Luis Lacalle Pou, had only been in office for two weeks, when on March 13th the first case was detected in Uruguay. The government immediately decreed national health emergency, suspended classes, urged the population to stay home, closed the borders and issued a communication campaign on hygiene and social distancing measures to prevent contagion. Uruguay never had a mandatory quarantine, the president was not willing to use punitive coercion, instead he used facilitation measures to minimize mobility in the country. “Uruguay had the advantage that it could observe the spread of the infection in other countries, but also the difficult situation of a government change”[4], said the Communications advisor of the Ministry of Health of Uruguay, Patricia Schroeder.

Responsible freedom “Libertad responsable

Although there was no mandatory quarantine the Uruguayans complied with the measure of staying at home (more than 90% of the population accepted the recommendation[5]). The new president pleaded for responsibility and solidarity in the use of our freedom. Why such adherence of non mandatory stay at home? From a social and behavioral science perspective, which helps explain behavior, I identified the Health Belief Model as explanatory:

Perceived susceptibility – Knowledge available of the high contagious rate made everyone vulnerable and at risk of being infected.

Perceived severity – Mass media communications showed Spain and Italy flooded hospitals and alarming high death rates of the virus.

Perceived benefits – In the first stage staying at home seemed the most effective behavioral mechanisms we could adopt to prevent the infection.

Perceived barriers – The government facilitated working at home of public entities and exhorted the private sector to do the same. Schools and social events for example where closed. The obstacles to staying at home were low.

In Uruguay, citizens complying to stay at home allowed to trace the outbreaks and to contain them. “By acting really fast we were able to completely identify and stop the transmission chain of the disease in every [outbreak],”[6] says Rafael Radi, a biochemist at Montevideo’s University de la Republica leading the government’s advisory group. Meanwhile the health infrastructure, scientific academy, social welfare and education systems promptly reorganized.

Strong actions which communicate

There were two actions of the government that evoked strong messages of union and confidence among the general public, these were:

  • The creation of the Coronavirus Fund drawn from public entities contributions and salaries of public workers who made over USD 1,800 monthly, including the president along with ministers and legislators who gave 20 percent of their salaries to contribute. The private sector also made voluntary contributions to this fund. A strong message of common solidarity was given, starting from the president himself.
  • Creation of Honorary Scientific Advisory Group (GACH) formed the 16th of April which constantly gives scientific advice to the Presidency for decision making. The doctors leading this group became official spokesmen for the general public giving confidence, clear conduct information and also depoliticizing the decisions made by the government.

Testing, tracking and isolatio

A solid scientific team developed a nationally produced testing kit, which allowed us to have testing available. Additionally, a lot of effort is done to track each case of positive test and trace contacts of infected individuals, isolate and test them. This is a key measure to contain the outbreaks.

Use of technology and strong Health System

According to the Health Minister Daniel Salinas, the strong infrastructure and health system of Uruguay has been decisive in the results against the coronavirus[7]. The country has a universal health system, with the integration of the private and public sector, available for everyone. The strategy applied was in-house testing, doctors treated patients at their home to avoid spread of the virus in the emergency doors.

Another advantage of Uruguay is its position as a technological hub of experts, wide connectivity and outstanding Internet penetration, which converged in the creation of the Coronavirus App (with Google and Apple’s support). The first App of Latin America that has a tracing mechanism that informs about exposition to COVID-19.

Conclusion

Strategies mentioned above, with strong leadership, clear and transparent communication, financial and food support of vulnerable groups, demographic and technological advantages, helped to contain the virus in this small part of the world. The president, Luis Lacalle Pou, assured that “if Uruguay has COVID-19 statistics better ranked than other countries in the world, it is not because of the government. What the government did was trust its citizens. I trust them” [8], “Success is relative” and “we are with our guard up all the time,” added the president. New challenges are faced every day, specially containing the dry border with Brazil. Multidisciplinary approaches and responsible freedom are crucial, behavioral change science could contribute to keep controlling this virus that has changed the world as we knew it.

Lic. Inés Besada Paullier, Montevideo, Uruguay. / Twitter: @inesbp / LinkedIn

Asociación Latinoamericana de Mercadeo Social (LAMSO) / @LAMSO_org

 

[1]  Ministerio de Salud, Uruguay. Visualizador de casos de coronavirus COVID-19 en Uruguay. 2020. https://www.gub.uy/sistema-nacional-emergencias/pagina-embebida/visualizador-casos-coronavirus-covid-19-uruguay Accessed October 16, 2020

[2] BMJ 2020;370:m3575 http://dx.doi.org/10.1136/bmj.m3575  September 18, 2020

[3] https://www.bbc.com/mundo/noticias-america-latina-52837193

[4] Schroeder, Patricia. COVID-19, ¿Solamente una crisis? Hacer empresa. April 2020

[5] http://www.cifra.com.uy/

[6] https://www.bmj.com/content/bmj/370/bmj.m3575.full.pdf

[7] https://www.bbc.com/mundo/noticias-america-latina-52837193

[8] Videoconference with ABC Internacional: https://www.presidencia.gub.uy/comunicacion/comunicacionnoticias/lacalle-pou-foro-uruguay-espana-mirando-futuro