Like so many doctors around the world, pediatric surgeon Roberto Herrera was exposed to the new coronavirus back in early March.
“Of course I was scared at first,” says Herrera. That's in no small part because he was also at-risk: he’s 61 and asthmatic. But Herrera insists he was never panicked. After all, he says, he lives in Costa Rica – which has reported only seven COVID-19 deaths and fewer than 800 cases.
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Next door in Panama, which has admittedly done more per capita coronavirus testing than Costa Rica has, there are 10 times more cases and 40 times more deaths. Costa Rica is just about the only country in Latin America and the Caribbean where growth curves for COVID cases and deaths are flattening.
Herrera was quickly quarantined at his San José home and did not become infected. He says most Ticos, as Costa Ricans are known, are aware of what their small Central American nation is doing right in this pandemic. And, he argues, it has to do with what’s it’s already been doing right for half a century.
“When you take a look at Costa Rica,” Herrera says, “ask yourself why there aren’t more Costa Rican immigrants in the U.S. compared to other Central American countries. Why do we stay? If you want to understand how we’ve been able to control the coronavirus, you need to understand what is going on here in terms of human development priorities like healthcare – and then you start thinking: Yeah!”
Yeah. Few countries in the Americas are as committed to public health as Costa Rica is. It’s a developing country, but it doesn’t have a military – so it can spend almost a tenth of its GDP on healthcare, as much as most developed countries do.
“We have an outstanding infrastructure and particularly medical talent,” says former Costa Rican President Luis Guillermo Solís, a visiting scholar at Florida International University’s Latin America and Caribbean Center. Solís, whose daughter is a doctor in Costa Rica, says that integrated national health infrastructure had the country poised to confront COVID-19 from the get-go.
“We were capable of processing the COVID-19 testing pretty rapidly,” says Solís, “with labs working full time so that the statistics were trustworthy.”
Critics – especiallly El Salvador's president, Nayib Bukele, who last week accused Costa Rica of using deception to flatten its corona-curves – say the Tico numbers aren't that trustworthy. El Salvador, in fact, has done three times more testing per 1,000 people; Panama has done five times more.
But public health experts say Costa Rica has done much better tracing of infected patients' contacts. That's allowed health officials there to do more effective coronavirus detective work.
"They have an excellent surveilance system," says Dr. Carlos Espinal, who heads the Global Health Consortium at FIU's Stempel College of Public Health.
“Because of the capacity to identify the cases and monitor the contacts, in Costa Rica they have been able to control new cases, and COVID-19 has not really spread out in the community as it has in most of Latin America.”
Last week, Espinal says, was a good example. Costa Rica has been especially vigilant about controlling its border with Nicaragua – where quarantine measures are almost nonexistent, and where no serious experts believe the astonishingly low case and death figures the authoritarian government is reporting. But last Tuesday Costa Rican officials detected 13 new COVID-19 cases among migrants crossing that border.
“It felt like stepping into quicksand,” says Dr. Mario Ruiz, medical director for Costa Rica’s social security system, known as La Caja, which oversees public healthcare. Ruiz says health officials worked fast to keep those potential “quicksand” cases from multiplying.
“We kept thinking about Singapore,” says Ruiz. “One month ago they were just like us, but then right now they’re suddenly having a lot more cases – because this very complex situation can change on you at any minute.”
Singapore may be backsliding – but Ruiz says the one constant for Costa Rica is Costa Ricans. Los Ticos have mostly abided by the stay-at-home and other lockdown orders from President Carlos Alvarado’s government. And every day about noon they turn on their televisions to listen to one official in particular: Costa Rica’s health minister, Dr. Daniel Salas.
Salas, an epidemiologist, is the Anthony Fauci of Costa Rica – but a lot more influential. He’s been able to get national curfews and fines enacted and enforced. And just after Easter last month, when it looked like los Ticos’ quarantine commitment might be slipping, Salas became the national nag:
“The lax behavior we saw on the street today,” Salas said during one of his TV chats, “is a bad omen for containing this pandemic.” And Costa Ricans like retired San José school teacher Patricia Morera listened.
“He’s truthful and he explains to all the Costa Rican people what he is doing with simple words, so everyone understands all his ideas,” Morera says of Salas, who last week let Ticos return to restaurants under strict guidelines – and on a trial basis.
“We know if we don’t follow the rules, maybe instead of having 800 cases we are going to have 2,000 or 20,000 or whatever.”
Morera adds a big reason Ticos are following those rules is that they’re taught to put healthcare on a pedestal. That’s true of Morera’s daughter, Ana Isabel Carvajal, a 19-year-old business administration student who’s become part of Costa Rica’s informal social media brigades that plaster Twitter, Facebook and Instagram with warnings about starting in-person partying again.
“Some people just posted a picture of themselves in a big group going to a restaurant,” says Carvajal, “and a lot of Costa Ricans got angry about it. We told them, ‘No, that’s not what the re-opening trial means.’ I’m very proud to see that social consciousness here.”
Something else Ticos have been proud to see is the spirit of pandemic volunteerism. Health experts say another big corona-containment factor has been Costa Rica’s long-standing emphasis on controlling conditions like asthma, diabetes and high blood pressure, which can exacerbate COVID-19 infection. But quarantine makes it harder to get medications for those ailments into people's hands, especially the elderly.
So the Toyota Rent-a-Car company in Costa Rica offered its cars and employees to ferry healthcare workers delivering those drugs directly to people’s homes – free of charge.
“At the end of the day we had a lot of assets we weren’t using,” says Andrés Lang, CEO of Toyota Rent-a-Car’s holding company. “There’s obviously no tourism in Costa Rica right now, but there are a lot of people at-risk for COVID-19 that we can help – and we want to keep as many of our people employed as we can.”
To be sure, Costa Rica has its own public healthcare problems. Diabetes rates are inordinately high and so, say critics, are healthcare spending rates. Meanwhile, out-of-pocket medical costs have begun to undermine the system’s vaunted accessibility.
Still, says Carvajal, this is Costa Rica’s moment to show the world – and express a little vindication.
“We are making history as a small country,” she says. “Look at us – it’s like we’re telling other, bigger countries that used to say we're not very advanced, ‘Follow us!’
“We don’t have an army – and we are controlling this pandemic better than countries that have armies. So…think about it.”
If Costa Rica continues to keep the pandemic contained, it likely will give other countries – including the U.S. – plenty to think about.