“The hardest part of watching my colleagues and patients suffer is not being able to say anything about it,” says Gabriel Romero, an attending physician at one of Venezuela's largest public clinics.
Romero, who asked that Nature not use his real name for fear of punishment by the Venezuelan government, is one of the many health-care workers in the country fighting COVID-19 despite a lack of basic medical equipment, a steady power and water supply, and adequate pay. When they have spoken out about what they say are unacceptable conditions, some have been detained by government forces.
Included in their list of complaints is a lack of reliable COVID-19 data.
Officially, Venezuela reports that it has had more than 326,000 COVID-19 infections and about 3,900 deaths amongst its 29 million inhabitants since the start of the pandemic. That’s 135 fatalities per million people. By contrast, its next-door neighbours Colombia and Brazil report about 2,440 and 2,700 fatalities per million people, respectively (see ‘Questionable COVID data’).
In looking at the data for South America, Romero and others say it’s obvious that Venezuela’s numbers do not reflect reality, and that the drastic undercount is driven by a lack of testing and infrastructure — but also by a deliberate effort by the government to downplay the pandemic. Because accurate statistics are crucial for aid organizations deciding where to send resources, and for local officials mulling whether to open schools and businesses, many doctors and nurses have taken matters into their own hands, collecting data from hospitals and reporting the numbers secretly to various research networks and non-governmental organizations (NGOs). These numbers are much higher than those appearing in official government reports.
“It’s a lot of pressure,” says Romero, who coordinates a clandestine network that collects these data. “I always worry that we could get detained. But I cannot live in a country where the official narrative is that everything is fine when we are living a totally different reality.”
The pandemic narrative
Venezuela’s economy has collapsed in the past decade because of corruption, financial mismanagement and the price of oil, its key export, plummeting. At least 5.4 million people have fled the country as a result, and of those remaining, about 90% now live in poverty, according to the United Nations.
It’s possible that this economic collapse has slowed the spread of the coronavirus SARS-CoV-2, say epidemiologists interviewed by Nature. It has made travel across the country difficult, and few Venezuelans have the means to go out to restaurants or bars, where super-spreader events might occur.
But the government data still do not line up with reports collected at hospitals, they point out. According to Médicos Unidos Venezuela, a collective of Venezuelan doctors monitoring the situation, more than 736 Venezuelan health-care workers have died from COVID-19 since last year. The collective sometimes reports higher weekly death rates for Venezuela’s health-care workers than the government reports for the entire country.
“Looking at all these indicators, the government figures are impossible,” says Maria Eugenia Grillet, an epidemiologist at the Central University of Venezuela in Caracas.
“It’s evident that the [government] data are completely misguided, incorrect and unhelpful,” says Pedro Delgado, vice-president of the Institute for Healthcare Improvement, an NGO based in Boston, Massachusetts. “The numbers make no sense.”
Venezuela’s Ministry of Health declined to comment when asked by Nature about discrepancies in its data compared with those reported by groups such as Médicos Unidos Venezuela and NGOs.
The picture on the ground
Venezuela’s true COVID-19 infection and death statistics are at least five to seven times as high as those the government is reporting, says Julio Castro, an infectious-diseases researcher at the Central University of Venezuela. He makes this estimate on the basis of data submitted to the National Hospital Survey in Venezuela, which he coordinates.
In their spare time and in secret, nurses and doctors such as Romero collect data about patient admissions and deaths at Venezuela’s 40 major hospitals to provide to the survey.
Castro says one of the reasons the government’s official statistics are low is a lack of COVID-19 diagnostic tests in the country. Gold-standard tests for determining whether a person is positive for COVID-19 — polymerase-chain reaction (PCR) tests — can be processed only at two approved laboratories in Caracas, he says. The labs are working at capacity, causing delays for weeks. And what’s more, for people outside Caracas, testing centres are unreachable because of fuel shortages, he adds.
Because of the lack of diagnostic tests, doctors and nurses submitting data to the National Hospital Survey instead evaluate whether a person has COVID-19 by assessing whether they have an acute respiratory infection — the main symptom of COVID-19. Health-care workers agree that although it isn’t a perfect indicator of COVID-19, it provides a more-trusted picture of reality than the government’s statistics, which are based on PCR tests.
Venezuela isn’t the only country to struggle with its COVID-19 statistics. In May, Peru updated its official death statistics after researchers warned they were not representative of the true situation in the country. After taking into consideration excess deaths — the number of people who died over a certain period, compared with the number of deaths researchers would expect based on a pre-pandemic baseline — the Peruvian government nearly tripled its official death tally.
Even wealthy nations such as the United States have an excess death count that is 20% higher than the government is reporting, probably owing to a variety of factors, such as misdiagnosis. But researchers especially use this method to get a more accurate view of COVID-19 statistics in places such as Venezuela, where tests are sparse, where many people do not die in hospital so their deaths aren’t registered, or where government data are deemed untrustworthy.
But in Venezuela, the method can’t be used because the Ministry of Health hasn’t published mortality statistics since its last national epidemiology report in 2016.
“It’s not just epidemiological data, we don’t have data for any indicator”, says Grillet, whether it’s the economy or public health.
In the absence of baseline data, researchers have been trying to get a handle on the situation in Venezuela from outside its borders. The Vector-borne disease control in Venezuela Network, an international group of researchers that studies infectious diseases in Venezuela, wanted to take nasal samples from people in the country suspected of having COVID-19, search for SARS-CoV-2 and sequence its genome, but was barred last year by the Ministry of Health from doing so. The researchers pivoted, and instead analysed samples in 2020 from some of the Venezuelans who had recently fled the economic crisis and migrated to Colombia, to get a window into Venezuela’s pandemic.
The network confirmed for the first time that six coronavirus variants — including two, Beta and Gamma, which are classified as variants of concern — had been circulating in Venezuela1. By contrast, the government has not released any genomic surveillance data.
Operating outside of Venezuela also means that the team that reported these results can avoid being detained by the Venezuelan government. At least 12 health-care professionals have been detained for speaking out about the situation in Venezuela during the pandemic, according to the human-rights-focused NGO Amnesty International. And last year, Diosdado Cabello, a senior government official in President Nicolás Maduro’s administration, suggested on national television that the Venezuelan Academy of Physical, Mathematical and Natural Sciences (ACFIMAN) — to which Grillet belongs — should be raided and its scientists arrested for releasing models that predicted an increase in coronavirus infections and deaths.
The government “is trying to keep the numbers low so they don’t give the impression that there is a large, uncontrolled outbreak”, says Castro.
Health-care workers in particular are under a lot of pressure just from doing their jobs, says Margarita Lampo, an ecologist who studies infectious diseases at ACFIMAN and the Venezuelan Institute for Scientific Research in Caracas. Add that stress to the fear of getting fired, or worse, for sharing their data, she adds, and it’s much more difficult. “We are very thankful for what they do. They should know that their work has been so important for our country.”