Uruguay is almost an island. It’s a tiny democratic republic bordered by the Atlantic Ocean on one side, and two major Latin American countries on the others: Brazil and Argentina. Both have been seriously hit by the pandemic, and Brazil alone has recorded more cases than the entire population of Uruguay, which has achieved one of the lowest rates of infection in the world.
In a continent with a troubled political past and present, Uruguay has a historical reputation for its effective democracy, as well as social and political achievements - not only for adept management of the pandemic, but for gently driving the country forward within a continent plagued by corruption, inequality and violence. And now, it’s handling of the coronavirus crisis so far is being hailed as another achievement.
Since the start of the global pandemic this tiny country, with a population of 3.5 million, has recorded just over 3,700 cases and 63 deaths, the overwhelming majority of which have been elderly people with chronic illnesses. Even though infection rates soared in Brazil, numbers in Uruguay have remained low since the start of the pandemic.
Several factors have worked to Uruguay’s advantage in controlling the virus. It has high sanitary and hygiene standards in comparison to the rest of the region; the country is not an international hub where people from all around the world land everyday - in fact, the Uruguayan airport has only four jet bridges; and the government made an early decision to close its borders when the first cases were detected in March.
Dr Giovanni Escalante, the WHO’s representative in Uruguay, has credited the simultaneous combination of public health policies, investment, epidemiological surveillance, isolation and quarantine for the country’s achievements in keeping COVID-19 at bay.
But he singled out one element in particular that has assisted with control of the virus: “Voluntary isolation is a key factor, the population within the framework of their leeway takes informed actions and follows the measures responsibly.”
Unlike many other countries, quarantine was voluntary from the beginning. In Uruguay, as with many countries in South America, many workers depend on going out of the home for employment, and to feed their families. Instead of mandatory orders, the government chose to inform people day by day about the situation and let the people decide on their actions. The president, Luis Lacalle Pou, emphasised the concept of “responsible freedom” to deal with the infection and the need for many families to continue working outside of home.
Another point frequently raised in Uruguay’s success is the fast and timely domestic manufacturing of PCR tests, the type identified by Australia’s TGA as the “gold standard” of COVID-19 tests. Between 1000 and 3000 tests have been made daily, and the positive readings have never exceeded one percent of the total tests. The strategy has allowed authorities to actively seek the cases, test, trace and isolate, in stark contrast with the country’s neighbours.
Uruguay’s efforts have also benefited from long term investment in public health: in 2008, 1,377,743 people had health coverage. In 2015 almost 2.5 million had healthcare.
In 2004, Public Health Expenditure was 3.2 per cent of GDP. In 2019, this had been increased to 6.6 per cent of GDP, according to the Pan American Health Organisation. In the World Bank’s view, this health spending has been one of the most efficient on the continent - although the government has indicated health investment will decline by $50 million US over the next five years.
When the pandemic was declared in March, the Uruguayan government country closed almost every facility where people could congregate: schools, restaurants, cinemas, theaters, several stores, and importantly: every office. The frequency of public transport was also reduced and large gatherings in public places were banned.
Restaurants started to open again in April. By June, Uruguay became the first country in Latin America to allow children back into classrooms for a few days a week. Shopping malls unlocked their doors and churches began to receive their congregations.
Montevideo, Uruguay Source: Flickr (Roxana Brongo)
At that time Health Minister Daniel Salinas, said “we cannot say that we are facing an epidemic scenario”. By the beginning of August, museums opened up, albeit with rigid protocols; and the beloved National Soccer League returned to rolling the ball, but without spectators.
Compliance has been considered to be an important element in Uruguay’s success. Stay-at-home rates have remained strong to allow essential workers to fulfil their roles, and face masks became the new outfit of choice in the cities.
But it hasn’t been entirely easy. The ‘new normal’ in Uruguay has meant the loss of around 10 per cent of jobs, with the unemployment rate rising. The economic outlook remains a major challenge.
And nor is everything open. The country still cannot enjoy the experience of massive live music events, or cheering on teams inside the stadiums for the favourite national sport. Borders haven’t reopened for tourism, but international commerce has managed to continue.
In recent weeks, numbers have been on the rise, most notably via outbreaks on the border with Brazil. Movement across this border has proved the biggest risk factor for Uruguay in recent months, with several cases detected amongst truck drivers, workers and parishioners moving across this zone where twin cities are only separated by a street or a small bridge over a river. 
And while containing these cases remains a priority, the government has been considering opening the border to tourists - an industry that claims seven per cent of the GDP. However, an infection rise in the twin cities of Rivera (Uruguay) and Santana do Livramento (Brazil), as well as the high rates of infection across Argentina and Brazil have led the government to decide to keep the borders closed to tourism during the coming summer season.
People attend a funeral due to coronavirus at a mass grave at the Nossa Senhora Aparecida cemetery in Manaus, Brazil. Source: EFE
Although the country is experiencing a rise in cases with 450 currently suffering from the virus there’s pressure for mounting a full re-opening in the capital city of Montevideo. Parents of primary school students are demanding the return of full-time face-to-face classes. Meanwhile Carlos Batthyany, the Executive Director of the Pasteur Institute in Uruguay, told the local press “we made a mistake” confining children.
“Children are a small population of those infected, they are less than 10 per cent”, he said. “When they are infected, it is exceptionally in serious cases, in Uruguay no positive child required hospitalisation.”
And while these conversations continue, the country is able to move along without the dire risks seen elsewhere. And aside from large scale events, the country is managing to enjoy life almost as usual.
Guillermo Garat is a journalist based in Montevideo, Uruguay.
