Self-medication and disinformation fuel Colombia’s Covid-19 crisis
On a drizzly day just before Christmas, Dr Yineth Agudelo-Zapata went about her rounds in Medellin General’s Hospital’s Covid-19 wing. The old building, recommissioned specifically for coronavirus patients, is a looming embodiment of the pandemic’s impact on Colombia.
When I visited, the brightly lit halls and waiting rooms were empty, but the wards were nearing their 150-bed capacity. According to Johns Hopkins statistics, Colombia has, to date, confirmed over 2.2 million Covid-19 cases and about 58,000 related deaths. That’s more than one fatality for every 1,000 people, a per capita rate only slightly lower than hotspots such as the U.S., Spain and Mexico.
Medellin, a city of over two million, remains one of the worst-hit areas in Colombia. To date, its three biggest municipalities have recorded over 234,000 cases and over 4,100 dead since the virus first arrived in March 2020.
Like many places, Colombia has been deluged with coronavirus-related misinformation, from both foreign and domestic sources. But experts say that a longstanding tradition of home remedies and folk medicine, plus the widespread off-label use of over-the-counter medications makes it more vulnerable to disinformation than other countries. What is more, many believe that these factors have complicated the official response to the crisis and that they could possibly damage the planned national vaccine rollout.
Agudelo-Zapata sees the evidence every day. She explained many of the people admitted to the hospital’s coronavirus facility have taken a variety of unproven treatments, believing that they can cure or protect them against Covid-19.
“Most of our patients arrive self-medicated, many having taken hydroxychloroquine, ivermectin and antibiotics,” she said, referring to antimalarial and antiparasitic drugs that have been widely discredited as possible treatments for Covid-19. “Some think we are going to harm them, and there are others who still believe that we are inventing the disease.”
Viruses can’t be treated with antibiotics and the prevailing view among medical professionals is that the off-label use of prescription and over-the-counter medicines is fraught with problems, ranging from the triggering of allergies to organ damage and even death.
Meanwhile, Ana Saavedra, an editor at the fact-checking project ColombiaCheck, told me that many traditional remedies — including steam, eucalyptus, lemon and a traditionally processed form of cane sugar known as panela — are now being widely shared as coronavirus cures on social media.
“The preference for home remedies for a wide range of diseases predates the pandemic,” she said. “But misinformation has multiplied them and given them much more relevance.”
One such falsehood involves moringa, a plant renowned across Colombia for its richness in vitamins and antioxidants, but not proven to have any effect against the coronavirus. In August 2020, it became the subject of a Facebook post that spread rapidly across Latin America and even ended up on television news in Colombia and Argentina.
In April 2020, inmates at a prison in the central Colombian town of Villavicencio, were given a tea made from moringa, supplied by local growers, to treat coronavirus symptoms. While doctors said that some patients would have recovered anyway, the post attributed the improvement in their condition directly to the herbal remedy.
“More than 1,000 infected inmates and guards say that a moringa drink healed them of Covid-19 and the cure was so effective that they now use it in 10 other prisons across the country,” it read.
In 2019, EU regulators raised objections to the sale of moringa in Europe, after researchers in Ethiopia, where moringa is also common, indicated a possible link between frequent consumption of moringa and thyroid problems. Despite this apparent risk and its lack of proven efficacy against Covid-19, demand for moringa has boomed in Colombia. By August, it was reportedly fetching $28 per kilogram, 20 times higher than its pre-pandemic cost.
Meeting misinformation head on
The municipality’s San Rafael Hospital also stands in stark contrast to Medellin General. Upon entering, I saw socially distanced patients waiting in sunny, open courtyards, shaded by the facility’s colonial architecture. Its Covid-19 ward was also empty.
But that doesn’t mean that the area is immune to misinformation. In her small office, head nurse Victoria Echavarria-Barco shared her own experience. One rumor had scared her mother so much that even when she developed Covid-19 symptoms, she refused to be tested.
The source was a viral Facebook post from May, which falsely accused Colombian doctors of running a racket in which they received the equivalent of $2,800 for each Covid-19 death.
“”Do not be fooled! ICUs and hospitals are empty. The Covid Cartel passes off healthy people as sick ones and forces cremations to increase the numbers of this false virus,” it read.
“I told her, ‘Mum, we’re not like that!’” said Echavarria-Barco.
Despite those assurances, her mother rejected any suggestion that she be tested. Fortunately, she recovered without ever visiting a doctor. The conspiracy, however, continues to circulate on Colombian social media to this day.
One explanation for such ideas is the Colombian public’s catastrophic lack of faith in the state and other social institutions. That suspicion runs so deep that a pre-pandemic survey by USAID found that 56.9% of Colombians totally distrust the national government. The only social institution trusted by the majority of people was family — and in a pandemic that comes with its own problems.
Almost every doctor and health expert I spoke to said that members of their own families had sent them misinformation via social media. Many added that the volume of messages they receive is exhausting.
However, María Patricia Agudelo, San Rafael’s chief administrator, explained that although people in rural areas receive the same misinformation as those in the city, via the exact same channels, the effect in Ebejico had been far less grave than in Medellin.
She attributes this to a team of six public health workers who spent the first months of the pandemic going door-to-door, visiting residents in all 30 of the municipality’s neighborhoods. They not only debunked coronavirus myths face to face, but offered practical instructions such as how to correctly wear a protective mask and wash hands. The effects of this early outreach, she believes, are lasting.
“We were out until 11 at night for weeks and we were able to visit every corner of the municipality, sitting down with people to hear about their fears and get them the correct information,” Agudelo said. “The people in their houses could see the institutional logo of the hospital on our jackets and the credibility that comes with it.”
Now, vaccines have become the latest front in Colombia’s coronavirus misinformation war. Social media teems with fake science and false comparisons of actual immunizations and over-the-counter medicines.
Vaccinations in Medellin began on February 18. Staff at Medellin General, including Agudelo-Zapata, were among the first to receive the Pfizer vaccine as part of Colombia’s plan to inoculate a million people before the end of March, focusing on health workers and those over the age of 80.
In a statement issued a few days before the rollout, Health Minister Fernando Ruiz-Gomez said that the biggest challenges for vaccination in Colombia would be securing enough doses for all, coordinating with local government and establishing public trust so that “people go to the vaccination point on their assigned day, without any kind of fear.”
Jamie Ordoñez, a Colombian epidemiologist and public health consultant, believes that a combination of timing and misinformation will prove pivotal in how quickly the virus is contained in Colombia.
“The more time the pandemic takes to resolve, there’s going to be more fertile ground for the infodemic,” he said, “As delays cause hopelessness to grow, people will be more willing to believe in anything to avoid getting sick.”
Back near the nurses station at Medellin General, Agudelo-Zapata washed her face shield in scalding water after a visit to an elderly coronavirus patient.
The size of Medellin’s population makes the hands-on approach deployed in Ebejico virtually impossible. However, she believes that disinformation can be effectively countered if medical professionals and others with an ability to explain scientific concepts to a mass audience take their fight to social media. She does this with her own family and, when she’s on the clock, often tackles patients’ misconceptions on video calls with the support of psychologists.
“My most tried and true strategy is dialogue. I’ve spent a lot of time talking with families and patients,” she said. “Used well, Facebook and WhatsApp can be powerful weapons, but we as doctors have to get involved in the media that people actually use — If we don’t, then who will?”
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