Venezuelans seek home care for COVID-19 amid crumbling health system

By Efrain Otero and Vivian Sequera

CARACAS (Reuters) – Venezuelan COVID-19 patients are paying doctors to come to their homes due to the high cost of private clinics and hospitals overflowing with patients and often lacking oxygen and medicine, doctors interviewed by Reuters said in recent weeks.

Family members tend to chip in or launch crowdfunding campaigns for infected relatives, said Laura Martinez, a 55-year-old resident of the lower middle-class Las Acacias neighborhood in western Caracas, whose husband and elderly parents were treated at home. Patients who receive home treatment for the coronavirus generally purchase respirators, oxygen tanks and anti-viral drugs.

President Nicolas Maduro’s government has said that the country, whose economy is mired in a brutal recession marked by hyperinflation, is experiencing a second wave of the virus. Official data have recorded around 1,000 new cases per day in recent weeks, though many health professionals warn the true toll is likely higher.

As the new wave gathered steam throughout March and April, home care, gained popularity thanks to word of mouth and social media. Such treatment often includes house calls, an option seen as a luxury in many developed countries but rendered cheap in Venezuela by a surfeit of underpaid doctors. Home visits cost $40-$80, depending on the severity of the patient’s symptoms, doctors said.

“It is the economic factor – without a doubt it is much cheaper for a doctor to visit one’s home,” Leonardo Acosta, a 25-year-old doctor, told Reuters in mid-April after a home visit in the capital Caracas.

“The cost of just being admitted to a clinic’s emergency ward is very high.”

Venezuela’s public hospitals frequently suffer from blackouts and routinely lack running water, according to medical associations who stage frequent protests over the inadequate conditions of the public health system.

Private clinics are better equipped but charge at least $1,500-$2,500 per night for inpatient care and as much as $5,000 per night for emergency care to treat acute respiratory problems.

That’s out of reach for the vast majority in a country where monthly minimum wage has not topped $5 in several years.

The information ministry did not immediately reply to a request for comment.

Patients are able to receive treatment at home as long as they do not require intubation, a delicate process that would require them to be transported to an intensive care unit, Acosta said.

For doctors, performing home visits means getting paid in U.S. dollars and making substantially more than they would in the public health system.

“I’m doing this in part for economic reasons,” said Carlos Hernandez, a 25-year-old doctor who like Acosta recently graduated from the Central University of Venezuela. He is also working in the public health system, as the country requires of recent graduates, but said he has not been paid in four months.

Given the country’s economic crisis, Acosta said he will often provide treatment even when the patient cannot pay in full.

“I understand the situation,” he said.

(Reporting by Efrain Otero, Vivian Sequera and Leonardo Fernandez; Editing by Lisa Shumaker)

Outbid and left hanging, U.S. states scramble for ventilators

By Nathan Layne

(Reuters) – On the final Thursday in March the Arkansas team in charge of procuring ventilators thought they had scored a coup: a vendor had agreed to sell them 500 of the breathing machines critical to keeping COVID-19 patients alive at $19,000 each.

The next day they were told the deal had vanished because a buyer representing New York was offering to purchase 10,000 units, pay cash upfront and double the price, a deal the vendor could not turn down. Reuters could not independently verify that New York bought the ventilators.

Either way, for Arkansas, the search for the machines goes on.

“We still want to purchase the 500,” said Dr. Steppe Mette, chief executive of UAMS Medical Center in Little Rock, who is helping oversee procurement of supplies for the state. “There are profiteers all over the place.”

Arkansas may never need those ventilators. It has 785 across the state, most of which are not currently in use, and data from New York and other hot spots in recent days suggest hospitalizations might be peaking.

In the past week Louisiana and Arizona scaled back their requests for ventilators from the federal government, while Oregon, Washington and California offered up spare units for use by other states.

But the episode illustrates how some states have been muscled aside in the scramble for equipment to combat a virus that has killed nearly 18,000 people in the United States, potentially leaving them vulnerable should the worst-case scenarios materialize or the virus return in subsequent waves.

The stakes are especially high when it comes to ventilators, which can be the difference between life or death for patients suffering from COVID-19, the respiratory illness caused by the novel coronavirus.

Reuters surveyed all 50 states about their ventilator needs. The 31 that either responded or have disclosed figures showed a collective intent to procure 70,000 units, including outstanding requests to the federal government and private sector.

(For an interactive graphic on ventilator inventories by state, click

The Federal Emergency Management Agency (FEMA) has acknowledged there aren’t enough ventilators in the Strategic National Stockpile to meet demand, and is distributing units to states most in need. According a FEMA spokesperson, the federal government has 8,644 ventilators available, including 8,044 in the stockpile and 600 from the Department of Defense.

Some states have criticized the federal government for crowding them out of the market. Rhode Island, which has 300 ventilators, one of the lower inventories among the states, said it is struggling to source the machines.

“Right now it’s almost impossible to procure ventilators,” Rhode Island Governor Gina Raimondo told reporters this week. “It’s really a very poorly organized system.”


Arkansas’ Mette said his procurement team had tried to buy the Shangrila 510S, a compact ventilator advertised on the website of the manufacturer, Beijing Aeonmed Co. Ltd. as “Ready to Confront COVID-19”, from a reseller of the machines.

The incident was significant enough that a report was given to Governor Asa Hutchinson, portions of which were read to Reuters. It says the order vanished in a matter of hours after buyers for New York secured a deal for 10,000 units, the maximum that could be produced in two months.

The office of New York Governor Andrew Cuomo did not respond to a request for comment. Cuomo has himself complained about receiving only 2,500 out of an order for 17,000 ventilators from China, with per-unit prices doubling since the outbreak.

Beijing Aeonmed said it had not applied for approval from the U.S. Food & Drug Administration (FDA) for the Shangrila 510S and that producing 10,000 units in such a short time was “unrealistic”.

Roger Biles, the head of a medical supplies company, InterMed Resources TN, helping Arkansas source ventilators from China, said the reseller told them it was New York that had bought the machines but there was no way to know for sure.

“If you snooze you lose in this environment. Product is going left and right,” Biles said. “We couldn’t get the money to them fast enough. They said they are all gone.”

Biles said the reseller provided certification that the Shangrila 510S could be sold in the United States because it had similar specifications to an approved machine, a common process to gain market access. The FDA did not respond to a request for comment.

The administration of President Donald Trump is working with Ford Motor Co and other manufacturers to produce 100,000 ventilators by the end of June, and FEMA has told states it will provide units 72 hours before any surge hits them.

Arkansas still wants a buffer, even with current projections showing it may now only need 300 ventilators at the apex of hospitalizations in the coming weeks, whereas a previous model indicated it may require 2,000 at peak.

“Prepare for the worst, hope for the best. We are still going on that philosophy,” Mette said.

(Reporting by Nathan Layne in Wilton, Connecticut and Roxanne Liu in Beijing; Editing by Paul Thomasch and Daniel Wallis)