A fear of hospitals is leading many Mexicans to delay treatment for coronavirus until it is too late for doctors to help them.
A gray Suzuki stopped outside the General Hospital of Mexico and deposited a heaving Victor Bailón at the entrance. He had refused to come to the hospital for days, convinced that doctors were killing coronavirus patients. By the time he hobbled into the triage area and collapsed on the floor, it was too late.
"Papito, breathe!" his wife screamed. "Please breathe."
Within an hour, Bailón was dead.
Mexico is battling one of the worst coronavirus outbreaks in the world, with more than 52,000 confirmed deaths, the third-highest toll of the pandemic. And its struggle has been made even harder by a pervasive phenomenon: a deeply rooted fear of hospitals.
The problem has long plagued nations overwhelmed by unfamiliar diseases. During the Ebola epidemic in 2014, many in Sierra Leone believed that hospitals had become hopeless death traps, leading sick people to stay home and inadvertently spread the disease to their families and neighbours.
Here in Mexico, a similar vicious cycle is taking place. As the pandemic crushes an already weak health care system, with bodies piling up in refrigerated trucks, many Mexicans see the Covid ward as a place where only death awaits — to be avoided at all cost.
The consequences, doctors, nurses and health ministers say, are severe. Mexicans are waiting to seek medical care until their cases are so bad that doctors can do little to help them. Thousands are dying before ever seeing the inside of a hospital, government data show, succumbing to the virus in taxis on the way there or in sickbeds at home.
Fighting infections at home may not only spread the disease more widely, epidemiologists say, but it also hides the true toll of the epidemic because an untold number of people die without ever being tested — and officially counted — as coronavirus victims.
Many Mexicans say they have good reason to be wary of hospitals: Nearly 40 per cent of people hospitalised with confirmed cases of the virus in Mexico City, the epicentre of the nation's outbreak, end up dying, government data show, a high mortality rate even when compared with some of the worst coronavirus hot spots worldwide. During the peak of the pandemic in New York City, less than 25 per cent of coronavirus patients died in hospitals, studies have estimated.
While the statistic may be imprecise because of limited testing, doctors and researchers confirmed that a startling number of people are dying in Mexico's hospitals.
During a surge of cases in May, almost half of all Covid-19 deaths in Mexico City hospitals occurred within 12 hours of the patient's being admitted, said Dr. Oliva López Arellano, Mexico City's health minister.
In the United States, people who died typically made it five days in the hospital.
Doctors say more patients would survive if they sought help earlier. Delaying treatment, they argue, simply leads to more deaths in hospitals — which then generates even more fear of hospitals.
The distrust is so pronounced that relatives of patients in Ecatepec, a municipality outside of Mexico City, stormed a hospital in May, attacking its employees, filming themselves next to bags of corpses and telling reporters that the institution was killing their loved ones.
"After seeing videos of what happens to people inside hospitals, screw that," said Bailón's brother, José Eduardo, who had recently spent 60 days at home recovering from his own bout with what he believes was the coronavirus. "I'd rather stay home and die there."
But many people who die at home in Mexico — or even on the way to the hospital — are never tested for the virus, so they are not counted as coronavirus victims. Instead, they fall into a statistical black hole of fatalities that are not officially tied to the pandemic.
Even by the official count, Mexico has already suffered more coronavirus deaths than any other nation but the United States and Brazil. And the government said recently that during a period of over three months this spring, there were 71,000 more deaths than expected, compared with previous years — an indication that the virus has claimed many more lives than the official tally suggests.
Adding to the confusion, political leaders here, as in many countries, have sown doubts about the virus and the need to seek medical care. The hugely popular president, Andrés Manuel López Obrador, said he uses religious amulets and his clean conscience to protect against the coronavirus, and he has advocated fighting the pandemic at home, with the help of families, rather than in hospitals.
Nearly 70 per cent of Mexicans said they would feel "unsafe" taking their loved ones to the hospital during the pandemic, in a survey published last month. A third said they would prefer to care for their relatives themselves.
Now the nation's top health officials have begun pleading with Mexicans to stop resisting medical care.
"It's very important that late care doesn't contribute to death," Hugo López-Gatell, the health official leading the country's response to the virus, said at a news conference last month. "Please, go to hospitals early, especially people who are most at risk."
Many are wary of the costs that come with a hospital stay. And in a country plagued by rampant government corruption, the fundamental distrust of authorities often extends to doctors and nurses in public hospitals.
At the General Hospital in Mexico City, where Bailón died, suspicion was running high. No one had wanted to come to the hospital, a place that seemed to swallow their loved ones and leave them outside, with few updates to calm the nerves. Everyone had a theory about the real cause of the virus and the destruction it had unleashed.
Modesto Gómez, whose wife was inside, heard the government was letting elderly people die of the virus because they had expensive pensions. Héctor Mauricio Ortega, whose father was intubated there with a Covid infection, said he believed doctors were purposely infecting people with the virus "because countries have a quota of people who need to die every year."
Raúl Pérez woke up in a panic on the benches outside the entrance. It was his 16th day sleeping there after his sister went in for brain surgery.
He said he had met seven families of patients who had come in for another illness and then died of the coronavirus.
"People think maybe they're injecting them with something or killing them in there," he said.
Pérez did not believe the rumours at first, but then doctors told him that his sister, who was still intubated after her brain surgery, had tested positive for coronavirus. Now he was frantic, calling all his relatives, telling them the hospital wanted his sister dead.
"They are letting people get infected," he said. "They just want to get rid of one more patient."
López, Mexico City's health minister, said that rumours of malicious medical practices had been widespread. Doctors were supposedly stealing the fluid from people's knees, or trading their fingerprint data gleaned from oximeter readings.
"There was a big fake news campaign spreading rumours that health workers were attacking people inside hospitals, profiting from their death," she said.
Dr. Ernesto Nepomuceno said that in his clinic in Iztapalapa, a poor neighbourhood in Mexico City, doctors perform oximeter readings on themselves to show patients that they are measuring oxygen levels, not recording personal data.
"We have to make great efforts to put people at ease," Nepomuceno said.
Two days before Bailón was wheeled into the General Hospital's intensive care unit, he visited a doctor in his tiny hometown an hour outside of the capital. His oxygen levels were low, but he begged his wife, Fabiola Palma Rodríguez, not to drive him to the hospital.
"Please don't take me there, I don't want to die," she recalled him telling her. By the time Bailón relented, he was already ravaged by the disease.
After a local hospital turned him away, he made the trip to Mexico City. He died on a stretcher in the General Hospital, Palma said, before doctors could intubate him.
"I would have taken him earlier, but we were both too scared," Palma said. "It is so unfair. I took him there alive and brought him back home dead the same day."
Aurora Arzate Nieves died on the same day as Bailón, in the same hospital, about 30 hours after being admitted. The matriarch of a tightly knit Mexican family, Arzate, 83, was known for her green mole dish and strong will. Her sons practically had to drag her to the hospital.
That decision was tormenting Eduardo Gutiérrez Arzate as he said a final goodbye to his mother, who was zipped into a bag inside a Ford minivan converted into a hearse by a funeral company near the hospital.
Pawing at the window, Gutiérrez begged his mother to wake up.
"I felt really guilty when I saw her," he said, standing outside the crematory, black smoke billowing overhead. She was scared of everything having to do with the coronavirus and of hospitals, where she would be surrounded by "depressed people" instead of her family.
"I asked her in that moment to forgive me," he said. "I asked her to forgive me for taking her to the hospital."
Written by: Natalie Kitroeff and Paulina Villegas
Photographs by: Daniel Berhulak
© 2020 THE NEW YORK TIMES