December 15, 2020
Dear Karuna –
As you may know, the U.S. has only 4% of the world’s population, but 18% of the world’s fatalities. Our
current 7-day averages are over 1.5 million new cases per week and over 17,000 deaths per week. We
are staying at home and have virtually no contact with anyone except for shopping.
I’ll discuss the COVID pandemic first and then the Copper Canyon trip. I hope this places things in
context for you and others in the group.
PART ONE – COVID
As a Pediatrician I speak from 45 years of experience with infectious disease. I have treated everything
from bubonic plague to malaria. I’ve watched many children and teens die or be severely damaged
from infections. I have never seen anything remotely like this, nor has anyone else now living. The last
such event – the Great Influenza Pandemic – began 102 years ago lasting over two years.
1) If someone gets ill, that means they were exposed to COVID almost two weeks ago…and if
someone dies, they likely were exposed 3-4 weeks earlier. This is why tracking the virus is so hard –
and it makes it very difficult for anyone to connect our behaviors with the consequences. If I get sick
tomorrow, I have no way to know where I got it nor what I might have done to prevent it.
This is why proactive measures designed to protect ourselves from each other are so crucial.
The practical consequences of the virus’s invisibility are predictable. Because of “pandemic fatigue” and
an inability or unwillingness to accept the public health message to stay home, flights in the U.S. over
Thanksgiving were higher than at any time since February. We are now seeing huge surges in case and
death rates. Early January will see yet another surge because of similar behaviors over Christmas.
2) As with all infectious agents there is a spectrum of illness and there are certain vulnerable
populations. If you are over age 60 and get this virus, your chances of dying are between 1 in 25 and 1
in 50; over age 70 they are 1 in 8 to 1 in 25; and over 80 they are 1 in 7. This virus is lethal. COVID is far
more dangerous than seasonal Influenza.
3. Discussions of the dangers seldom include long lasting physical and/or neurological problems.
There are many deleterious effects – and we won’t have a clear understanding of the true cost of this
virus for a long time. Young healthy adults are having strokes, long-term cognitive problems, and/or
severe inflammation of the heart.
4. In the U.S., the actual case and fatality rates are significantly underreported. The case rates are
artificially low for one reason: There is totally inadequate testing. Epidemiologists everywhere place the
actual case load at least 5 times higher than the reported case load. Fatality rates are artificially low for
a similar reason: Not everyone who dies of COVID is tested, many die at home or of COVID-induced
events that can’t be “proven”. The way we know this is simple: We look at “Excess death rates”. How
many people usually die at a given time of year is well known and the numbers are remarkably
consistent from year to year. This year, all over the world, there have been many more deaths than one
would expect based on past records. The only real change is COVID. In confirmation, the surges in
excess mortality exactly mirror the spikes in COVID mortality.
5. Short of a vaccine, there is NO effective preventative treatment. This is a brand-new germ – no one
on the entire planet has ever been exposed to it before. My wife and I take vitamin and herbal
supplements, have a healthy diet, sleep well – and I’m sure that those help to keep our immune system
healthy. Unfortunately, such interventions won’t protect us from this novel virus nor guarantee a mild
response to it. There are far too many reports of extremely healthy, robust people who have done all
those things and have died or have suffered severe long-term consequences from COVID.
6. The reasons for COVID prevention in everyone are NOT only to protect the vulnerable; they are to
protect the medical system from collapse. If the health system collapses, mortality will skyrocket.
I am not being hyperbolic. In many countries, medical systems are overloaded. In the U.S., there is a
severe shortage of travelling ICU nurses because all states are experiencing surges simultaneously.
Physicians are quitting/retiring early. In Sweden, nurses are quitting en masse – this was discussed in an
article in Bloomberg just 4 days ago. Medical providers are at the breaking point.
7. Our intuitive decision making can get us into trouble.
When the COVID pandemic began in the U.S., it was concentrated on the East and West coasts in urban
areas; the very rural areas in our country had almost no cases. Unfortunately, the claims by some that
the pandemic was a hoax were compelling to people in rural areas who had never seen a case and never
thought they would. They didn’t believe the threat was real, so they didn’t wear masks, didn’t socially
distance and didn’t protect themselves. That was an example of intuitive (experience-based) thinking –
and it was very wrong.
Now, the rural hospitals are overwhelmed and the ICU beds are near 100% capacity. They are bringing
in refrigerator trucks for the dead bodies and setting up field hospitals.
8. Any distribution of vaccines will take months and will have no practical impact on the surge in cases
this Winter and Spring.
The reason for this is mathematical. Introducing the vaccine now is like throwing several large buckets
of water at a raging house fire. It won’t begin to have a major impact until late Summer, 2021. It’s
important to have realistic expectations.
PART TWO: MEXICO
1. Although the numbers are unknown, it’s clear that the pandemic is out of control in Mexico. The
number of cases is likely much higher than anyone realizes. Further, we suspect that the expatriate
community is isolated from the true impact of the pandemic on Mexicans.
The factual dilemma in Mexico is that the numbers are unknown – they are simply not reliable because
of lack of testing and the fact that privately done tests are not required to be reported.
However, there is a cross-cultural problem. I would venture to say that most expats residing in Mexico
live in parallel communities with their Mexican neighbors. Most are not truly fluent in Spanish; most do
not have a deep understanding of the Mexican culture; most tend to congregate mainly with one
another and get their information from one another. It would not be a surprise if the expats viewed the
pandemic through a different, protected lens. I suspect that the expats think the pandemic is not as
much of a problem – because they don’t see it.
To demonstrate: Our friend Eric insists that it’s extremely safe in Ajijic because he knows of “no one
who knows anyone” who has had COVID; yet our Spanish teacher Lina who has lived in the village near
Seis Esquinas for many years tells us that there is a large cluster of cases in her neighborhood. The
families are simply not reporting because of embarrassment and/or governmental suspicion.
Looking at the available numbers, there have been 1.2 million cases in Mexico and 114 thousand deaths
as of today.
This would mean Mexico has the highest case fatality rate in the world at 9.1% (one out of every 11
people who get the virus die). The next highest CFR is Iran at 4.7% and the U.S. is at 1.8%.
Karuna, I don’t believe Mexico’s reported case and fatality numbers. The Case Fatality Rate is too much
of an outlier. No other country is close to it.
Better explanations are that there is very little testing and that the total number of cases is severely
underreported. The implication is that the actual case load is much higher than is being reported. In
other words, there are many more people infected in Mexico than people understand – which makes it
even more difficult to avoid exposure and risk.
2. In many ways, the Mexican experience mirrors the rural U.S. The pandemic wave in Mexico hit
later and people were in denial because they saw so little illness.
3. Mexico has no effective ban on tourism. This means that it is importing COVID. Further, the United
States is an exporter of COVID.
U.S. citizens are currently banned from the European Union because of the high likelihood that a U.S.
traveler may carry COVID with or without knowing it. Unfortunately, unlike the E.U., Mexico has chosen
not to enforce a ban from COVID-exporting countries.
4. The above plus the fact that Mexico has a very large informal economy (made up of people who
must work daily in order to eat) means that the pandemic experience in Mexico is going to get much
worse over the next several months.
PART THREE: OUR DECISION
Our concern last Spring was for the protection of the Rarámuri as well as ourselves.
Nothing really has changed. We know that people can be infectious before they are aware that they
are sick. We also know that medical resources in the remote areas surrounding the barrancas are
scarce. We know that the only truly safe form of travel is by car with only people from the same
We know that COVID is intense in Chihuahua. 4 weeks ago Chihuahua had the highest rates of COVID
hospitalization in the country. It is now in a yellow-light status; I wouldn’t have any way of knowing
what the future will bring, but doubt that there will be much relief because of the coming Christmas
surge – which may be much more intense in Mexico than in the U.S.
The group that wants to go to Copper Canyon is elderly. All but four are over 70 years old, or close by
one or two years, . If any of us gets the virus, we will be at great risk.
Our response is a measured one:
1) We don’t know what the true infection rate in Mexico is. But we believe it is far higher than
stated. As is true world-wide, we can expect the pandemic to get much worse before it gets
2) Given the current surge, it’s unrealistic to expect it to subside by March.
3) We cannot assume that someone who looks well is not infectious.
4) It will take at least a year after a vaccine becomes available before we will begin to see true
population protection – assuming people are willing to be vaccinated.
5) You should assume that anyone coming from the United States is potentially infected, and you
should require a 10-14-day self-quarantine before allowing them to join the group – ourselves
6) We are not in a position to self-quarantine for 10-14 days before the trip.
7) Most importantly, indigenous peoples need to be protected. This is our highest priority. Our
tourism is not a necessity; their health is.
8) Why risk contracting and/or spreading the disease?
We will not be traveling anywhere for the foreseeable future – not to San Diego or Boston or
Philadelphia to see our children; not to Mexico. The risks of group travel are unacceptably high,
especially when people are coming from such diverse places geographically.
We are very disappointed that we cannot see the barrancas – we know they are spectacular. We are
certain that sometime in the future it will be possible.
Many, many blessings.
Ted (and Priscilla)