If you want no disappointments, don’t indulge in illusions.” -Panamanian Proverb

Other Pandemic National Case Studies can be found here.

The bicontinental nation of Panama enjoys a unique position, holding the Panama Canal as one of the world’s most important strategic assets, connecting the Atlantic and Pacific Oceans into a single trade network by the shortest route between most localities. 

This helped make Panama, a largely Mestizo nation of 4.4 million, into Central America’s wealthiest nation, but that gap between Panama and the rest really took off after the December 31, 1999 handoff of control over the canal. That handoff came with the benefits of greater participation in the international banking that flocked to Panama over the decades to help conduct the business side of Panama Canal shipping and cargo ownership transfer.

Panama became a favorite destination for expat Americans due to its status as a tax haven. The capital of Panama City is home to minority populations from North America (Caribbean nations in particular) and South America, Europe, Asia, and Australia. After the financial crisis that followed the mortgage bond market collapse, Panama updated its taxation treaties to close much of the difference, though the population influx remains substantial.

Panama provides us with one of the more interesting case studies among nations using hydroxychloroquine to treat COVID-19 early during the pandemic. Like many nations, Panama used hydroxychloroqine (HCQ) together with azithromycin (AZM) early on during the “pandemic”, but took a pause in late May when the WHO declared HCQ a failure following the publication of the Surgisphere paper, now considered by most people to be a fraud. From that moment, the novel coronavirus took off in Panama, spreading like wildfire, and the case fatality rate (CFR), which was falling in May began to rise by late June. In July (21st), Panama reversed the ban and has recently experienced what looks like the early stages of viral attenuation as both cases and fatalities have been dropping. This stands in contrast to Costa Rica, whose recent case increase might be related to the explosion of cases in Panama since late May, and El Salvador, which maintained HCQ use throughout the pandemic.

Panama is another nation that put the brakes on HCQ in late May, specifically May 26, but reversed that policy on July 21. Around 10 days after ceasing HCQ treatment, Panama’s 7-day CFR, which was at an all time low relative to the rest of the world’s, and well below world averages, began to climb. Panama’s normalized CFR hit an all time high on July 25, then declined almost 40% over the following two weeks.

I put together the following graph to show the ratio of Panama’s case fatality rate (CFR; COVID deaths divided by cases) to those of the rest of the world.

We clearly see the red data series take off from less than half (the world average) to just over the world average after halting use of HCQ. Upon allowing use of the drug, that trend largely reverts, though given the political climate, it is unlikely that all physicians returned to using the drug.

While CFR provides a good test of an antiviral’s efficacy, when widely used, we see a demonstrable and profound difference in overall mortality associated with the natural experiment of stopping and starting use of HCQ:

Detractors of HCQ might simply claim that COVID-19 spread more through Central America during an expected Summer wave. But they can’t explain away the CFR change that made Panama’s COVID mortality curve much sharper than those of either North America or South America, specifically coinciding with the stopping and starting of HCQ usage

It’s hard to argue with sharp first and second derivatives.

Panamanian doctors, with their up close and personal experience with the patients, apparently felt the same way. They purchased 2,900,000 doses of HCQ and 450,000 doses of ivermectin to distribute in self-treatment kits for people isolating with the virus (Torres-Atencio et al, Correspondence with Nature 2020).

Panama begin its experimental mass vaccination campaign on January 21, 2021. Apparently unconcerned with differentiating the effects of any of the vaccines, Panama used a mixture of Pfizer, Sputnik V, AstraZeneca, and Johnson & Johnson vaccines. The program really ramped up in July and August. By the end of 2021, Panama had vaccinated just over 70% of its population. As of August 1, 2022, that number stands just above 80%, though few people have received a first dose since March.

Prior to the mass vaccination program, Panama experienced roughly 1 COVID-19 case per 125 residents per month. Since the vaccination campaign began, Paname has experienced roughly 1 COVID-19 case per 125 residents per month.

Despite being highly vaccinated, Panama has suffered one of the worst case rates in the Western hemisphere. It is noteworthy that Panama’s CFR, which was falling for most of 2020, remained relatively constant through 2021, only to fall once the vaccine campaign slowed down.

Also, the excess deaths were higher in Panama in 2021 than in 2020, whereas excess deaths typically mean-revert after a higher proportion of fragile or elderly people die the previous year. The sharp elevation began during the period during which the more-often frail elderly were being vaccinated.

This does not speak well for the vaccination campaign. By October, physicians in Panama were engaged in both sides of heated debates over whether or not the quasi-vaccines work at all. More recently, Panama looks anything like a nation that trusts its government, or perhaps the system of implicit world governance of the plandemonium

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By GIL