Beyond the hotspots of Brazil and Mexico, the coronavirus is threatening to overwhelm Latin American cities stretching from Chile to the Colombian Amazon in an alarming sign that the pandemic may be only at the start of its destructive march through the region.
More than 90% of intensive care beds were full last week in Chile's capital, Santiago, whose main cemetery dug 1,000 emergency graves to prepare for a wave of deaths.
In Lima, Peru, patients took up 80% of intensive care beds as of Friday. Peru has the world's 12th-highest number of confirmed cases, with more than 90,000. We're in bad shape," said Pilar Mazzetti, head of the Peruvian government's COVID-19 task force. This is war.
In some cities, doctors say patients are dying because of a lack of ventilators or because they couldn't get to a hospital fast enough.
With intensive care units swamped, officials plan to move patients from capitals like Lima and Santiago to hospitals in smaller cities that aren't as busy running the risk of spreading the disease further.
Latin American countries halted international flights and rolled out social distancing guidelines around the same time as the US and Europe, delaying the arrival of large-scale infection, said Dr Marcos Espinal, director of communicable diseases at the Pan American Health Organization.
Latin America was the last wave, said Espinal, who previously worked at the World Health Organization.
He warned that authorities need to maintain anti-virus restrictions even as the US and Europe reopen. Some of the hardest-hit cities, like Lima and Santiago, imposed strict, early lockdowns.
But officials have struggled to enforce them, whether among the wealthy who are used to flouting regulations or lower-income people who depend on day labor or selling things on the street to feed their families.
Latin America is the world's most unequal region, a reality that Espinal said made it difficult to balance health and economic growth, with millions facing increased poverty during quarantines, curfews and shutdowns.
A month after swamping the Ecuadorian coastal city of Guayaquil in one of the first serious blows to Latin America, COVID-19 is sickening thousands in the capital of Quito, where 80% of intensive care beds were occupied as of Friday.
In terms of intensive care, we're stripped bare," city health secretary Lenn Mantilla said.
Quito has more than 2,400 confirmed infections, and Health Minister Juan Carlos Zevallos said he expected the peak to come toward the end of June.
He assured citizens that the city was prepared and would avoid the fate of Guayaquil, where hundreds died at home, left in living rooms for days before overworked coroners could retrieve the bodies.
Those who perished in hospitals in coastal cities were put in chilled shipping containers that served as makeshift morgues.
The number of deaths in Quito jumped alarmingly over the weekend, from 114 to 209, and doctors said they dreaded the coming days.
I have a 26-year-old woman next to me who walked in. Three hours later, she's suffocating because we don't have a respirator available,'' said an intensive care doctor, who spoke on condition of anonymity because he was not allowed to speak to the media.
I think we're getting to the point that you saw in Europe, where people died for lack of respirators."
Ecuador has banned most private car trips and imposed a 2 pm to 5 am daily quarantine, but thousands of people can be seen buying from street vendors across the capital.
The worst-hit country in Latin America remains Brazil, which is third in the world for reported infections at more than 250,000 even with limited testing.
More than 85 percent of intensive care beds are full in Rio de Janeiro and Sao Paulo.
Now, other countries are surging. Chile has imposed new restrictions in Santiago after cases doubled over the past week, to more than 34,000 in the country of 18 million people.
Under the new restrictions, people will have to receive a police permit to leave home, with violators fined the equivalent of thousands of dollars. Essential workers are exempted.
We're on very, very thin ice," said Claudio Castillo, a professor of public policy and health at the University of Santiago.
In Colombia's Amazon region, cases have shot up in recent weeks, from 105 at the start of the month to 1,006 on Monday. The infections are concentrated in Leticia, a city on the Amazon river that borders both Brazil and Peru.
Locals believe it's related to the increase in cases in Brazil's Amazon. Even though Colombia's president has militarised the border, many still cross. Residents often work in one country and live in the other.
Leticia relies on two poorly equipped hospitals, which have about a half-dozen respirators between them. Authorities recently began transporting seriously ill patients to Bogota after a failure at a hospital oxygen plant. Officials said Monday that they will open hotels in Leticia to take in people with less severe coronavirus cases.
Health workers also complain of limited access to testing and say they are overworked to the point of collapse.
In Mexico, intensive care occupancy is below 50 per cent in most cities, although deaths have begun to overwhelm funeral homes and crematoriums in the Mexico City borough of Iztapalapa.
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