Venezuela and the Chavez Legacy

The Biden administration on Monday declared an estimated 320,000 Venezuelan migrants in the United States eligible for temporary protected status, a category of legal residence that would open a path to U.S. citizenship for them under the immigration bill President Biden sent to Congress last week.

Eligibility extends only to Venezuelans in the country as of March 8 who apply within the next 180 days and meet vetting requirements. The program is intended to protect those who are unable to return home safely because of natural disaster, violence or civil unrest.

“The living conditions in Venezuela reveal a country in turmoil, unable to protect its own citizens,” said Homeland Security Secretary Alejandro Mayorkas, who officially made the designation.

The decision to grant temporary protected status, or TPS, marked the most visible step thus far toward the implementation of campaign pledges Biden made to adopt a Venezuela policy differing from that of President Donald Trump.

Biden promised to increase humanitarian aid to those suffering from scarce food and medicine inside Venezuela, as well as the millions of Venezuelan refugees scattered across Latin America. He said he would mobilize more international pressure to force President Nicolás Maduro to negotiate with opposition leaders toward free and fair elections and to combat corruption that — along with heavy U.S. sanctions — has brought the Venezuelan economy to near-ruin.

But any significant changes will be difficult to see. Trump sanctions remain in effect and “under review,” according to a senior administration official who briefed reporters on the TPS decision. The official spoke on the condition of anonymity under White House ground rules.

Any increased international focus on more-coordinated pressure on Maduro has been largely overshadowed by major foreign policy challenges elsewhere.

Even the TPS implementation provided little substantive change for Venezuelans who have fled to the United States, most of them to Florida.

Legal residence is important to a key voting bloc in the state. While Trump had repeatedly refused to grant TPS to Venezuelans — and his administration secretly deported a number of them — he won Florida in last year’s election with a strong boost from Hispanic voters there after alleging that Biden would bring Venezuela-style socialism to the country.

But on his last full day in office, Trump authorized deferred enforcement departure, or DED, for Venezuelans, giving them temporary immunity from immigration action. Both the Trump order and TPS are good for 18 months and cost $545 in application and approval fees with work authorization.

Biden will face additional tests later this year when previously granted TPS expires for hundreds of thousands of refugees from other countries living in the United States under the program. Trump terminated the status for nationals of El Salvador, Haiti, Honduras, Nepal, Nicaragua and Sudan — including some who had been in the country many years under repeated extensions — although those actions were blocked by ongoing legal challenges.

Biden’s immigration bill, which is likely to encounter major challenges in Congress, would include migrants living in the United States under TPS and DED among those eligible for permanent residence, followed by citizenship after three years.

The vast majority of the nearly 5 million Venezuelan migrants who have fled economic devastation and the authoritarian regime over the past three years are in Latin America.

Biden’s move comes one month after Colombia — which hosts 1.7 million Venezuelan migrants — won international praise for offering them 10-year temporary protection status, a step that is set to help them gain access to coronavirus vaccines.

Maduro has recently expressed measured optimism that a Biden administration could spell a shift in the Trump sanctions, although the senior administration official said the new administration “is in no rush” to lift them.

The administration has also said it does not intend to negotiate with Maduro, a task it believes should be left to the Venezuelan opposition.

“There is always room for dialogue,” Maduro said during a news conference last month. “There are sectors in the United States that interpret this as a sign of weakness. . . . I hope there is thorough rectification of these policies.”

Venezuelan opposition officials say they believe the Biden team may be better positioned than the Trump administration to work with European allies, who have resisted some measures to ramp up pressure on Maduro.

Last week, Secretary of State Antony Blinken made his first formal contact with opposition leader Juan Guaidó, who is recognized by the United States and dozens of other nations as Venezuela’s legitimate leader. The opposition, which remains divided over Guaidó’s continued leadership, has worked with U.S. officials to try to formulate a new strategy for maintaining internal unity and pressure on Maduro.

“The United States continues to be one of our main allies in achieving a transition,” Guaidó tweeted after the telephone conversation. He later told a Colombian news outlet that “we always had confidence in the Biden administration, and we have it today.”

CARACAS, Venezuela — Venezuela’s raging coronavirus outbreak had filled nearly every hospital bed in the capital, leaving the Fuentes family scrambling when three of its members came down with acute cases of covid-19 at virtually the same time.

Their solution: Build their own medical ward inside their four-bedroom home.

Across Latin America, the haves and the have-nots are living and dying in two radically different pandemics — a natural extension of the economic inequality lived daily by 652 million people from the Rio Grande to Tierra del Fuego. In one of the most unequal regions of the globe — and among the hardest hit by the coronavirus — perhaps no single country is witnessing a larger gap than the “Workers’ Paradise”: Nicolás Maduro’s Venezuela.

Doctors here say the need for patients to source their care privately, or to purchase their own medical supplies for use in bare-bones public hospitals, is leaving untold numbers of poor Venezuelans to die during the pandemic. But the Fuenteses, aided financially by a family member now living in the United States, were able to buy oxygen tanks, IV drips, saline solution, needles and other costly supplies, then hire nurses to provide 24-hour care at home.

Like other Latin Americans in the middle and upper classes, they paid for doctors to make house calls. They even bought lifesaving courses of remdesivir, sourced from a burgeoning local black market for coronavirus drugs, at $140 per dose. After a total outlay of $20,000 in three weeks — a sum equal to 1,667 years worth of salary at Venezuela’s minimum wage — two ill family members have recovered. A third remains hooked up to oxygen and under 24-hour care, his condition gradually improving.

“If you don’t have money, you don’t have a chance,” said Belinda Fuentes, a 44-year old fitness instructor in New York who emptied her life savings to help her parents and older brother.

For thousands in Latin America, where the richest 1 percent earn 21 percent of the region’s income, double the average in the industrialized world, survival in a worsening pandemic is boiling down to economics.

“Sometimes, it’s just about the cost of oxygen, which some health services do not have enough of,” said Ciro Ugarte, director of health emergencies at the Pan American Health Organization. “Families are having to buy it and bring it to hospitals. If they don’t have the money, in severe cases, their family member will probably die.”

In Brazil, the epicenter of the region’s coronavirus crisis, cases are still surging, overburdening a health-care system skewed to serve the rich. Of the 45,848 intensive care beds in Brazil, slightly more than half are in costly private hospitals that serve a quarter of the population.

During Mexico’s punishing second coronavirus wave in January, more than 50 percent of covid-19 patients admitted to hospitals run by the Mexican Social Security Institute, the nation’s largest public health network, subsequently died. The rate in better-funded private hospitals was 20 percent, according to an analysis commissioned by the World Health Organization and released last week by the Institute for Global Health Sciences at the University of California at San Francisco.

Private hospitals in Latin America, where care can cost upward of $2,000 a day, remain largely the purview of the very rich. Home care is emerging as a less expensive alternative, even as it drains the resources of a middle class devastated by pandemic-related job losses.

Dario Morales, a 36-year-old flight attendant in Peru, said his mother was infected in February. His stepfather, also diagnosed with the coronavirus, had died days earlier at a public hospital in the coastal city of Trujillo.

To avoid that fate, his mother pleaded with him to pay for home care. The bill for 10 days of oxygen, specialized drugs and in-home care from nurses and doctors: a financially crippling $2,800. He managed to cover it by giving up his apartment and moving in with friends.

“If we took her to a public hospital, it would have been, ‘Oh sorry, we don’t have space,’" Morales said. “Even if they did find a bed, she’d get no attention because there are too many patients and too few doctors and nurses.”

In Venezuela, a broken socialist state, the public health-care system has been so weakened that its citizens bear the highest out-of-pocket health-care costs in Latin America. Venezuelans cover 63 percent of their health expenditures on average, according to WHO and Organization for Economic Cooperation and Development data — nearly double the rate in Chile, and more than four times that of Argentina.

Public hospitals are so underequipped and underfunded that one survey found that 92 percent of X-ray machines did not work and 68 percent of facilities lacked consistent running water. Patients routinely supply their own oxygen, needles, antibiotics and saline solution.

After sidestepping the worst of the pandemic last year, Venezuela ended strict lockdowns in December and has now witnessed a terrible surge. Official data from President Maduro’s opaque authoritarian government show roughly 183,000 infected and 1,900 dead. But those numbers, doctors say, do not begin to capture the true extent of the outbreak.

“If you got sick today, I have nowhere to put you,” said Julio Castro, an infectious-diseases specialist and adviser to the Venezuelan opposition on the coronavirus response. “For a year we have warned that things could get worse, and now the worst is happening.”

The pandemic has exacerbated scarcities of medical supplies and drugs, fueling a proliferation of Whats App chat rooms filled with private vendors offering oxygen concentrators for $5,000 and oxygen tanks for $500. Those are sums accessible only to the small and disappearing middle class and wealthy elites, leaving thousands of Venezuelans in need to turn to social media or GoFundMe sites.

In what once was South America’s richest nation per capita, years of corruption and mismanagement and falling oil prices have fueled deeper inequality. The rich and connected buy imported foods and lavish cars and belong to elegant country clubs. The extreme poor — 79.3 percent of the nation, according to a survey by Andres Bello Catholic University in Caracas — live in squalor, often in violent slums, and lack adequate food. Many have lost weight from what some call “the Maduro diet.”

Venezuela has secured precious few vaccine doses, and has reserved them for emergency responders and the elderly. Still, some elites have managed to access them. One wealthy Venezuelan said he had obtained the Russian Sputnik V vaccine through a personal local contact. The man, who spoke on the condition of anonymity out of fear of government retribution, said he had purchased vaccinations for himself and several staff members from the Domingo Luciani Hospital in Caracas at $200 a dose.

“If you have the money to pay, you can talk to the [nurse] on the floor and get what you need,” he said.

For the poorest Venezuelans, meanwhile, the cost of the pandemic is fatally high.

Marilin Mijares came down with the covid-19 symptoms of cough, exhaustion and difficulty breathing two weeks ago. Her daughter Marialber Cabrera, a 35-year old who resells used goods in the northern state of Aragua, said she pleaded with the staff at two public hospitals to admit her.

“They were both at full capacity,” Cabrera said. “There was no room.”

Even if a bed became free, she was told, the family would have to provide the supplies — medical gloves ($15 a box), masks ($10 a box), an oxygen tank ($100) and refills ($50 each). For Cabrera’s father, a security guard who earns $6 a month, the cost was unimaginably high.

Cabrera’s grandmother had caught the virus and recovered, so they began a similar treatment for her mother at home: a combination of vitamins and ibuprofen purchased with donations from neighbors and extended family. But her mother’s symptoms worsened. When her breathing became extremely labored, Cabrera began begging private suppliers.

“I told them over the phone that we didn’t have any money and that my mom really needed oxygen,” she said, her voice breaking. “They just said, ´There is nothing we can do for you if you can’t pay.’”

Her family began a grim vigil, trying to comfort her mother as her condition deteriorated.

“The last time I saw her, she asked me to give her a shower,” Cabrera said. “She told me she loved me and that her love was unconditional and forever.”

The next morning, Cabrera was in line at a public hospital attempting to arrange an X-ray appointment for her mother when her father called. Mijares had started to “suffocate.”

“My dad was crying, saying she couldn't breathe,” Cabrera said. “My neighbors helped my father put her in a car. She died there. She couldn't breathe.”

“If she had had oxygen, my mother would still be alive,” she said. “What we are living is horrible.”

Now, both she and her father have come down with symptoms.

“Everything is in God’s hands now,” she said.