Haiti on Sunday reported its first novel coronavirus death, a 55-year-old man who had underlying health conditions.

The health ministry said the man suffered from diabetes and hypertension.

He was one of only 21 confirmed cases of the COVID-19 virus in Haiti, a demographically young country where over half those diagnosed with the disease have been under age 45.

Only 218 tests for the new coronavirus have been carried out in Haïti since the first two cases were confirmed March 19, however, leading to criticism from the national medical community of the government’s handling of the pandemic.

Since the virus first appeared, the government has announced stringent measures to contain it, but they have not been rigorously followed or enforced.

A ban on gatherings of 10 or more people is routinely violated, notably in the country’s crowded public transportation system.

Stay-at-home measures, like those in place in Italy and France, are difficult to apply in Haiti because the vast majority of its inhabitants depend on the informal economy to survive.

The density of the population of Port-au-Prince, the most populous capital in the Caribbean, with three million people, also makes strategies like social distancing impractical.