Hospitals here can hardly cope with the flood of children suffering from respiratory complaints stemming from air pollution this winter.
A blanket of smog has covered the city for a week, helping spread an influenza epidemic and sending 3,500 children with respiratory ailments into hospitals each day.
To clean up the smog, "we need to take some drastic decisions which are going to change the way people live in this city," said Javier Vergara, regional director of the National Environmental Commission.
That means getting people out of their cars and into public transport. That's easier said than done, especially in a city where the number of cars is growing 10% a year.
Smog levels have remained little changed since the late 1980s, in spite of a steep reduction in the number and age of buses circulating in the city.
The problem is critical. Santiago's air pollution causes between 1,300 and 2,900 premature deaths every year, according to a 1994 report by Harvard and Columbia universities. The report estimated the resulting annual health-care tab at $1 billion.
"We are surrounded by this atrocious air and there is nothing I can do to stop my son breathing it," said Ximena Armendariz, a graphic designer whose 2-year-old boy has contracted bronchial pneumonia twice since March.
For a country that prides itself on its economic growth and aims to join the first world in the first few years of the next century, the smog is becoming a national disgrace.
The Medical College, which represents Chile's doctors, has accused the government of negligence and even questioned the accuracy of official pollution readings.
The government is reacting. Santiago was declared "pollution-saturated" today, clearing the way for authorities to draw up a decontamination plan. The plan, which will take a year to formulate, is expected to include a ban on all factories that add to pollution in the city.
The plan would still allow replacement of existing factories with plants that don't pollute any further. In addition, the city's system of "pollution rights" could allow one company to buy another's allowance for pollution.
Santiago is probably the second-most-polluted city in the world after Mexico City, suffering from particle pollution and ozone contamination. Both pollutants cause breathing difficulties, help spread infections and may cause cancer.
The city's most serious problem is particle pollution, which is more than twice Los Angeles' level and slightly above Mexico City's levels.
"The smog irritates my eyes and it's depressing thinking that I am going to have a child that's going to breath this air and suffer from respiratory problems," said Armendariz, who is six months pregnant.
Pollution levels worsen in winter when a cap of warm air above the city prevents the cooler air below from escaping, a condition known as inversion.
An environmental "pre-emergency" is called when particle contamination exceeds 300 micrograms per cubic meter, which happens about five times a year. By comparison, the infamous London smog of 1962 smothered the city with about 800 micrograms per cubic meter.
The particles are produced by industry, diesel engines and the general activity of the city which throws dust into the air.
Ozone, on the other hand, is formed by nitrogen oxides emitted by cars' gas-burning combustion engines and by hydrocarbons under the effect of sunlight. Santiago, with 650,000 cars, has the same level of ozone pollution as Los Angeles, which has 10 million cars.
Ozone readings exceed safety levels about 170 days a year in both cities, compared with about 300 times a year in Mexico City. However, while ozone pollution is declining in Los Angeles, it's rising in Santiago.
"The policies to fight ozone are very different from those to combat particle pollution," National Environmental Commission regional director Vergara said.
To fight ozone, the government has to get people to stop using their cars and to start using public transportation, he said. To combat particle contamination, they have to make public transportation environmentally friendly.
But the government has been spending most of its money on new roads. The rise in traffic that tends to accompany improved roads often leaves congestion no better than before the new construction.
"We need a strong transport policy to get people out of their cars and into buses or the metro," Vergara said. "We don't only want to stop the smog worsening, we want to bring it down."
Yet, changes to the public transportation system are limited. A third metro line is under construction and should be up and running by next year, 20 years after the last line was built.
The two existing metro lines are there as much to make operational profits for the government as to provide a public service, closing down at 10:30 p.m., three hours earlier than their counterparts in European cities.
An attempt to introduce electric trolley buses three years ago failed after one mayor refused to let the buses through her district, complaining the cables were too ugly.
The Medical College accused the government of lacking the courage to try more radical solutions that could bring it into conflict with the owners and drivers of Santiago's 9,000 buses.
To be sure, bus companies have invested about $300 million over the last five years improving emission standards, but more needs to be done, Vergara said. One possible solution would be to convert them to natural gas, a fuel source that a yet-to-be-built pipeline will bring to Santiago from Argentina.
"The only permanent solution is getting used to the smog," said Armendariz, who is seriously thinking of moving out of Santiago. "It doesn't matter how far we live from work," she said. "I don't want my child growing up breathing this air."