A: Peru has one of the highest excess death rates in the world and more than 47,000 people in Peru have died from COVID-19 as of March 2021 with excess deaths at nearly 2,600 per million (from a population of 32 million).
How did this happen?
TL; DR: Controlling COVID-19 requires many public health measures and a one size fits all approach does not work.
🧮 To understand what is happening in Peru, remember that excess deaths represent deaths from all causes during an event or time period (like a public health emergency) that are above what we would expect to see under normal conditions (an average during the same time period from previous years). So, for example, if we normally see 25,000 deaths at this time of the year and we currently see 47,000 deaths, excess deaths represent 22,000 deaths from a cause outside of those expected in normal conditions. Since Peru is a small country, reporting total number of deaths might minimize the impact of COVID-19 on deaths. But, if we look at excess deaths per million, Peru is at the top of the list of countries in the world for excess deaths (by logic attributed to COVID-19; see figure from The Financial Times).
âť“So why is this? Peru was one of the first countries to go into lockdown (restricting movement, imposing curfews and allowing people to leave their homes only for essential reasons) on March 16, 2020 and continued until June 2020. Yet, as of March 30, 2021, Peru reported a total of 29,703 deaths (compared to 11,085 expected) with a deviation from expected deaths of 168% (approximately 18,618 more people died than expected). Excess deaths are a good indicator of how a disease is impacting a population as it represents both counted and not counted deaths during a time period. This is particularly important in countries where records and resources may be limited thus hampering the ability to attribute a death to COVID-19. In other words, Peru is having a difficult time controlling COVID-19.
↔️ Why this is continuing to occur is a result of a variety of factors:
1-Internal migration. In the initial phases of the lockdown, many business were closed. However, in Peru, many individuals who work in cities, for example, come from rural areas and/or work in the informal sector (up to 70% of the population). Without transportation and financial support, many individuals returned to more rural areas with their families. This migration alone may have spread disease. They may have also continued to travel via public transport and/or work in the informal sector in close proximity where social distancing is difficult.
2-Way of living. In Peru, individuals with limited income (up to 25% of the population is considered to be living at or below the national poverty line) often live in crowded spaces, may need to go to crowded markets daily due to lack of refrigeration or limited income, and may not have access to electronic funds – thus may crowd at banks and/or other public places.
3-Hospital capacity. Peru, as compared to other countries in South America, has very few intensive care unit beds, approximately 1,656 in the entire country (approximately 32 million people). In comparison, Bogota, Colombia alone has 1,800 ICU beds for a population of 7.4 million individuals. When there are not enough hospital beds, people cannot receive treatment, either for COVID-19 or other reasons for presenting to the hospital. This can increase the risk of death.
4-Border closures and restriction of movement. The closure of borders and restriction of movement also made it difficult to obtain critical supplies such as PPE and oxygen. It also left individuals from neighboring countries unable to leave to return to their home countries. Lack of PPE and medical equipment could lead to increased risk of infection and death; restriction of movement could also lead to increased risk of infection due to crowding at the borders as well as necessity to continue working during times of lockdown.
5-Political change-There was a national election at the end of 2020 and April 2021. Since voting is mandatory in Peru, many individuals waited in polling site lines to vote. In addition, the underlying changes in administration may have contributed to changes in policy and direction to control the virus. Another vote will take place in June 2021 for a second round of voting.
6-Vaccines. Vaccines came late to Peru for a multitude of reasons. Peru received and began administering the Sinopharm vaccine (BBIBP-CorV) in mid-February 2021 as well as Pfizer vaccines and others (such as Novavax) through COVAX (the global effort to get vaccines to low and middle income countries) as of March 2021. Only about 1.8% of the population has been vaccinated.
7-Variants. The P1 variant that is causing an increase in COVID-19 infections and deaths in Brazil and in other South American countries, has also been spreading in Peru. Up to 40% of the diagnosed cases in Lima have been confirmed as the P1 variant. This makes the control of its spread even more important due to its high transmissibility.
🧮 Taken in sum, this information suggests that it is not a given that Peru must continue to struggle to control the pandemic; rather that one strategy does not work for all countries without taking into context the population, lifestyle, internal resources, and financial support for individuals and communities. With careful consideration, we are hopeful that the tide will turn in Peru for the benefit of the population.
To our siblings in Peru, we see you and will continue to support smart measures to control this pandemic. Estamos con ustedes.
With Love,
Those Nerdy Girls
Additional Coverage on the story:
Interview with Dr. Valerie Paz-Soldan
Video on Excess Deaths in Peru
BMJ Article on Excess Deaths in Peru
