Lima, Peru – While the world watches in horror as India’s coronavirus case count explodes, another intense outbreak is unfolding – albeit on a much smaller scale – in Peru, which sits atop the global per capita mortality rankings.
The Andean nation has registered more than 4,000 excess dead per million residents since the start of the pandemic, or more than 166,815 deaths, the Financial Times reported, a 123 percent rise compared with the historical average.
Excess deaths are viewed as more accurate than the official Peruvian health ministry figure of 62,126 confirmed deaths linked to the coronavirus.
“Almost all Peruvians know someone who has died from COVID,” said Cesar Carcamo, an epidemiologist at Cayetano Heredia University, Peru’s leading medical school.
The country also is experiencing its deadliest period since the novel coronavirus first arrived, with 9,458 deaths recorded in April – its highest monthly death toll – although the figures have now started to come back down.
Experts attribute Peru’s disastrous pandemic performance to a cocktail of factors: poverty, a crumbling public healthcare system, a national oxygen duopoly that has failed to meet demand, and the emergence of new strains of the virus.
Poverty manifests itself in a series of ways in the context of COVID-19, from overcrowded, multigenerational housing, to the fact that 70 percent of the Peruvian workforce is informally employed, frequently needing to violate public health restrictions or go hungry.
Compounding the crisis has been widespread coronavirus disinformation, including even experts urging people to use anti-malaria drug hydroxychloroquine and ivermectin, a medicine used against parasites, to prevent or treat COVID-19.
Neither medication works, according to scientific studies, and both can have “collateral effects”, said Carlos Lescano, president of the Peruvian Society of Intensive Care Doctors.
Yet with Peru’s healthcare system overwhelmed – the national waiting list for intensive care beds hit 2,000 patients last month – many Peruvians have had little choice but to treat gravely ill relatives at home, with some buying oxygen at speculative prices.
Administering oxygen without medical supervision has also made matters worse, said Lescano, leading families to delay inevitable hospital admissions until it is too late. “By the time they arrive, these patients often need mechanical ventilation,” he told Al Jazeera.
At the start of the pandemic, then-President Martin Vizcarra was praised for swiftly implementing one of the strictest lockdowns in the world. “The fact that we had a significant surge after that first lockdown was relaxed just shows it worked,” said Carcamo.
Nevertheless, the government has also been accused of failing to follow the science. Initially, when the first few coronavirus cases were reported, the health ministry tracked down the patients’ contacts. But even before the pandemic got out of control, the Vizcarra administration abandoned that effort.
The next misstep, critics argue, was Peru’s reliance during the first wave on blood tests, which reveal whether a person has coronavirus antibodies – in other words, whether they have been infected at least a week or two previously. Unlike the PCR, or molecular, tests widely used elsewhere, those blood tests do not show whether a person is contagious at the time they are carried out.
“The mistake wasn’t in using these tests. They are useful, especially if you’re trying to find out how many people have already been infected. But we were using them the wrong way,” said Carcamo.
Another key element in Peru’s inability to tame the pandemic has been what Camille Webb, an infectious diseases expert at Lima’s Alexander von Humboldt Institute of Tropical Medicine, describes as the government’s “inability to communicate very simple messages”.
To this day, there has yet to be a sustained campaign of primetime TV public service announcements to share basic messages about social distancing and other public health measures.
Under political pressure from a hostile Congress that removed Vizcarra last November, the current government, led by interim President Francisco Sagasti, has adopted a similar approach to the Vizcarra administration.
Meanwhile, as Peru heads to a presidential runoff in June, candidates Keiko Fujimori and Pedro Castillo are promising to vaccinate all Peruvians this year but have been criticised for lacking detailed plans to manage the pandemic and disregarding social distancing rules at campaign events.
Fujimori has also put in charge of her coronavirus team a molecular biologist who previously made headlines for falsely claiming that vaccines were made from distilled water and even raised the risk of contracting COVID-19, in an apparent attempt to destabilise the Sagasti administration.
Another reason Peru has recorded sky-high coronavirus numbers may be the arrival of new, more easily transmissible coronavirus variants, experts say.
In March, it emerged that a strain first discovered in Brazil accounted for 40 percent of new cases in Lima, the capital. But now scientists believe that the dominant variant in Peru may be one that originated in the country itself, or in Chile. It was discovered in March by Pablo Tsukayama, a researcher at Cayetano Heredia University.
Little is known so far about this new strain, including whether it is more contagious or more lethal.
“We think that 40 percent of Peruvians were infected in the first wave,” said Carcamo. “The fact that the second wave has been even worse tells me that people are getting re-infected.”
Meanwhile, vaccinations began in January but have been moving slowly. As of Tuesday, 635,147 people had received two doses – principally of China’s Sinopharm jab – out of a total population of 32 million. Another 546,394 have received a single shot and are waiting for their second dose.
But for the family of Denisse Hauyon, a 38-year-old travel agent in Lima, those vaccinations are coming too late.
In the last two weeks, she has lost three relatives to COVID-19. Her 72-year-old uncle, Tito Geldres, a lawyer, passed away in a public hospital just days before he was due to get vaccinated, and her aunt, Norma Abad, 70, who lives in New York but was staying with relatives in Peru to support them through the pandemic, passed away at their home.
“Tito was very careful. We can’t work out how he was infected,” said Hauyon. “The system is not working. Everything is just so dark right now.”