Report in October 2021

COVID−19 in Peru: 18 months crossing troubled waters.

Dan Omura, Vice-principal, La Unión School
Lima – PERU

On Monday March 2nd 2020, we started the academic year in La Unión School as many other schools in Peru [1]. Teachers were excited to meet their new students and the school was full of voices, laughter and joy. On that same day, during lunchtime, some science teachers were talking about this new disease that was spreading from China. We had been receiving news since January about it, but it seemed so far away that it would unlikely reach Peru, little did we know at that time that it would not only reach our country but spread to all continents.

The first COVID−19 case was confirmed by Peruvian president, Mr. Martin Vizcarra, on a televised address on March 6. It was a 25 years−old airline employee who returned from vacations in Europe. Rapidly, a national preparation plan was presented by the government in order to face the risk of this new coronavirus in Peru, increasing the budget of the national health system.

By March 15, president Vizcarra informed the nation that there were now 72 confirmed COVID−19 cases. This national speech changed everything in the way we used to live in Peru, a national emergency state and a mandatory national quarantine were declared, closing all Peruvian borders and suspending most civil rights and forbidding all forms of social gatherings.

One of the most shocking aspects of this national quarantine was that all ground and air transportation was suspended, causing distress in many people who got locked down in places away from home, even outside of Peru. Another aspect was that main cities attract workers from other areas in the country but most of the economically active population in Peru has an informal job or is self-employed (at the time of the lockdown it was 67%, by September 2021 this number has grown to 73%) [2] so during the quarantine they were not able to work. This affected almost 6 million people who lost their jobs [3] and in the middle of desperation, people started walking hundreds of kilometers leaving the cities and trying to return to their hometowns, generating an internal humanitarian crisis.

Only essential workers would receive a special pass and just one person per family could go walking to buy food. In the cities, everything but banks, hospitals, drugstores and supermarkets were closed, but in the countryside agriculture, mining and industry almost did not stop. Transportation restrictions also impacted on the distribution and accessibility of certain goods such as toilet paper, flour and bread, medicines, medicinal alcohol and disinfectant cleaners. Evidently there was an increase in demand (sometimes irrationally) but distribution improved as cargo transportation got used to new biosafety protocols.

Figure 1: Empty shelves in a local supermarket in Lima.
Source: Author's personal photograph

The strict quarantine lasted for about six months (it varied depending on each region), but curfews are still active in all the country. The hour of transit restriction depends on the health alert level of each region and those that fail to respect the curfew are taken to the closest police station and receive a fine. Now we can move freely again inside Peru or fly to other countries, but ground borders are still closed.

Figure 2: Desolated plaza in Cusco a few minutes before curfew.
Note: Plaza Regocijo used to be very popular among tourists visiting Cusco.
Source: Author's personal photograph.

This pandemic also represents one of the greatest economic crises that Peru has faced in recent years. There was a contraction in the Gross Domestic Product (GDP) of 11.1% in 2020, according to the National Institute of Statistics and Informatics (INEI) [4], this is the first time in more than 20 years that Peru has had negative economic growth. The most affected areas were: Hospitality and Restaurants (−50.45%), Transportation, Storage and Messaging (−26.81%), Services (−19.71%), and Commerce (−15.98%). The government established several protective measures giving low interest credit to different sectors, specifically big and medium companies. The general fund for this program, called Reactiva Peru, is S/60,000 million Peruvian soles (about $15 million US dollars). Additionally, the government established several aids to low−income families through several payments between S/600.00 to S/760.00 soles ($150.00 to $190.00 US dollars), reaching 8.4 million households in urban and rural areas. This was the largest financial operation in the history of Peru, which directly benefited almost 21 million Peruvians [5].

The economic crisis has also been influenced by the political unrest that took place in the middle of the pandemic, which included president Martín Vizcarra being vacated from office, then Mr. Manuel Merino, congress chairman, became national president, but resigned 5 days after. This situation forced a congressional election that ended with Mr. Francisco Sagasti elected as new congress chairman, therefore head of a new temporary government that had to call for national general elections in April 2021. In this electoral process, with a very significant percentage absenteeism, Mr. Pedro Castillo, was elected as new president of Peru for 5 years and took office last July, in the middle of a very restricted and discreet celebration of the bicentennial of independence.

Even though Peru has had very strict quarantine measures and the increment of the assigned budget to the Ministry of Health, we have been one of the most affected countries by COVID−19. By the end of September 2021, there have been more than 2,130,000 reported cases distributed in two long "waves" of about 8 months each (Figure 3). The second wave was most dramatic, especially this March with more than 240,000 cases reported during that month. At the present moment we are in a period of low active/new cases with only 3,325 hospitalized COVID−19 patients [6] of which only 25% is in need of assisted mechanical ventilation.

Figure 3: Monthly evolution of new COVID−19 cases in Peru
Source: Adapted from Sala situacional COVID−19 Peru by the Ministry of Health[6]

Since the beginning of the pandemic, there have been almost 200,000 deaths, with a general monthly distribution quite similar to those of new cases (Figure 4). During 2021 most months have had case fatality rates above 10% (Table 1), which is very high compared to other countries and may not correlate to all the restrictive measures that have been imposed: mandatory use of two masks and reduction of attendance capacity in all public spaces (restaurants, malls, markets, etc.). All shops must take the temperature of anybody who is coming in, and they need to disinfect their shoes and hands. In order to use public transportation you also need to wear a transparent face shield (Figure 5).

Figure 4: Monthly evolution of deaths by COVID−19 in Peru.
Source: Adapted from Sala situacional COVID−19 Peru by the Ministry of Health [6]

2020 COVID−19
Deaths Case Fatality
2021 COVID−19
Deaths Case Fatality
MAR 7,323 163 2.2% JAN 173,016 11,068 6.4%
APR 80,245 5,024 6.3% FEB 179,517 18,724 10.4%
MAY 149,204 16,106 10.8% MAR 241,768 21,089 8.7%
JUN 124,000 17,293 13.9% APR 145,479 23,562 16.2%
JUL 183,858 18,259 9.9% MAY 110,413 16,960 15.4%
AUG 226,903 17,486 7.7% JUN 61,385 5,930 9.7%
SEP 120,915 8,260 6.8% JUL 24,958 3,446 13.8%
OCT 66,089 4,304 6.5% AUG 15,026 1,544 10.3%
NOV 43,682 2,989 6.8% SEP 12,642 1,037 8.2%
DEC 56,772 3,679 6.5%  

Table 1: Monthly evolution of Case Fatality Rate of COVID−19 in Peru.
Source: Adapted from Sala situacional COVID−19 Peru by the Ministry of Health [6]

Figure 5: Worker using protective cloths and implements for using public transportation.
Source: Author's personal photograph.

The health system in Peru has been under strong pressure, at the beginning of the pandemic there were only 1,052 intensive care unit (ICU) beds in the whole country, this number has been increasing to reach 2,027 ICU beds and the projection is to reach 3,000 [7]. At the moment only 45% of ICU beds is being used, but during the most critical months, there were long waiting lists of patients in all medical facilities. Another crucial aspect was the increase in the demand for medicinal oxygen, which became very difficult to obtain and a considerable number of hospitals had severe shortages during several months. Private and nonprofit organizations donated oxygen plants to different regions in Peru in order to satisfy the increasing demand. In an unprecedented situation, the government received international donations of medicinal oxygen in order to cover the local deficit [8].

In Peru, COVID−19 can be diagnosed clinically but also through laboratory testing. At the beginning of the pandemic, serological and antigen tests were more common as the capacity for processing PCR tests has been increasing. In the public health system these tests are free, but you need to present symptoms in order to get tested. If you go to a private clinic you can get a PCR test for S/200.00 soles ($50.00 US dollars) or an antigen test for S/120.00 soles ($30.00 US dollars). COVID−19 treatment in Peru now follows very closely World Health Organization (WHO) recommendations, at the beginning of the pandemic Ivermectin was very popular, even sponsored in television, but in March 2021 it was withdrawn from the national list of drugs to treat COVID−19.

Genomic surveillance is very limited in Peru but in December 2020 a new variant of SARS−COV−2 virus (Lambda, C.37) was reported by Dr. Pablo Tsukayama [9] of Universidad Peruana Cayetano Heredia and by March 2021 it was the most common variant in the country. WHO designated it as a variant of interest as it has spread widely throughout South America reaching more than 40 different countries [10]. But the situation has swiftly changed after the first case of Delta variant was reported in June 2021 and based on limited genomic information it seems to be the predominant variant in Peru now by the end of September.

On the other hand, the vaccination program is moving fast in Peru and it is completely free. At the moment more than 13 million people are fully vaccinated with two doses, while more than 3 million people already have one dose. The total number of applied doses is little above 30 million. Pfizer−BioNTech vaccines represents 57% of all applied doses, Sinopharm 39% and Oxford/AstraZeneca only reaches 4%. Since the vaccination program started in April 2021, the number of deaths related to COVID−19 has significantly decreased [11].

Health and economic indicators are slowly moving back to normal, but there is one particular area that has been neglected during all this time. Education is the most affected area in Peru with schools being closed since March 2020. The Ministry of Education set a national plan to reopen schools in 2021, but of all 111,640 schools (public and private ones) only 5,350 have reopened and can have limited activities on campus [12] and according to UNICEF Peru there are around 70,000 schools that could start classes, but have not been authorized by the government.

As a way to cope with closed schools, the Ministry of Education launched "Aprendo en Casa", a national radio and television program to support distance learning. This program simulates a classroom setting but there is no virtual learning platform that secures teacher−student interaction. Most public teachers rely on social networking platforms or instant messaging services in order to contact their students, being this one of the most serious concerns about how they can foster the learning processes of their students. Some public schools have started a solidarity program to help underprivileged students get a monthly internet plan, so they can connect with their peers and teachers. On the other hand, private schools rapidly moved into virtual education using different learning platforms that allow video conferences between teachers and students as well as virtual classrooms, generating a greater gap between private and public school systems.

18 months have passed since our students stepped foot in La Unión School: hallways are empty, the playground is silent, the building may seem desolated, but our community is still vibrant and very supportive, contributing and donating food for charities and school materials for other learning communities. We have taken advantage of virtual education and now we have more contact with foreign institutions through webinars, conference calls or virtual meetings. We have learned to cherish our time together, to value simple things in life and never to take for granted what we have been given.

La Unión School would like to send its best wishes to all institutions participating in the Sakura Science Program, a message of hope, resilience and fraternity.

[1] In Peru the school year runs from March to December.

[2] Instituto Peruano de Economía (Sept. 06, 2021). Empleo en el Perú: Entre la precariedad y la recuperación. El Comercio, Lima−Peru.

[3] Instituto Peruano de Economía (2020). Mercado laboral peruano: impacto por COVID−19 y recomendaciones de política. Final Report for the International Labour Organization (ILO). IPE, Lima−Peru.

[4] INEI (2021). Producto Bruto Interno Trimestral. Informe Técnico No 1 Febrero 2021.

[5] El Peruano (October 10, 2020). 8.4 millones de hogares recibirán Bono Familiar Universal de 760 soles. Diario Oficial El Peruano.

[6] Information retrieved from Sala situacional COVID−19 Peru by the Ministry of Health.

[7] Andina (May 5, 2021). Perú tendrá 3,000 camas UCI en julio para afrontar eventual tercera ola. Agencia Peruana de Noticias, Andina.

[8] El Peruano (March 11, 2021). Primer lote de oxígeno medicinal procedente de Chile llegó a Lima, donado por la SNMPE. Diario oficial El Peruano.

[9] Sanjay Mishra (July 15, 2021). La inusual variante lambda está propagándose rápidamente por Sudamérica: esto es lo que sabemos. National Geographic.

[10] El Comercio (Aug. 15, 2021). Lambda, la variante que supera a Delta en el Perú y que preocupa a los cintíficos. El Comercio Perú.

[11] Revollé, A (2021). Así avanza la vacunación contra la COVID−19 en Perú. Diario La República, Lima.

[12] UNICEF (Sept.16, 2021). Las escuelas siguen cerradas para casi 77 millones de estudiantes 18 meses después de la pandemia. Nota de prensa UNICEF.