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The record of deaths from covid-19 in Peru has its reasons

2020-09-03T21:30:23.000Z


A poor health system, lack of primary care, shortage of ICUs, and overcrowding hamper the fight against the pandemic


Funeral of a woman who died from the covid, in a cemetery in Lima, Peru, on August 25. Rodrigo Abd / AP

Peru is the country with the highest mortality per inhabitant in Latin America from coronavirus.

To understand this exceptionality, several causes must be considered: the health authority and experts agree that the high incidence of the pandemic is mainly due to the lack of access to health services, a weakened health system, the closure of the primary level of attention and "the impossibility of confining properly", indicates the epidemiologist César Cárcamo.

The areas with the highest number of deaths, compared to the three previous years, are the urban coast and some regions of the Amazon, effectively combining population, density and size factors, but also access to adequate care.

“In Spain they declare quarantine and everyone goes to their own department to telework and continues to earn their salary.

Here, the person goes with the rest of their family to that room they have rented in a house they share with other families, and every day they don't go out to work is a day they don't have to eat.

Staying at home does not mean any protection: informality (at work) and overcrowding in Peru contribute to making quarantine less feasible and less effective, ”explains Cárcamo, a researcher at the Cayetano Heredia University and a member of the Prospective Group that advises the Ministry of Health in the measures to face the pandemic.

Before the virus arrived in Peru in March, 70% of employment was informal, according to official figures.

Lima has a third of the country's population and its most populated district with the greatest housing deficit is San Juan de Lurigancho, where the capital's highest excess of death is recorded between March and August.

At the end of July, a study of the prevalence of the new coronavirus in Lima and Callao determined that 18% of the inhabitants were infected: a higher proportion of those infected was a population living in poverty and living in overcrowding.

According to data prior to the pandemic from the National Institute of Statistics and Informatics (INEI), in San Juan de Lurigancho monetary poverty affects 15% to 20% of the people.

Until this Wednesday, the Ministry of Health has reported 29,259 deaths from covid-19, accounted for after a rapid test or molecular test was performed.

At the beginning of August, the minister said that the deaths from the disease would be about 47,000, taking into account data from the National System of Deaths (Sinadef), a faster registration platform than the one that carries data from the pandemic.

Cárcamo points out that if the number of deaths registered in Sinadef by doctors who have recorded covid-19 in the death certificate is considered, the deceased would amount to 60,000.

Taking into account the Sinadef figures, EL PAÍS calculates that between March and August 2020 there were an excess of 74,000 deaths compared to the average of those months in the previous three years.

These are deaths from all causes, during a pandemic that has other effects on access to health and care (for example, reducing access for those who suffer from other diseases), and not necessarily due to infections.

In any case, Cárcamo points out that the high number of deaths in Peru from or during the epidemic "does correspond to reality, but it is not necessarily comparable to countries that have another way of registering deaths, such as Brazil or Chile."

And, indeed, the Sinadef platform is particularly up-to-date and transparent, offering a record for each death that occurred in the country for which data is available until the end of August.

Lack of access

When Peru ordered mandatory confinement in mid-March, it closed hospital offices and health personnel only attended emergencies, deliveries and COVID-19 patients.

Since then, President Martín Vizcarra has reiterated that having few critical care beds has increased the number;

however, the starting point was very low.

”A disadvantage for Peru in terms of mortality is the lack of access to health services.

Compared with other countries, when the pandemic began there were very few ICU beds, which caused many people to die without the possibility of being treated, ”says Cárcamo.

“The count ranged from 125 to 250 critical care beds in the country;

in April the Government increased and now there are more than 1,200, but they never reached: we reached the peak of the pandemic and people went to the hospital and could not enter the ICU ”, adds the researcher.

A second aspect that determines the serious death toll in Peru is the shortage of medical personnel.

“An ICU bed can be implemented from one day to the next, but a professional cannot.

In the absence of this, anesthesiologists or emergeniologists who are not specialists in intensive care but know how to handle a mechanical ventilator, and residents or doctors from other specialties treated patients (of covid-19), but the management in these conditions is not the same.

The pandemic has gripped the country with a weakened health system, ”says Cárcamo.

The Medical College of Peru and its regional sections demanded since June that the Government apply the tracing of contacts of the infected, the epidemiological fence and the opening of the primary health care level, but little of this happened.

The Minister of Health, Pilar Mazzetti, estimates that only 35% to 40% of the staff are working.

”At one point it was seen that only the essentials were going to be left: emergency services.

In practice, they did not offer primary care because the doctors who attended there were past the age of risk of covid-19, and those who were active were taken to secondary or tertiary care hospitals.

Primary care was left without staff because either it was infected or it was high risk, ”says the epidemiologist.

No fence or tracking

In an interview with the foreign press, the Minister of Health said a couple of weeks ago that given the difficulty of making epidemiological fences -or isolation of infected- "localized quarantines have been carried out to reduce the mobility of people."

Last Friday, the Government extended the state of emergency again for a month, the curfew, the ban on going out on Sundays, and established a total quarantine in four regions and the one located in 45 provinces of 14 regions.

Consulted Cárcamo about the lack of contact tracing of the positives, he replied that “the system of the national epidemiology network has been overwhelmed.

The team could not follow the contacts, more people signed up and it was not enough.

The pandemic has been ahead of the response capacity at all times ”, something that is reflected in the high rate of positivity on the total of tests carried out in the country.

A covid-19 suspect consulted by this newspaper, who did not have access to a molecular test and was negative in the rapid test, but had all the symptoms, called the emergency number 113 several times in early August and the care was poor. .

"No wonder people die, I had to consult two other doctors," he described.

Peru has made more than 3,200,000 diagnoses, but of them, 82% were rapid tests (75% of the total of positives), which have a great margin of error.

In fact, this type of test (technically called “serological” because it detects the presence of antibodies generated by a previous infection) is usually used not as a diagnostic method, but to check aggregate seroprevalence, that is, percentages of people affected in the past over the total entire populations.

Their massive use is perhaps the clearest example of the overflow of the capabilities of the Peruvian system in the face of the pandemic.

Information about the coronavirus

- Here you can follow the last hour on the evolution of the pandemic

- This is how the coronavirus curve evolves in Spain and in each autonomy

- Download the tracking application for Spain

- Search engine: The new normal by municipalities

- Guide to action against the disease

Source: elparis

All life articles on 2020-09-03

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