World Report
COVID-19 strains remote regions of Peru
The health system in Iquitos is stretched and the true number of COVID-19 cases and deaths
is unclear. Barbara Fraser reports from Lima.
The first COVID-19 case in the Peruvian His figure included suspected cases, Of the nearly 124 000 confirmed
Amazon, detected on March 17, which the official Health Ministry cases reported as of May 25, only 27%
seemed to be a one-off—a tour guide count does not. With a shortage of had been detected by PCR; the rest were
who apparently caught it from foreign test kits, it has been impossible to test positive results from antibody tests.
visitors. Within weeks, however, everyone who is symptomatic, much “It is very misleading and confusing
Carlos Calampa saw patients over less those who died before they could to combine the results of both of those
flowing into the corridors of the Loreto be tested, Calampa said. By May 25, the tests...because they’re telling you very
Regional Hospital in Iquitos, where he Health Ministry’s official death count different things” said William Moss,
was director. for Loreto had risen to 280 confirmed executive director of the International
More than 500 tanks of oxygen a Vaccine Access Center at Johns Hopkins
day were needed, but the hospital’s “...840 000 COVID-19 tests University (Baltimore, MD, USA).
poorly maintained oxygen plant administered nationwide, Eduardo Gotuzzo, a member of the
could provide only a fraction. Private but only about 15% have been Peruvian Health Ministry COVID-19
providers raised prices from about PCR tests that detect active advisory committee, said PCR test
US$150 a tank to nearly $1000, out of infection. The rest have been kits have not been available on the
reach for most people in Iquitos, a city antibody tests...” international market. Peru also has
of 500 000 people and capital of the little laboratory capacity for processing
Loreto region. deaths, although the regional health PCR tests.
Iquitos is not linked to the rest office lists more than 1000, including Peru’s situation could be further
of Peru by road and flights were suspected cases. Both the ministry’s complicated in the coming winter
grounded as part of a nationwide official count and the region’s figures months, when influenza and
lockdown from March 16, so obtaining probably omit some people who died pneumonia cases generally rise,
supplies was difficult. Calampa’s at home from COVID-19 or other said Gabriel Carrasco, an associate
hospital and others in the city lacked diseases, possibly complicated by the researcher at Cayetano Heredia
sufficient protective equipment. Of the coronavirus, Calampa said. Many of National University in Lima. If people
33 doctors who have died of COVID-19 those people lived in the city’s shanty with COVID-19-like symptoms are
in Peru, 17 worked in Loreto. towns. automatically referred to hospitals
Peru reported its first COVID-19 case One reason for the lag in the official treating patients with COVID-19, “it
on March 6, and officially reported count was a data-entry backlog at could further congest a system that is
almost 124 000 cases and more than the hospital, where most of the already operating at its limits”, he said.
3600 deaths on May 25. In mid-May, epidemiology staff were off sick. By May 25, COVID-19 cases and
however, Loreto’s official death toll Sharing data is further complicated deaths had dropped in Iquitos but were
was only 83, despite grim reports by Peru’s fragmented state health sys rising in remote areas accessible only
of the collapse of Iquitos’ health tem, which includes public hospitals, by river or light plane, Calampa said.
system and of people dying at home. a social security system, and hospitals He is reinforcing staff and coordinating
Then Calampa—who had just been for the police and military, all keeping with the military to deliver medicine,
named regional health director—and separate records, some of them oxygen, and other supplies to health
Luis Espinoza, an infectious disease manually. centres on the Marañón, Corrientes,
specialist at the hospital, released a But even the updated case count and Tigre rivers, where much of the
chart showing that the number of could be inaccurate, experts say. population is Indigenous. Another
deaths as of May 13 was closer to 800. Peruvian officials point to the more target is the shared Peru, Colombia,
That figure included patients with than 840 000 COVID-19 tests admin and Brazil border on the Amazon
COVID-19 who died in the regional istered nationwide, but only about River. The virus is also spreading in the
hospital, people who died at home 15% have been PCR tests that detect neighbouring Ucayali region, where as
with COVID-19 symptoms, whether or active infection. The rest have been of May 25 there were 3200 cases and
not they were diagnosed, and a partial antibody tests, which indicate that 114 confirmed COVID-19 deaths.
count of patients who died at other a person has been infected at an
health centres in Iquitos, Espinoza said. unspecified time. Barbara Fraser
1684 www.thelancet.com Vol 395 May 30, 2020
