Why Covid threatens 3rd world mining i.e. Peru“For decades we’ve had an underfunded health system with poor primary care and hospitals that are outdated. By the time the pandemic hit, we had underpaid health professionals and very low numbers of intensive care beds,” says Patricia Garca, Peru’s minister of health in 2016-17. Peru has 1656 ICU beds for its population of 33 million people4; neighbouring Colombia—where the healthcare system has barely kept up with covid-19 admissions—has around 1800 beds in the capital of Bogota alone, where 8 million reside.
“If you add additional layers of stress to a health system that was already on the brink of collapse, you’ll have collapse,” says Mateo Prochazka. He is one of several Peruvian epidemiologists who told The BMJ that the biggest challenge they faced as medical trainees was freeing up beds in hospitals perennially running at capacity. Covid-19 tipped the system over the edge. Many of the country’s excess deaths were likely from people suffering from other illnesses who could not be treated because of the health system’s collapse.
Local solutions missing
Peru also ticks off the checklist of features that have hampered pandemic responses across Latin America: diverse populations and geographies; deep poverty; cramped, multigenerational housing; and a lack of laboratories for testing. The list is long and, in most cases, more severe in Peru than its regional neighbours.
These contextual factors are critical in considering any pandemic control tactics, says Garca, pointing to a shortage of water and electricity, a lack of trust in the government after years of political instability, and a labour market that relies on informal employment. The fact that around three quarters of people work in informal jobs meant they had to risk either contracting covid-19 or going hungry during lockdown. Like in other South American countries, most people eventually opted for the former.
Cultural norms draw people together, increasing chances of transmission. Most Peruvians shop daily. Stocking up with a weekly shop would mean breaking a lifelong habit. It’s also impossible for the 40% who do not have a refrigerator. As a result, markets quickly became a major vector of the disease. As many as 86% of people in Lima’s markets tested positive during the first wave of cases in May 2020. Then-president Martn Vizcarra acknowledged the crisis but did not shut markets down because of the need to supply food.
Food was promised to families on low incomes but was distributed through local municipalities who had no experience in doing so. It, too, arrived slowly, Paz-Soldan says. Yet a system that could have been used as a conduit already existed: comedores populares—low cost restaurants which distribute government donated food with volunteer cooks.
Some experts say that Peru’s failure was caused by the expectation that just mirroring containment tactics applied in Europe and North America would stem the spread. “Had each intervention been adapted to context, we may have been able to bend the curve a little bit better than we did,” Prochazka says, pointing to the Ebola epidemic in West Africa during 2013-15. Initial tactics there failed because of a Euro-centric response from international organisations sent to help. They didn’t consider local culture, such as how traditional funerals involved family washing of the body of the deceased. Once control measures were “adapted to context and grounded in local understandings of disease and these control measures,” they were more effective, he says.
https://www.bmj.com/content/372/bmj.n611
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