On 8 April, President Martín Vizcarra informed that the Council of Ministers had approved an extension of the state of emergency in Peru for another two weeks, until Sunday 26 April. The decision came as no surprise since the number of cases of Covid-19 and resultant deaths have continued to rise sharply over the last week.

As of 10 April, the number of cases stood at 5,897 and the number of confirmed deaths was 169. This compares with the figures of 1,414 and 61 respectively seven days earlier. The graph, updated daily in La República, shows how steep the curve has become on both accounts in the last few days. As we have made clear in previous newsletters, however, the official figures almost certainly understate the numbers of people affected.

In his announcement, Vizcarra said that Peru was passing through “the most difficult part” of the propagation of the virus, but that the measures taken to date were “giving good results”.

Given (i) the overcrowding typical of poor neighbourhoods of cities like Lima, (ii) the extent of the informal sector and the inability of street traders to obey the government’s attempts to stem economic activity, and (iii) the poor quality of public hospitals in underprivileged areas in Peruvian cities, the impact of Covid-19 threatens to be much more severe on the poor than on wealthier sectors of society.

Poor parts of Lima are home to huge numbers living in close contact with one another. According to the 2017 census, the district of San Juan de Lurigancho is home to more than 1 million people. Other massive districts on the fringes of the city, such as Santa María del Triunfo, Villa El Salvador and Carabayllo, are not much behind. Once the contagion really takes root in these communities, the health system will be unable to cope. The death toll could be massive.

Poverty, poor nutrition, overcrowded perilous housing, inadequate sanitation and lack of clean water all accelerate the spread of infection. The effectiveness of the Peruvian response will depend partly on the extent and use of diagnostic testing, and the rapid identification of new infections, likely to be greatest in poor, densely population urban areas. Crucially it will depend on anticipatory planning, and the mobilisation of funds and of personnel, ongoing close monitoring of the spread, and swift appropriate further actions.

Deaths amongst those infected will partly depend on underlying health conditions, as well as hospital intensive care facilities which can keep large numbers of individuals alive while their bodies fight off the infection in the absence of any specific treatment. There are no doubt some excellent facilities in Lima and major regional centres, but questions remain about who will be admitted to them, how they will be staffed and the extent to which resources will be given to help them meet the likely demand.

Up to now, according to figures compiled by the Centro Nacional de Epidemiología, Prevención y Control de Enfermedades to 5 April, the worst affected areas of Lima (which is still by far the worst affected part of Peru) were districts like Jesús María, the central core of old Lima (Cercado) and Miraflores. These three accounted for 22.5%, 17.8% and 5.3% of the total for metropolitan Lima, although these districts’ percentage of the total population (as reported in the 2017 census) was far smaller.

A number of explanations have been advanced for why such middle-to-upper class parts of Lima seems to be suffering worse. One such is the fact that most people entering Peru from abroad appear to reside in these neighbourhoods. Since they arise from testing, the figures may also under-report the onset of the virus in less affluent parts of the capital.

The next few weeks will show the extent to which the virus takes hold in such areas.