The daily figures on Covid-19 this week make grim reading and suggest that the contagion taking place in Lima’s poorest districts is swiftly surpassing the government’s ability to control it. Over the last seven days (since 22 April) the number of cases identified has risen from 21,000 to 40,459 (on 1 May) and those who have died from it have risen from 634 to 1,124. The graph updated daily by La República shows an inexorable upwards movement.

In many respects the current crisis reveals the weakness of health policy (especially in the field of public health) over recent years, if not decades. Health spending represents a mere 2.2% of public spending, well below the 6% recommended by the World Health Organization (WHO) and also well below the proportions spent on health in most other countries in the region. Arguably, then, Covid-19 is simply holding up a mirror to the health system and its capacity to deal with epidemics of scale.

The problem, of course, is made much worse by the measures the government has been forced to adopt in order to try to stem contagion. People in low-income neighbourhoods of Lima, where the majority have no stable employment, simply cannot earn the money to feed their families. As we mentioned last week, in order to mitigate social distress the government unveiled a 750 soles (US$225) payment on 23 April, more generous and wide-ranging than its original scheme.

Rather than adopting the traditional approach of targeting vulnerable groups, this bono started from the recognition that all living in low-income areas, urban and rural, are ‘vulnerable’ in the present circumstances, it was a matter simply of exempting those who are not so vulnerable (e.g. wage earners).

But the problem lies in implementation. Not all families have bank accounts through which the bono can be transferred, especially in rural areas. Many authorities continue to operate on the notion that it is a matter of identifying who is ‘vulnerable’. This is slowing down distribution. According to Eduardo Zegarra at GRADE, a development NGO, this ‘bono universal’ will only reach 700,000 agricultural families, leaving some 1.3 million families in rural areas without assistance.

The situation will be further complicated by the thousands who are taking to the roads to escape disease, unemployment and hunger in the capital city. The Peruvian media last week published pictures of indigent families defying the quarantine, sleeping on roadsides in their attempt to score a lift to their places of origin, often hundreds of miles away.

Those seeking to escape in this way number 160,000 according to official figures. Concerned not to let this migration become itself a channel for infection, government officials began trying to test those on the road and (in conjunction with regional and local authorities) to provide them with transport and shelter. But most have opted to continue on their way rather than wait for government assistance. They have received generous solidarity from people along the way, often equally poor.

The media have also shown up the difficulties of aid reaching their intended beneficiaries in the form of food parcels distributed by local mayors but funded by government for that purpose.

The contraction of demand for food in cities, for lack of money, is also hitting rural producer households through a fall in market prices for key food products like potatoes. This may impact in the future through a reduction in the areas planted by producers, causing problems of food security further down the line.

The fact that government assistance is not reaching many people means that they are forced out into the streets and markets to seek out work and food come what may, thus defying the quarantine. The main places where people congregate are in the markets. On 29 April, Vizcarra announced that of the 842 street sellers who had been tested in the Caquetá market (in central Lima) 163 turned out positive. They simply take their infection home at the close of day.

In these circumstances, it is arguable that community self-help represents a more fruitful approach to the alleviation of suffering. This has worked well in the past, whether through neighbourhood initiatives, mothers’ clubs, or communal feeding facilities (comedores populares). However, many of these have played a very secondary role in recent times. Still, they could possibly be revived, at least in some parts of the city as an effective means to ensure survival.

Perhaps the paradox in the current situation is that while the state system struggles to meet the challenges thrown down by the Covid-19 crisis, the president’s popularity ratings remain at extraordinarily high levels (around 80%). Part is explicable by the fact that there are few obvious alternatives, and part by the lack of a very coherent opposition. But in good measure it is also down to Vizcarra’s skill in presenting the relevant information to the public in a coherent, intelligible and fairly transparent manner. He thus seems to provide leadership at a particularly difficult conjuncture.