The differing regional impact of COVID-19

Panellists:

  • Ruth Iguiñiz-Romero: Assistant Professor in Public Health, Universidad Peruana Cayetano Heredia
  • Carlos Herz: Director of the Centro Bartolomé de las Casas, Cusco
  • Rafael Barrio de Mendoza: Project Coordinator, Propuesta Ciudadana

Moderator:

  • Barbara Fraser: Journalist, editor of Earthbeat, National Catholic Reporter

Barbara as the moderator introduced the event with a brief summary of the situation to date. The government took admirably early steps in response to the threat posed by the virus. It imposed a curfew on 15 March, even before the first case occurred, and closed Peru’s borders. What was not anticipated was the result of the poor health facilities available and the impossibility of a family surviving and feeding itself under complete lock down with some 73% of the working population in the informal sector. Unable to subsist in the city, streams of people began making their way (against all the rules) back to their communities of origin. The virus quickly spread to the conurbations of the north coast and more slowly to the south, and gradually penetrated to rural areas and the highlands. A city quickly affected was Iquitos in the Amazon jungle.

By the end of June, the depth of the economic recession forced some opening up: by 15 July inter-provincial travel was formally allowed and mining companies were encouraged restart production subject to submitting plans that showed how health protocols were being applied. The curve has very recently levelled off a little: Peru is now recording around 150 deaths per day, compared to more than 200 in August. Public health officials caution, however, that the official death toll of about 30,000 is an underreporting. A comparison of total non-violent deaths this year with the rate in previous years indicates that more than 50,000 people have died during the pandemic, and many of those ‘excess deaths’ are probably due to Covid-19. Peru has one of the world’s highest ‘excess death’ counts and one of the highest figures of Covid-19 deaths per million inhabitants.

It should be noted that the rate of cases is misleading. While Peruvian officials have made much of the fact that Peru has been doing more Covid tests than other countries, the vast majority of the tests – 1 in 7 during most of the pandemic, and about 25% now – are serological tests that detect antibodies, not molecular tests that detect active cases. The inability to detect active cases hampered Peru’s early response. The lack of use of molecular tests was partly due to lack of availability of molecular test kits on the international market when Peru tried to buy them and lack of laboratory capacity for analyzing them. Under Health Minister Pilar Mazzetti, Peru is now obtaining more molecular test kits.

The three panellists took the floor in turn, with Power Point presentations available as shown.

Ruth Iguíñiz spoke first. For her the key points were the long history of abandonment of the health sector and the huge deficiencies in the supply of services (download Power Point presentation). But perhaps above all a vital flaw was the way a highly centralised state operates in ‘silos’ with one ministry not communicating with another. The situation was made worse by the government’s short-term perspective and by the instability of political leadership in the sector. There were no less than three health ministers since March.

Rafael Barrio de Mendoza described how an ‘infrastructure of risk’ could explain the passage of the virus from conurbations to smaller towns and the rural areas in the north of the country (download Power Point presentation). In this the failure to organise food supplies proved crucial, since people had to move to find subsistence.

Carlos Herz focused on the south. The virus had taken off in July in Cusco and Arequipa and was now was worst in Puno (download Power Point presentation). He emphasized deficiencies of the state – clientelistic and corrupt in many places which contributed to ‘institutional precariousness’. A lack of social cohesion didn’t help, though in their work in the south, the Centro Bartolomé de las Casas(CBC) had encountered some good examples of social organisation and networks which had helped to mitigate the situation.

The floor was then opened for questions and comments.

  • What was the role of social organisation and how did this show up comparatively?
    The rondas had been significant, particularly in Cajamarca. So yes, the existence of good social organisation has helped in limiting transmission from one place to another. Individual people can act as vectors, and once the problem is raging over society, it becomes much harder to exercise control.
  • Has corruption contributed to the bad outcome?
    Yes, in part, for example as controls on purchasing were eased. This allowed test kits to be purchased at very different prices.
  • Have controls hampered speed of response?
    Yes. But more fundamentally, there is a lack of information on the extent to which food distribution companies benefitted from the food programme. Rafael pointed to the fact that, following the 2017 El Nino disaster in the north, people had gained knowledge, for example, about mandatory drug standards and how to implement them. Ruth argued that a key problem affecting public employees is that many lack the confidence to act beyond what is specified in norm and legislation; when a new problem arises, they do not respond for fear of breaching established rules.
  • The ‘bono’ (a cash transfer) was a good idea, but could it have been made more effective?
    Yes, by reducing red tap, e.g. by allowing people to show their ID card at the Banco de la Nación. This should have been sufficient.

In summary, the theme that resounded throughout was the fragility and over-centralised nature of the state. The pandemic was a situation that cried out for a locally sensitive response, drawing on community cooperation. However, this need was met with a system which, for fear of corruption and loss of central control, could hardly have been less prepared to adopt such a response. The system was characterised by inefficient and inappropriate levels of central control, policy developed in ‘silos’, and the prevalence of a ‘clinical’ vision based around hospitals not around society and social need. Public servants lacked the training and indeed the authority to respond to new and unforeseen situations. While changing this was impractical in the short term, a start had to be made.

Barbara posed a final challenging question to the panellists: if you can only recommend one thing to do right now, what would it be? Ruth focussed on the need for positive leadership: we need to know how we can manage the immediate challenges of the pandemic going forward, not just what we may not do. Carlos argued for the strengthening of local capacity, and better networking and promotion of the power for change that resides among communities. Rafael rightly reminded us of how powerful local action had been in the time of cholera in the early 1990s: grass roots communities needed to be empowered to take on and solve these situations so as to reduce the risk of contagion.

The next webinar, on 26 September, will focus on the Amazon and the impact of the pandemic on indigenous peoples. Mark your calendars for 10am Peru time, 4pm UK time on the 26th.