LIMA, Peru—Months into the coronavirus pandemic, Peru has suffered the world’s worst per capita death toll, a surge in death that has left tens of thousands of families heartbroken. Including my own.
On Sept. 2, my father-in-law, Abelardo Márquez, died from Covid-19, a disease one doctor told us had swept through his lungs like a forest fire. He was the backbone of my wife’s big family, a gifted artist who painted Peru’s stunning Andean countryside. A kind and gentle man married for nearly 60 years, he was also a second father to his 14 grandchildren who called him Papá Bilin.
Today, Abelardo is one of more than 34,000 Peruvians confirmed to have died from Covid-19, giving the country the world’s highest per capita mortality rate at over 107 deaths per 100,000 people. Seven of 10 Peruvians say they personally know someone who died from Covid-19, a recent Ipsos poll said.
The U.S. has 71 deaths per 100,000 people, while hard-hit Brazil is at 76, according to Johns Hopkins University.
Here, the microscopic virus took advantage of deep-rooted problems that an inefficient state and dysfunctional political class never resolved. The tidal wave of infections dragged on for months, crushing hospitals that were already in decay due to a lack of spending on health care.
“It was the perfect powder keg,” said Rosa López, a doctor in the intensive care unit at Lima’s Guillermo Almenara Irigoyen Hospital. “The Peruvian health system began the pandemic with no capacity to respond.”
An initial lockdown by President Martín Vizcarra slowed the virus’s spread, but authorities couldn’t enforce it for long. Within days, workers in Peru’s massive informal economy—about 70% of the country’s labor force—had to choose between staying home or going hungry.
The government was slow to transfer cash to poor households, most of which don’t have bank accounts, forcing people to line up at banks that became hotbeds of infection. Officials overlooked other petri dishes of contagion like busy food markets. The government bought millions of cheap rapid tests, but those proved ineffective in diagnosing patients and reducing contagion. The government said its response was hampered by years of underinvestments in health care and that the rapid tests were the only ones available as wealthier countries bought up the more accurate molecular tests.
In our home, the virus seemed distant for the first months of the pandemic. But when my wife’s uncle died in July, she mentioned that it felt like it was closing in. The man who made our wedding rings had already died. A friend’s father fell victim. The mother of another friend. A Catholic priest we know well told us his brother died. A neighbor in our building passed away.
By early August, wailing ambulance sirens pierced our neighborhood. That is when my father-in-law thought he had a minor cold, nothing unusual during the cool winter months here. We became concerned when he lost his appetite and didn’t want to get out of bed, a rarity for a healthy 85-year-old who still lifted weights.
As the number of U.S. coronavirus deaths surpasses 200,000, public-health experts point to a series of missteps and miscalculations in the country’s response. Here’s a look back at how the U.S. became the center of the global pandemic. Photo Illustration: Carter McCall/WSJ
He had hypertension, though it was controlled by medication. At a trip to the beach a few months prior, he had played in the sand with his grandchildren. During a trip a few years ago to Canada, where I am from, he helped carry luggage and enthusiastically shoveled snow at my parents’ house.
The first doctor who saw him said it looked like bronchitis. A rapid test that detects coronavirus antibodies came back negative. Hearing the results, Abelardo looked up, his hands in a prayer position, and said, “Thank God, thank God.” But a molecular test that looks for the virus’s genetic material later came back positive.
My in-laws had always been a part of our lives in Peru. We lived with them for nearly 10 years when our first child was born. Later we lived in separate apartments, but in the same complex of two buildings in a middle-class neighborhood in Lima, seeing each other frequently for meals and visits.
When the pandemic hit, we took precautions like mask-wearing and hand-washing. Abelardo would still take his frequent walks and occasionally shopped at a nearby, outdoor market. He saw grandchildren. We tried to keep a distance, but it was tough with the younger ones.
A few days after Abelardo fell ill, my son woke up with a fever. Then the rest of my family came down with symptoms like a fever, sore throat or dry cough, which went away after a few days. Four of us tested positive for Covid-19, including myself. We are unsure how we got infected.
Abelardo’s voice became hoarse, but he assured us he was fine, seeming more concerned with our health. He never complained, maybe because he had lived through so much. As a young man, he was grabbed off the street and forced into the military during the dictatorship of Gen. Manuel Odría. In the 1980s, as hyperinflation raged, family meals consisted of rice and an egg. When Maoist insurgents plunged Lima into darkness in the 1980s by blowing up electricity towers, he would finish his oil paintings by candlelight.
Because Abelardo’s age put him in a high-risk age group, he might not have survived in any other country. But as a cough developed into shortness of breath, his chances felt particularly dire in Peru. He never made it into an intensive care room at Lima’s overwhelmed hospitals.
For decades, Peru spent far less on health care than most of Latin America, allocating this year the equivalent of just 2.2% of gross domestic product for public-health expenditures. That is about half of the regional average and a quarter of what Organization for Economic Cooperation and Development nations spend on average, according to the World Health Organization. Corruption is rampant in the health sector, resulting in shortages of overpriced medicine and equipment.
With the influx of patients during the pandemic, hospitals faced a shortage of lifesaving oxygen. Family members also struggled to refill oxygen tanks for relatives at home, a consequence of a monopoly by companies that couldn’t cope with the spike in demand that led to price gouging. A businessman who refused to jack up his oxygen prices was nicknamed “The Angel of Oxygen,” as desperate people lined up at his store in the middle of the night. He died from the virus.
More on Covid-19 in Latin America
Peru also has an acute health-care staff shortage. The country has half as many doctors per capita than neighboring Chile and far fewer nurses than most other Latin American countries, a situation made worse now as health workers deemed high risk if infected with Covid-19 stay home.
President Vizcarra’s stimulus package added hundreds of new critical care beds that officials say saved thousands of lives. It still wasn’t enough, as patients died in makeshift tents on hospital parking lots.
Doctors had to choose which patients wouldn’t get treatment, likely guaranteeing their death. When one ICU bed opened up at Dos de Mayo Hospital in central Lima in June, doctors discussed whom to save among 50 critically ill patients. They settled on a 35-year-old father with young children who was his home’s breadwinner. He survived, but 37% of Covid-19 patients admitted to the hospital during the first three months of the outbreak didn’t, said Jesús Valverde, a doctor in the ICU at Dos de Mayo and the president of Peru’s Society of Intensive Care Medicine.
“We had to be very selective, right from the beginning,” he said. “It’s a disaster what happened to us.”
The Health Ministry issued guidelines to help make those heart-wrenching decisions. It says that age alone shouldn’t be a factor in determining who gets access to limited health resources. During a pandemic, the reality is different. At two Lima hospitals, doctors and nurses told my wife and me that patients over 70 years old were unlikely to be admitted to critical-care units. Private clinics were overwhelmed, too.
“They let them die because they calculate they’ll be unable to recover,” a doctor at Lima’s Hospital Rebagliati wrote my wife in a WhatsApp message. “I never thought I’d witness this. So much death, so many good people.”
So Abelardo stayed home, while he could, with his main physician checking in every few days. Nurses administered shots of drugs intended to ward off pneumonia and other complications, including enoxaparin, an anticoagulant that prevents blood clotting. Two of his adult grandchildren and a niece took turns at his side, keeping a close eye on his oxygen saturation.
When his oxygen levels began to fall, we rushed out to buy cylinders—but we struggled to find places to refill them. My family in Canada offered to pay for a concentrator for Abelardo that supplies medicinal oxygen by extracting impurities from the air.
He was stable for several days, even showing signs of improvement. He cracked jokes and sat up to drink juice made from camu camu, an Amazonian fruit. His doctor said the treatment seemed to be working. My wife’s family was hopeful, but still worried.
Then, about 2½ weeks after the first, subtle symptoms, his oxygen levels tumbled into dangerous territory. An X-ray showed he was developing pneumonia. His granddaughter sat by his side, holding his hand for comfort as he took quick, short breaths. We told him we loved him.
An ambulance took Abelardo to the Dos de Mayo Hospital, where he waited outside for several hours before getting a bed in an overflow tent. His family bundled him up in warm clothes and a blanket to protect against Lima’s cold nights. His daughter, granddaughter and niece took turns at his side. Early in the morning, he died. His family prayed.
Abelardo would have turned 86 at the end of September. Any other year, we would celebrate by going out for dinner and have cake and presents. This year, my wife wrote the 33 names of his family on a helium balloon. She walked over to a park and let it go, a small gift for her dad.
“We miss you,” my 5-year-old son said, as the balloon disappeared into the gray sky.
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Write to Ryan Dube at email@example.com
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