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How did it get so bad so fast? Coronavirus in the Amazon.

A bit of context-edited background at the start, originally written on 20 March 2020: Peru has taken a very aggressive approach to containing the spread of the virus. On 15 March, a state of emergency was declared nationwide, and at midnight on 16 March, all land, air and sea borders were ordered closed until 31 March. I and the academic group I was with were fortunate to be on one of the last flights permitted to depart for the US, and we took off two hours before midnight, even as the usually bustling Lima airport was closing down around us. Earlier that day, we had arrived at the Iquitos airport many hours early to ensure that would get on our flight to Lima.

The state of emergency announcement came as a surprise to many, and thousands of foreigners (including hundreds of Americans) are trapped in Peru. Trekkers, ecotourists at remote lodges, researchers, volunteers and many others either didn't receive news of the announcement, or found it impossible to depart the country on such short notice [most have since been able to leave on various repatriation flights]. There are severe restrictions on travel within Peru, with no domestic or international passenger flights, no bus, no train, no boat and no taxi services, a total ban on public events and gatherings, parks and beaches closed, all restaurants and bars closed, and police and military patrolling the streets to ensure that people stay in place at home and observe mandatory curfew. Only a few people at a time are being allowed out to purchase essentials. The nurse-technician at our Orosa River clinic texted me the day I departed asking for additional medicines and supplies. The local population that the clinic serves were all convinced that they had coronavirus (even if it was only the common cold), but getting anything to the clinic with the travel restrictions is extremely difficult. Our general manager, Fernando Rios, was going to see if he could take some of the medications and supplies we have stocked on our medical boat and send them to the Orosa Clinic by one means or another. [we were not able to do so until May]

Although the emergency decree lasts until 31 March, it is quite likely that it may be extended beyond that if the strict controls on movement are not sufficient to control the spread of the virus. The first documented case in Peru was detected on 6 March, and by 16 March, there were 86 confirmed cases, mostly in Lima and Cusco. Yesterday [20 March] I heard that there were two presumed cases in Iquitos, but I haven't been able to get an updated official count on the current number of cases. If the virus isn't contained, then the Peruvian medical system is certainly going to be overwhelmed, and significant mortality can be expected. I'm hopeful that the aggressive approach will work though.

Even if the state of emergency is lifted on 1 April, it is unlikely that normal flights will resume anytime soon after. Given the explosion of cases that we are seeing in the US (and yes, it is going to get much worse), I don't believe that Peru will be allowing flights to/from the US through the end of April at the least, and possibly into May. The earliest that normal travel will resume is likely going to be June or July at the earliest. I hope (but don't expect) that I will be proved wrong. [And as I add this to the blog on 8 September, my worst fears have have been confirmed and amplified].

A Turn for the Worse

With a fast and rigorous shut-down, I fully expected that Peru would be able to control the spread of coronavirus beyond the metropolitan area of Lima with its population of 10+ million people. So how did Iquitos, an isolated jungle city accessible only by plane and boat with a metro population of ~600,000 become the epicenter of coronavirus in Peru? The first two confirmed infections in Iquitos were both tour guides for local lodges – they had been in contact with asymptomatic tourists.

Houses built on stilts are inundated at high water on the Mazan River near Iquitos in the summer of 2019.

After that, the rapid spread of the virus can pretty much be explained in two words: crowding & poverty. Iquitos is on a narrow peninsula of high ground sandwiched between three rivers. With an annual rise and fall of water levels of up to 14 meters (~45 feet - this is NOT a typo!), the city cannot spread out very far. For the most part, houses are small and crammed together, usually sharing common walls, and usually with multiple generations living in the same house and sharing a single bathroom. Social isolation within a household is impossible, and if one family member is exposed and infected, then every person in the household is going to be exposed. Population density is high.

The majority of the population of Iquitos is jammed into an area about 7 miles long by 1.5 to 2 miles wide (inside the yellow lines).

In the poorest areas of town, houses are very small, and in areas of the Belen district (and other districts), shantytowns have been built on the only remaining open areas – the floodplain. Some houses are on large logs and float up and down with the rise and fall of the rivers, while others are built on stilts. Water levels are highest in April and May, and makeshift catwalks – often only 2 or 3 boards wide – provide the only pedestrian access. Again, social distancing is impossible. You can’t stay 6-feet away when passing someone on a “sidewalk” that is only 3-feet wide.

A floating house in the Bellavista district of Iquitos. The owners (and their dogs) make a living by guarding boats. No electricity, no plumbing and no running water apart from the river... Photo by Laura Goodwin.

A majority of residents in the poorer areas of town also lack any kind of refrigeration. They don’t have the option of storing perishables in the refrigerator or freezer, so most people shop for their food on a daily basis, buying only what perishables they need for that day. People can’t shop once every 10-14 days and then stay home. They also do their shopping in crowded, unsanitary, informal markets where the prices are cheapest. That means a lot of person to person contact, ideal for the spread of the virus. Likewise, most residents of poorer areas are part of the informal economy – they make a day-to-day living selling produce, or an assortment of household and personal items. No sales means no food, so there is regular (though generally covert) flouting of the quarantine rules.

The floodplain of the Nanay River on the outskirts of Iquitos. High ground starts with the roadway in the extreme lower right corner. Everything else floods annually. Photo by Laura Goodwin.

One small town mayor in central Peru took the flouting of rules to unusual lengths. When police arrived to arrest him for violating the local travel ban, he had been drinking heavily with his buddies. In an attempt to avoid arrest, he laid down in a coffin (mask on) and pretended to be dead (news report from 23 May). He may have use of that coffin again, and sooner than he would like - hey, doesn't everyone have a spare coffin lying around?

As the state of emergency was extended time and time again, additional factors came into play. Emergency survival payments to families from the government resulted in blocks-long lines of thousands of (socially-distanced and masked) people outside of banks. The lines would start the night before, and even though the effort of social-distancing was made, the bank lines still amounted to mass gatherings. Local authorities in some places like the smaller town of Mazan also announced week-long shut-downs of businesses, with the result that people from outlying areas rushed to town the day before the shutdown, and crowded into stores to buy essentials, effectively destroying any public health benefit that might have resulted from the shutdown. Not only was social distancing impossible in stores but also in the small boats people used to get to town (see photo below).

Check out the Covid-19 Timeline for additional information on the spread and impact of Covid-19 in our area of the Peruvian Amazon.

Market days and other events mean small boats jam-packed with passengers as residents of outlying areas travel to town. Boats are the only transport option and gasoline is expensive, so this is the ultimate in boat-pooling. My count is a minimum of 32 people on this boat - try packing that many into your VW van! Photo from the Mazan River by Bernie Wallerich.

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