Hospitals in Iquitos, Peru, had already been locked in a months-long struggle against a dengue fever epidemic when Covid-19 hit. The hospitals have been in a dire state since mid-April – an estimated 80% of the department’s healthcare workers have fallen ill and they are running out of oxygen and beds for sick patients. One doctor says the situation is “out of control”.

Iquitos is the capital of Loreto, Peru’s northernmost department, which is located in the Amazon rainforest. The city, which is home to nearly 500,000 people, is only accessible by plane or boat. There is no entry-route by land. Iquitos ranks amongst the Latin American cities hardest hit by Covid-19, which include Guayaquil in Ecuador, Manaus in Brazil and Tijuana in Mexico, according to news agency EFE.

A recent video filmed in the morgue in the Loreto Regional Hospital looked eerily similar to videos filmed in Guayaquil, the city in Ecuador that has been ravaged by the virus. The Loreto footage shows corpses piling up. In the video, you can see at least 16 bodies wrapped up in plastic bags that had been sitting there for several days. The Loreto Regional Hospital is one of two hospitals in Iquitos accepting Covid-19 patients, alongside EsSalud Hospital.

Bodies wrapped up in plastic bags stack up in the morgue in the Loreto Regional Hospital in Iquitos. This video was posted on April 22.

"About 80% of healthcare workers in Loreto have contracted the virus"

Juan Ramirez Arevalo is a doctor at EsSalud Hospital.
 
We saw the first patients with Covid-19 symptoms in late March. But as numbers grew, the situation became more difficult. It started to get really complicated in mid-April. Every single day, more than 200 new patients with Covid-19 symptoms or pneumonia come to my hospital or Loreto Regional Hospital, which takes the majority of them. We are completely overwhelmed.

Patients sit on the floor and on chairs in the hallways of the Loreto Regional Hospital (this video was posted on April 29).
 
As a rule, the health of the patients when they arrive at hospital is much worse than it was at the start of the pandemic. I think it's because people know that the hospitals are overwhelmed so they try to stay at home. It’s only when they start to get really, really ill that they go to the hospital. Essentially, they are coming to the hospital to die.

Every day, 15 to 20 patients suspected of having Covid-19 die in my hospital. The number is closer to 30 at the Loreto Regional Hospital. And that’s not even counting the people who die at home. There isn’t enough space in the morgue, so sometimes the bodies are just left right where the person died until someone can pick them up.
 
Healthcare workers wrap up the body of a patient who died in the hallway at EsSalud Hospital. (This video was posted on April 26)
 
Shortage of beds, medicine and oxygen

We only have 60 or 70 beds in my hospital and only four or five of those are in intensive care. Because we are overflowing, we’ve had to move patients outside -- currently we are treating about 100 of them outside. Some are in a tent and we set up small spaces on the patio for others. However, just a few days ago, we were able to open up a temporary field hospital with several dozen beds so that should improve the situation. 

There are no more beds at EsSalud Hospital, so these patients are being treated outside. (Photo posted on April 22)

"These are photos from the [Loreto] Regional Hospital. They don’t even have beds for the patients any more [...]", wrote this journalist on April 22.

Extra beds were set up in the hallways of the Loreto Regional Hospital, shortly after the previous photos showing patients without beds were posted online. You can see more photos by clicking here.
 
However, we are still low on supplies of oxygen and medicine to treat patients. As you can’t get to Iquitos by road, it’s really hard to get those supplies in. Since last week, military planes have been bringing in medicine every day, but it’s not enough. Before that, only one or two planes a week were coming in.

The need for oxygen is about four or five times more than usual, so the supply made by a local factory just isn’t enough. We worked with the Colegio Médico del Perú [Editor’s note: the institution that represents doctors in Peru] to buy our own bottles of oxygen from Lima, which started to arrive earlier this week. A priest in Iquitos - who is also trained as a doctor - managed to raise the funds to set up two oxygen-producing stations here. That’s what the government should have done weeks ago.
 
Lack of doctors

The other big issue is the lack of doctors. Even before the pandemic, there weren’t enough of us. There are only about 650 doctors in the entire department of Loreto [which has about a million inhabitants]. Of those doctors, 166 have contracted Covid-19, around 60 of them are in quarantine because they are suspected of having the virus and about 150 are in quarantine because they are high-risk for contracting the disease because of their age or other underlying conditions that they have. That means that there are only 274 doctors left in the entire department of Loreto to fight this pandemic, only about 100 of whom are in Iquitos. Generally speaking, about 80% of healthcare workers in Loreto have been infected.

Four doctors in Iquitos just died of Covid-19. One of them hadn’t even got his diploma yet. [Editor’s note: Currently about 20 young doctors who don’t yet have their medical school diplomas have been volunteering to treat Covid-19 patients because of the shortage of medical personnel.]
 
A group of young doctors, who don’t yet have their diplomas, have been volunteering at the Loreto Regional Hospital. They’ve been sleeping on site.
 
Why Iquitos’ hospitals have been overwhelmed for months

The hospitals in Iquitos have actually been overwhelmed since December because of epidemics of dengue fever and leptospirosis. There haven’t been enough beds. [Editor’s note: Since 2019, Latin America has been overwhelmed with the worst epidemic of dengue fever in its history.] But these illnesses were concentrated in several areas in the north and south of Iquitos and the death rate remained relatively low. But now the entire city has been hit by coronavirus.

The situation has, quite simply, gone out of control. We’ve been fighting for a larger budget for healthcare for years, but no one responded to our demands. Now we can clearly see the result.
 


"No one wants to help me [...], help me, please," cries a woman in the hallways of the Loreto Regional Hospital.


Help on the way for hospitals

The Peruvian Minister of the Economy just announced a $26 billion economic support package, which is roughly equivalent to 12% of the GDP, to help the economy weather the Covid-19 crisis. The plan includes support for hospitals, which have been under financial pressure for years because of austerity policies.

According to figures released by the Ministry of Health on May 7, 1,627 people have died of coronavirus out of a total of 58,526 confirmed cases in Peru, which has a population of 32 million. After Brazil and Ecuador, Peru has the third-largest number of deaths related to Covid-19 in Latin America.

In mid-March, the government declared a state of emergency and put in place a quarantine, which was set to be lifted on May 10, as well as a curfew.

Article by Chloé Lauvergnier (@clauvergnier).