key: cord-1013249-25hv0qer
authors: Valenzuela-Rodriguez, German; Zambrano, Lysien I.; Muñoz-Lara, Fausto; Pecho-Silva, Samuel; Arteaga-Livias, Kovy; Rodriguez-Morales, Alfonso J.
title: Intranational differences in the case fatality rates for COVID-19 among Peruvian physicians
date: 2020-09-13
journal: Int J Infect Dis
DOI: 10.1016/j.ijid.2020.09.018
sha: 5bd009e95eb5f90d30ce01c6b64020ef99dec0f3
doc_id: 1013249
cord_uid: 25hv0qer

nan

Peru is one of the most currently affected countries in Latin America and worldwide because of COVID-19 pandemic in terms of the number of infections and deceased people (Ministry of Health of Peru, 2020; Johns Hopkins University of Medicine, 2020).

Unfortunately, physicians and other health care workers (HCW) have been significantly affected since the beginning of the pandemic (Ollarves-Carrero et al, 2020 (21.4%) in clinical specialities, and 3 (2.15%) in specialities related to diagnostic procedures. Moreover, it was reported that the death of 5 physicians recently graduated (3.55%).

In some departments such as Loreto, Ucayali, Madre de Dios, Amazonas, San Martin (all of them from the Jungle Region), and Tumbes, Huancavelica, and Ayacucho, there is a significant lack of attention in terms of infrastructure of health services, number of physicians and well-standardized processes for health attention, the percentage of infected physicians considering the total number of registered physicians was above 20%.

On the other hand, CFR% among physicians was higher than the entire population (4.59%), being higher in Arequipa (8.75%), Loreto, Lima, and Piura (Table 1) . (PAHO, 2020; CIDRAP, 2020) . Although the number of physicians infected in Peru may be considered lower, compared to other countries in the region, the CFR% of physicians in Peru due to COVID-19 seems to be higher (~5%), reaching even higher values in some areas of the country, as discussed.

Especially in developing countries, lack of personal protective equipment (PPE) and its inappropriate use are risk factors to acquire the infection for COVID-19 among physicians (Ing et al, 2020; Mhango et al, 2020) . Moreover, overexposure to infected patients with an excessive workload in regions with scarce physicians and inferior systems of infection controls could be associated factors (Mhango et al, 2020) . In Peru, the lack of mechanical ventilators, well-equipped intensive care units, and oxygen, in most of the departments, with the higher levels of lethality among physicians was reported (Diario Gestion Peru, 2020) . For this situation, we consider as significant measures to provide for physicians and other health care practitioners, adequate PPE, and increased attention in health services. At the end of August 2020, the number of infected nurses in Peru is ~5,000, and the number of deceased nurses is 71 (1.42%) (Diario Co Latino, 2020). Still, especially to prioritize physicians' attention, taking into account they accomplish a critical mission in the first line of defence during the pandemic. 

Health agency: COVID-19 hitting health workers hard in Americas

Physician deaths from coronavirus (COVID-19)

Gremio de Enfermería denuncia abandono del Gobierno en Perú

Medical College of Peru. Observatorio del Colegio Médico del Perú

COVID-19 Risk Factors Among Health Workers. A Rapid Review. Safety and Health at Work

Ministry of Health of Peru. Sala Situacional del Ministerio de Salud

Healthcare Worker with COVID-19 in Madrid, Spain

Alert -COVID-19 among healthcare workers

CFR%, case fatality rate. *Number of physicians at the department.