Trends in relevant excess mortality in Peru and nine areas during the first wave of COVID-19 pandemic between January and May 2020: A descriptive study

Abstract Introduction: COVID-19 has arrived the main capitals of Peru and caused direct and indirect deaths. Though mortality data is reported through SINADEF, relevant excess mortality (REM) remains unknown.Objective: To estimate the monthly relevant excess mortality for all causes and non-related with violent and COVID-19 causes between January and May 2020 in Peru and nine areas with the highest absolute numbers of deaths by COVID-19. Material and Methods: To estimate relevant excess mortality, we calculated the monthly upper and lower limits of historical mortality (95% confidence interval) and the average for the last 3 years (2017-2019). REM was considered when observed values exceed the estimated upper limit plus corresponding 2 standard deviations. We also determined REM excluding non-related with violent and COVID-19 causes.Findings: Relevant excess mortality of 35 deaths per 100 000 population from all causes during April and May 2020 were found in Peru with no difference when we excluded violent deaths. In addition, Callao had the highest REM followed by Lima, Ucayali, Loreto, Piura, Ica, Ancash, and La Libertad. In country and capitals analysis, male and individuals over 60 years were the most affected groups.Discussion: Relevant excess mortality determination is a needed, easy and low-cost approach to monitor the progress of COVID pandemic and to evaluate the effectiveness of policy measures. This surveillance method should expand to the 25 locations of Peru. Conclusion: COVID-19 accounted for 45% of the relevant excess all-cause deaths, leaving 54.29% unattributed to COVID-19. Hence, it is necessary to rethink the policy measures in order to avoid direct and indirect deaths attributed to the pandemic.