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BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1918 (Published 14 May 2020) Cite this as: BMJ 2020;369:m1918

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Clearing the path for COVID-19 in Peru? The decision of supervised walks for children and adolescents

Dear Editor,

Peru is facing a tremendous burden from the COVID-19 pandemic since it is among the 15 countries in the world with the highest number of positive COVID-19 cases and second in Latin America only after Brazil (1). May 18, 2020 constitutes the day 64 of lockdown that resulted in 94,933 positive cases, with a 2.94% lethality rate, and with the city of Lima having the majority of cases (64.5%) nationwide (2). On May 9 a national decree was published that extended the lockdown for 2 more weeks, and it announced that supervised walks for children and adolescents of less than 14 years were to be allowed starting May 18 (3). They were to be supervised by an adult living in the same household to ensure the fulfillment of sanitary recommendations (3). The circulation is to be limited to one daily walk for a maximum of 30 minutes, up to 500 meters of distance, and with a social distance of at least 2 meters (3). Peru became the second country in the world to implement this measure, based on the one Spain implemented on April 26 (4).

Children exhibit milder symptoms and a better prognosis (5); however, their role in transmitting the disease remains unclear. The measure in Spain was controversial and revised multiple times (4). The concern was a potential increase in positive cases in children and adolescents that could infect the higher risk population. On May 13 it was reported that the number of cases increased by 32% (1,848 to 2,448) in people under 19 years and by 35% (634 to 857) in children under 10 (6). To add the concern, a study in Madrid reported that 60% of children (0-15 years) need to be hospitalized once diagnosed with COVID-19 (7).

The debate in Peru reached climax with an open letter by the Peruvian Psychiatric Association, on May 16, that portrayed their deep concern and urged the government to implement the measure once the cases started to decline (8). It continued stating that Peru is an undisciplined society (9) where most likely adults will use the measure to abuse the system causing an inevitable increase in contagion (8, 9). The criticism led to the publication of an epidemiological alert (10) during the morning of May 18 with additional recommendations: limits of 65 years for supervising adult, no toys, no running, and a maximum of 2 children per adult. The most surprising change was the prohibition of this measure in the majority of Lima and other cities in Peru due to the high number of confirmed cases and the contagion risk (10). However, at that time thousands of people already went out with children that carried toys and bicycles in cities with high number of confirmed cases as it was amply portrayed by the media. We will stay vigilant of this measure and how it affects the COVID-19 statistics in a country where as of May 12 there are over 1472 cases in children (0-11 years) and 834 in adolescents (12-17 years) (11) and the pediatric hospitals are already saturated with adult patients.

References:
1. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (JHU) 2019 [Available from: https://coronavirus.jhu.edu/map.html accessed 18 May 2020.
2. Sala Situacional COVID-19 Peru: Ministerio de Salud del Perú (MINSA); 2020 [Available from: https://covid19.minsa.gob.pe/sala_situacional.asp accessed 18 May 2020.
3. PCM. Decreto Supremo Nº 083-2020-PCM - Prórroga del Estado de Emergencia por coronavirus hasta el 24 de mayo de 2020: Presidencia del Consejo de Ministros, 2020.
4. Guía de buenas prácticas en las salidas de la población infantil durante el estado de alarma. In: Sanidad Md, ed.: Gobierno de España, 2020.
5. Ludvigsson JF. Systematic review of COVID-19 in children shows milder cases and a better prognosis than adults. Acta paediatrica (Oslo, Norway : 1992) 2020;109(6):1088-95. doi: 10.1111/apa.15270 [published Online First: 2020/03/24]
6. Castro C. Sanidad reconoce preocupación por el aumento de contagios en niños. El Independiente 2020.
7. Tagarro A, Epalza C, Santos M, et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA Pediatrics 2020 doi: 10.1001/jamapediatrics.2020.1346
8. Pronunciamiento de APP sobre salida de menores en contexto del COVID 19: Asociación Psiquiátrica Peruana (APP); 2020 [Available from: http://www.app.org.pe/noticia.html?id=185&fbclid=IwAR366guaWr_O3vM1gZwh5... accessed May 17, 2020.
9. Riera C, Fabre I. Las indisciplinas sociales. Una excusa para no mirar allá. Collectivus, Revista de Ciencias Sociales 2017;4(1):104-25. doi: http://dx.doi.org/10.15648/Coll.1.2017.6
10. MINSA. Alerta Epidemiológica ante el desplazamiento de niños, niñas y adolescentes menores de 14 años y transmisión de Covid-19 en el Perú. In: (MINSA) MdSdP, ed. Alerta Epidemiológica AE-017-2020: Ministerio de Salud - Centro Nacional de Epidemiología, Prevención y Control de Enfermedades, 2020.
11. MINSA. Situación Actual "COVID-19" al 12 de mayo 2020: Centro Nacional de Epidemiología, Prevención y Control de Enfermedades - Ministerio de Salud del Perú, 2020.

Competing interests: No competing interests

23 May 2020
Jaime A. Yáñez
Professor
Aldo Alvarez-Risco; Jaime Delgado-Zegarra
Universidad Peruana de Ciencias Aplicadas
Lima, Peru