Article Epidemiological Analysis of COVID-19 Cases in Native Amazonian Communities from Peru Cecilia Pajuelo-Reyes 1 , Hugo J. Valencia 1 , Carla C. Montenegro 1 , Eduardo Quezada 2 , Lizandro Gonzales 2 , Norma Cruz 2 , Carlos Canelo 3 , Carla Ordinola 1 , Jorge L. Maicelo Quintana 4 , Juan R. Tejedo 1,5 , Rafael Tapia-Limonchi 1 and Stella M. Chenet 1,6, *   Citation: Pajuelo-Reyes, C.; Valencia, H.J.; Montenegro, C.C.; Quezada, E.; Gonzales, L.; Cruz, N.; Canelo, C.; Ordinola, C.; Maicelo Quintana, J.L.; Tejedo, J.R.; et al. Epidemiological Analysis of COVID-19 Cases in Native Amazonian Communities from Peru. Epidemiologia 2021, 2, 490–501. https://doi.org/10.3390 /epidemiologia2040034 Academic Editor: Alberto Arnedo-Pena Received: 31 August 2021 Accepted: 26 September 2021 Published: 9 October 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- iations. Copyright: © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). 1 Instituto de Enfermedades Tropicales (IET), Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Chachapoyas 01001, Peru; cecilia.pajuelo@untrm.edu.pe (C.P.-R.); hugo.valencia@untrm.edu.pe (H.J.V.); carla.montenegro@untrm.edu.pe (C.C.M.); carla.ordinola@untrm.edu.pe (C.O.); juan.tejedo@untrm.edu.pe (J.R.T.); rafael.tapia@untrm.edu.pe (R.T.-L.) 2 Dirección Regional de Salud (DIRESA), Chachapoyas 01001, Peru; eduquezadat2@gmail.com (E.Q.); lgonzalesc@hotmail.com (L.G.); normacruz55@hotmail.com (N.C.) 3 Gobierno Regional de Amazonas (GOREA), Chachapoyas 01001, Peru; ccanelounion@hotmail.com 4 Instituto de Investigación para el Desarrollo Sustentable de Ceja de Selva (INDES-CES), Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas (UNTRM), Chachapoyas 01001, Peru; jmaicelo@untrm.edu.pe 5 Departamento de Biologia Molecular e Ingenieria Bioquímica, Universidad Pablo de Olavide (UPO), 41001 Sevilla, Spain 6 Facultad de Medicina, Universidad de los Andes, Santiago de Chile 7550000, Chile * Correspondence: stella.chenet@untrm.edu.pe Abstract: Despite early control measures, SARS-CoV-2 reached all regions of Peru during the first wave of the pandemic, including native communities of the Peruvian Amazon. Here, we aimed to describe the epidemiological situation of COVID-19 in the Amazonas region of Peru using an open database of 11,124 COVID-19 cases reported from 19 March to 29 July 2020, including 3278 cases from native communities. A high-incidence area in northern Amazonas (Condorcanqui) reported a cumulative incidence of 63.84/1000 inhabitants with a much lower death rate (0.95%) than the national average. Our results showed at least eight significant factors for mortality, and the Native Amazonian ethnicity as a protective factor. Molecular confirmatory tests are necessary to better explain the high incidence of antibody response reported in these communities. Keywords: native communities; COVID-19; Peru; hazard ratio; transmission chain; epidemiol- ogy; RDTs 1. Introduction In December 2019, a new viral respiratory disease was reported in Wuhan, China. The agent was later identified as a novel coronavirus named Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) responsible for the Coronavirus Disease 2019 (COVID-19). It has spread worldwide as a pandemic with 85,520,927 confirmed cases and 1,849,436 deaths in 2020 [1]. Peru reported its first imported case in Lima on 6 March 2020. The patient, a 25-year-old Peruvian resident, traveled to several countries in Europe. Ten days later, on March 16th, the Government declared a national emergency, quarantine, and lockdown, and closed the borders, with only 86 confirmed cases and no deaths [2]. In 2020, the Peruvian Ministry of Health (MINSA) reported 1,017,199 confirmed cases and 37,724 deaths due to COVID-19 [3], being the eighteenth country with the highest number of cases and the thirteenth with the highest number of deaths in the world [1]. Despite early control measures, SARS-CoV-2 reached all regions of Peru, including Amazonas, which is located in the north part of the country [4]. Amazonas is divided into seven provinces: Bagua, Bongara, Chachapoyas, Condorcanqui, Luya, Rodriguez de Mendoza, and Utcubamba, with 426,806 inhabitants, representing 1.3% of the total Epidemiologia 2021, 2, 490–501. https://doi.org/10.3390/epidemiologia2040034 https://www.mdpi.com/journal/epidemiologia