Regional clustering and waves patterns due to COVID-19 by the index virus and the lambda/gamma, and delta/omicron SARS-CoV-2 variants in Peru

BACKGROUND: Coronavirus disease 2019 (COVID-19) impact varies substantially due to various factors, so it is critical to characterize its main differences to inform decision-makers about where to focus their interventions and differentiate mitigation strategies. Up to this date, little is known about the patterns and regional clustering of COVID-19 waves worldwide. METHODS: We assessed the patterns and regional clustering of COVID-19 waves in Peru by using the weekly mortality rates for each of the 25 regions as an outcome of interest. We obtained the death counts from the National Informatics System of Deaths and population estimates from the National Registry of Identification and Civil Status. In addition, we characterized each wave according to its duration, peak, and mortality rates by age group and gender. Additionally, we used polynomial regression models to compare them graphically and performed a cluster analysis to identify regional patterns. RESULTS: We estimated the average mortality rate at the first, second, and third waves at 13.01, 14.12, and 9.82 per 100,000 inhabitants, respectively, with higher mortality rates among elders and men. The patterns of each wave varied substantially in terms of duration, peak, impact, and wave shapes. Based on our clustering analysis, during the first wave caused by the index virus, the 25 regions of Peru presented six different wave patterns. However, the regions were clustered in two different wave patterns during the second and third, caused by alpha/lambda/delta and omicron. CONCLUSIONS: The propagation of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) variants behaved in Peru with varying wave patterns and regional clustering. During the COVID-19 pandemic, the weekly mortality rates followed different spatiotemporal patterns with solid clustering, which might help project the impact of future waves of COVID-19.