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Hellen Nañez’s father died in an intensive care unit in southern Peru last month, the 14th member of her family to die from Covid-19. Aunts, uncles, cousins, her father, a grandfather — all have succumbed to what the government recognised this week was the world’s most deadly outbreak of coronavirus.

“My family life has been totally destroyed,” she said from her home town of Pisco. “I don’t want to leave the house any more. I can’t sleep, I don’t want to eat and I don’t know what I’m going to do next.”

A single mother with a two-year-old daughter, Nañez spent thousands of dollars on medical treatment for her family and is now heavily in debt.

Peru’s failings amid the pandemic have become a central campaign theme as the nation prepares to choose its fifth president in five years on Sunday in a highly divisive run-off election between two candidates who won less than a third of the votes between them in the first round.

The Covid crisis has helped propel a formerly unknown rural primary school teacher and union activist to a narrow lead in the polls. Pedro Castillo is running on a Marxist platform of nationalisation and higher taxes, to the alarm of investors and business people.

“Castillo doesn’t know what he wants to do,” said a senior executive at a Peruvian bank. “He says one thing one day and another thing another day. In any case, the mastermind of the campaign is not Pedro Castillo but [the head of his party] Vladimir Cerrón, who is super-radical . . . Cerrón was educated in Cuba in the most closed economy imaginable.”

But Castillo has fired up poorer Peruvians across the country’s left-behind towns and villages with folksy charm, the story of his life as a teacher in a remote Andean village and a simple message: “No more poor people in a rich country.” His rival, Keiko Fujimori, has no such clear slogan and has struggled to overcome a reputation as an obstructive politician accused of corruption; she denies wrongdoing.

Part of Castillo’s appeal stems from popular anger at Peru’s failure to handle the pandemic effectively. Revised government figures last Monday recognised what excess death figures had been suggesting for months: Peru has the world’s highest coronavirus mortality rate.

The extent of the health disaster might seem surprising. A middle-income country that has grown steadily, invested in public services and reduced poverty over the past two decades, Peru was often lauded as one of Latin America’s success stories.

When the pandemic hit in March 2020, the government imposed a strict lockdown and followed up with generous help for homes and businesses. The lockdown killed the economy, which contracted nearly 40 per cent in the second quarter, but infections and deaths soared anyway amid lax enforcement and ineffective sanitary measures.

María Antonieta Alva, who was finance minister at the time, said the pandemic had shown up the best and the worst of Peru. On the one hand, “prudent management of public finances allowed the implementation of one of the most ambitious economic response packages in Latin America”, she told the Financial Times.

But, on the other, “it uncovered decades of neglect in the microeconomy, the things which affect the day to day life of Peruvians: a collapsed health system, abuse of dominant positions in uncompetitive markets such as oxygen and medicines and alarming levels of financial exclusion”, she said. “These enormous gaps compromised the effectiveness of the measures implemented by the government [to contain the pandemic].”

Presidential candidates Pedro Castillo and Keiko Fujimori during the signing of a ‘pledge to democracy’ ahead of the runoff vote © Ernesto Benavides/AFP/Getty Images