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Dudley L, Couper I, Kannangarage NW, Naidoo S, Ribas CR, Koller TS, Young T. COVID-19 preparedness and response in rural and remote areas: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002602. [PMID: 37967067 PMCID: PMC10651055 DOI: 10.1371/journal.pgph.0002602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 10/23/2023] [Indexed: 11/17/2023]
Abstract
This scoping review used the Arksey and O'Malley approach to explore COVID-19 preparedness and response in rural and remote areas to identify lessons to inform future health preparedness and response planning. A search of scientific and grey literature for rural COVID-19 preparedness and responses identified 5 668 articles published between 2019 and early 2022. A total of 293 articles were included, of which 160 (54.5%) were from high income countries and 106 (36.2%) from middle income countries. Studies focused mostly on the Maintenance of Essential Health Services (63; 21.5%), Surveillance, epidemiological investigation, contact tracing and adjustment of public health and social measures (60; 20.5%), Coordination and Planning (32; 10.9%); Case Management (30; 10.2%), Social Determinants of Health (29; 10%) and Risk Communication (22; 7.5%). Rural health systems were less prepared and national COVID-19 responses were often not adequately tailored to rural areas. Promising COVID-19 responses involved local leaders and communities, were collaborative and multisectoral, and engaged local cultures. Non-pharmaceutical interventions were applied less, support for access to water and sanitation at scale was weak, and more targeted approaches to the isolation of cases and quarantine of contacts were preferable to blanket lockdowns. Rural pharmacists, community health workers and agricultural extension workers assisted in overcoming shortages of health professionals. Vaccination coverage was hindered by weaker rural health systems. Digital technology enabled better coordination, communication, and access to health services, yet for some was inaccessible. Rural livelihoods and food security were affected through disruptions to local labour markets, farm produce markets and input supply chains. Important lessons include the need for rural proofing national health preparedness and response and optimizing synergies between top-down planning with localised planning and coordination. Equity-oriented rural health systems strengthening and action on rural social determinants is essential to better prepare for and respond to future outbreaks.
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Affiliation(s)
- Lilian Dudley
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Ian Couper
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | | | - Selvan Naidoo
- Ukwanda Centre for Rural Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Clara Rodriguez Ribas
- Health Emergencies Program, World Health Organisation, Headquarters, Geneva, Switzerland
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Theadora Swift Koller
- Department for Gender, Equity and Human Rights, Director General’s Office, World Health Organization, Headquarters, Geneva, Switzerland
| | - Taryn Young
- Division of Epidemiology and Biostatistics, Department of Global Health, Stellenbosch University, Cape Town, South Africa
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Orellana-Manzano A, Cordeiro FB, Garcia-Angulo A, Centeno E, Vizcaíno-Tumbaco MJ, Poveda S, Murillo R, Andrade-Molina D, Mirabá M, Mehta S, Cárdenas W. A report on SARS-CoV-2 first wave in Ecuador: drug consumption dynamics. Front Pharmacol 2023; 14:1197973. [PMID: 37388452 PMCID: PMC10300276 DOI: 10.3389/fphar.2023.1197973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 05/30/2023] [Indexed: 07/01/2023] Open
Abstract
Introduction: The first COVID-19 wave in Ecuador started in March 2020 and extended until November. Several types of drugs have been proposed as a potential treatment during this period, and some affected people have self-medicated. Method: A retrospective study was conducted with 10,175 individuals who underwent RT-PCR tests for SARS-CoV-2 from July to November 2020. We compared the number of positive and negative cases in Ecuador with symptoms and drug consumption. The Chi-square test of independence compared clinical and demographic data and PCR test results. Odds ratios analyzed drug consumption dynamics. Results: Of 10,175 cases, 570 were positive for COVID-19, while 9,605 were negative. In positive cases, there was no association between the RT-PCR result and sex, age, or comorbidities. When considering demographic data, Cotopaxi and Napo had the highest rates of positive cases (25.7% and 18.8%, respectively). Manabí, Santa Elena, and Guayas regions had fewer than 10% positive cases. The Drug consumption dynamic analysis showed that negative COVID-19 cases presented higher drug consumption than positive cases. In both groups, the most consumed medication was acetaminophen. Acetaminophen and Antihistamines had higher odds of consumption in positive PCR cases than in negative. Symptoms like fever and cough were more related to positive RT-PCR results. Conclusion: The first COVID-19 wave in Ecuador has affected the provinces differently. At a national level, the consumption of drugs has been highly associated with self-medication.
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Affiliation(s)
- Andrea Orellana-Manzano
- Laboratorio Para Investigaciones Biomédicas, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Fernanda B. Cordeiro
- Laboratorio Para Investigaciones Biomédicas, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Andrea Garcia-Angulo
- Facultad de Ciencias Naturales y Matemáticas, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Elizabeth Centeno
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - María José Vizcaíno-Tumbaco
- Laboratorio Para Investigaciones Biomédicas, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Sebastián Poveda
- Facultad de Ciencias Naturales y Matemáticas, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Ricardo Murillo
- Facultad de Ciencias Naturales y Matemáticas, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Derly Andrade-Molina
- Laboratorio de Ciencias Omicas, Facultad de Ciencias de la Salud, Universidad Espíritu Santo, Samborondon, Ecuador
| | - Mariuxi Mirabá
- Laboratorio Para Investigaciones Biomédicas, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
| | - Saurabh Mehta
- Division of Nutritional Sciences, Cornell University, Ithaca, NY, United States
| | - Washington Cárdenas
- Laboratorio Para Investigaciones Biomédicas, Facultad de Ciencias de la Vida, Escuela Superior Politécnica del Litoral (ESPOL), Guayaquil, Ecuador
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Landier J, Bassez L, Bendiane MK, Chaud P, Franke F, Nauleau S, Danjou F, Malfait P, Rebaudet S, Gaudart J. Social deprivation and SARS-CoV-2 testing: a population-based analysis in a highly contrasted southern France region. Front Public Health 2023; 11:1162711. [PMID: 37250096 PMCID: PMC10213643 DOI: 10.3389/fpubh.2023.1162711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023] Open
Abstract
Background Testing was the cornerstone of the COVID-19 epidemic response in most countries until vaccination became available for the general population. Social inequalities generally affect access to healthcare and health behaviors, and COVID-19 was rapidly shown to impact deprived population more drastically. In support of the regional health agency in Provence-Alpes-Côte d'Azur (PACA) in South-Eastern France, we analyzed the relationship between testing rate and socio-demographic characteristics of the population, to identify gaps in testing coverage and improve targeting of response strategies. Methods We conducted an ecological analysis of SARS-CoV-2/COVID-19 testing rate in the PACA region, based on data aggregated at the finest spatial resolution available in France (IRIS) and by periods defined by public health implemented measures and major epidemiological changes. Using general census data, population density, and specific deprivation indices, we used principal component analysis followed by hierarchical clustering to define profiles describing local socio-demographic characteristics. We analyzed the association between these profiles and testing rates in a generalized additive multilevel model, adjusting for access to healthcare, presence of a retirement home, and the age profile of the population. Results We identified 6 socio-demographic profiles across the 2,306 analyzed IRIS spatial units: privileged, remote, intermediate, downtown, deprived, and very deprived (ordered by increasing social deprivation index). Profiles also ranged from rural (remote) to high density urban areas (downtown, very deprived). From July 2020 to December 2021, we analyzed SARS-CoV-2/COVID-19 testing rate over 10 periods. Testing rates fluctuated strongly but were highest in privileged and downtown areas, and lowest in very deprived ones. The lowest adjusted testing rate ratios (aTRR) between privileged (reference) and other profiles occurred after implementation of a mandatory healthpass for many leisure activities in July 2021. Periods of contextual testing near Christmas displayed the largest aTRR, especially during the last periods of 2021 after the end of free convenience testing for unvaccinated individuals. Conclusion We characterized in-depth local heterogeneity and temporal trends in testing rates and identified areas and circumstances associated with low testing rates, which the regional health agency targeted specifically for the deployment of health mediation activities.
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Affiliation(s)
- Jordi Landier
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Léa Bassez
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Marc-Karim Bendiane
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
| | - Pascal Chaud
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Florian Franke
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Steve Nauleau
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Fabrice Danjou
- Agence Régionale de la Santé Provence Alpes Côte d’Azur, Marseille, France
| | - Philippe Malfait
- Santé Publique France Cellule Régionale Paca-Corse, Marseille, France
| | - Stanislas Rebaudet
- Aix Marseille Univ, IRD, INSERM, SESSTIM, Aix Marseille Institute of Public Health, ISSPAM, Marseille, France
- Hôpital Européen Marseille, Marseille, France
| | - Jean Gaudart
- Aix Marseille Univ, APHM, Inserm, IRD, SESSTIM, ISSPAM, Hop Timone, BioSTIC, Marseille, France
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Morales-Jadán D, Vallejo-Janeta AP, Bastidas V, Paredes-Espinosa MB, Freire-Paspuel B, Rivera-Olivero I, Ortiz-Prado E, Henriquez-Trujillo AR, Lozada T, Garcia-Bereguiain MA. High SARS-CoV-2 infection rates and viral loads in community-dwelling individuals from rural indigenous and mestizo communities from the Andes during the first wave of the COVID-19 pandemic in Ecuador. Front Med (Lausanne) 2023; 10:1001679. [PMID: 36844208 PMCID: PMC9949717 DOI: 10.3389/fmed.2023.1001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
Background Neglected indigenous groups and underserved rural populations in Latin America are highly vulnerable to COVID-19 due to poor health infrastructure and limited access to SARS-CoV-2 diagnosis. The Andean region in Ecuador includes a large number of isolated rural mestizo and indigenous communities living under poverty conditions. Objective We herein present a retrospective analysis of the surveillance SARS-CoV-2 testing in community-dwelling populations from four provinces in the Ecuadorian Andes, carried out during the first weeks after the national lockdown was lifted in June 2020. Results A total number of 1,021 people were tested for SARS-CoV-2 by RT-qPCR, resulting in an overall high infection rate of 26.2% (268/1,021, 95% CI: 23.6-29%), which was over 50% in several communities. Interestingly, community-dwelling super spreaders with viral loads over 108 copies/mL represented 7.46% (20/268, 95% CI: 4.8-11.1%) of the SARS-CoV-2 infected population. Conclusion These results support that COVID-19 community transmission in rural communities from the Andean region was happening at the early stages of the COVID-19 pandemic in Ecuador and point out the weakness of the COVID-19 control program. Community-dwelling individuals in neglected rural and indigenous communities should be considered for a successful control and surveillance program in future pandemics in low- and middle-income countries.
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Affiliation(s)
- Diana Morales-Jadán
- One Health Research Group, Universidad de las Américas, Quito, Ecuador,“UDLA COVID-19 Team, ” Universidad de Las Américas, Quito, Ecuador
| | - Alexander Paolo Vallejo-Janeta
- One Health Research Group, Universidad de las Américas, Quito, Ecuador,“UDLA COVID-19 Team, ” Universidad de Las Américas, Quito, Ecuador
| | - Vanessa Bastidas
- “UDLA COVID-19 Team, ” Universidad de Las Américas, Quito, Ecuador
| | | | | | | | - Esteban Ortiz-Prado
- One Health Research Group, Universidad de las Américas, Quito, Ecuador,Universidad Latina de Costa Rica, San José, Costa Rica
| | | | - Tannya Lozada
- “UDLA COVID-19 Team, ” Universidad de Las Américas, Quito, Ecuador
| | | | - Miguel Angel Garcia-Bereguiain
- One Health Research Group, Universidad de las Américas, Quito, Ecuador,Universidad Latina de Costa Rica, San José, Costa Rica,*Correspondence: Miguel Angel Garcia-Bereguiain ✉
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Ortiz-Prado E, Izquierdo-Condoy JS, Fernandez-Naranjo R, Vasconez J, Dávila Rosero MG, Revelo-Bastidas D, Herrería-Quiñonez D, Rubio-Neira M. The deadly impact of COVID-19 among children from Latin America: The case of Ecuador. Front Pediatr 2023; 11:1060311. [PMID: 37152328 PMCID: PMC10160383 DOI: 10.3389/fped.2023.1060311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 03/17/2023] [Indexed: 05/09/2023] Open
Abstract
Background The SARS-CoV-2 pandemic remains a critical global health concern, with older adults being the most vulnerable group. Nonetheless, it is crucial to recognize that COVID-19 has caused numerous deaths in children worldwide. Emerging evidence indicates that infants and breastfeeding children, particularly those aged below one year, face a greater risk of hospitalization and mortality than older children with COVID-19. Objective This study aimed to describe the epidemiology of COVID-19 among children during the early phase of the pandemic in Ecuador. Methods We conducted a country-wide population-based analysis of the epidemiology of COVID-19, using incidence and mortality data reported from Ecuador between February 15, 2020 and May 14 2021. Measurements of frequency, central tendency, dispersion, and absolute differences were calculated for all categorical and continuous variables. Results At least 34,001 cases (23,587 confirmed cases, 5,315 probable and 5,099 suspected) and 258 COVID-19 related deaths have been reported among children in Ecuador during the first 16 months of the pandemic. The overall incidence rate was 612 cases per 100,000 children, the mortality rate was 3 per 100,000, while the case fatality rate was 0.76%. The highest risk group for infection was children and adolescents between 15 and 19 years of age; however, the highest mortality rate occurred in children under one year of age. The largest provinces, such as Pichincha, Guavas and Manabí, were the ones that reported the highest number of cases, 27%, 12.1% and 10.8%, respectively. Conclusions This study is the first to report on COVID-19 epidemics among children in Ecuador. Our findings reveal that younger children have a lower risk of SARS-CoV-2 infection, but a higher risk of mortality compared to older children and adolescents. Additionally, we observed significant disparities in infection rates and outcomes among children living in rural areas, those with comorbidities, and those from indigenous ethnic groups.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
- Facultad de Ciencias de la Salud, Universidad Latina de Costa Rica,San José, Costa Rica
- Correspondence: Esteban Ortiz-Prado
| | - Juan S. Izquierdo-Condoy
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Raul Fernandez-Naranjo
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Jorge Vasconez
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - María Gabriela Dávila Rosero
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Doménica Revelo-Bastidas
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Diva Herrería-Quiñonez
- One Health Research Group, Faculty of Health Science, Universidad de Las Américas, Calle de los Colimes y Avenida De los Granados, Quito, Ecuador
| | - Mario Rubio-Neira
- Department of Cardiology, Baca Ortiz Pediatric Hospital, Quito, Ecuador
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Ortiz-Prado E, Vásconez JE, Vallejo-Janeta AP, Morales-Jadán D, Henriquez-Trujillo AR, Rivera-Olivero IA, Andrade F, Lozada T, Garcia-Bereguiain MA. High rates of SARS-CoV-2 infection in funeral home workers in Ecuador: Is it an occupational risk for COVID-19? Front Public Health 2022; 10:1012434. [PMID: 36438256 PMCID: PMC9692081 DOI: 10.3389/fpubh.2022.1012434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/29/2022] [Indexed: 11/13/2022] Open
Abstract
Aim The COVID-19 outbreak has already caused more than 6.5 million deaths, overwhelming health systems worldwide. The unusual demand for funeral home services could make these workers a potential risk group for occupational exposure to SARS-CoV-2 associated with corpses management for COVID-19 patients. Methodology This is a cross-sectional study aimed to describe the infection rate of SARS-CoV-2 in funeral home staff by testing them with RT-qPCR in Quito, Ecuador. A total of 232 funeral home workers, representing more than 40% of funeral home personnel in Quito, were included in the study, in June 2020, immediately after the population lockdown was lifted in Ecuador. Results A total of 48 individuals tested positive for SARS-CoV-2, yielding an infection rate of 20.7%. The SARS-CoV-2 infection rate was 18.1 and 20.0% among personnel managing corpses or not managing corpses, respectively. Among the SARS-CoV-2 positive patients, 81.3% reported no symptoms related to COVID-19, and 3 individuals had high viral loads over 108 copies/ml. Conclusion The high SARS-CoV-2 infection rate in funeral home staff suggested a potential occupational risk for COVID-19 but not related to corpses management. Public health guidelines for safe corpses management for COVID-19 victims and safe funeral services should be reinforced.
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Affiliation(s)
- Esteban Ortiz-Prado
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador,Universidad Latina de Costa Rica, San Jose, Costa Rica,*Correspondence: Esteban Ortiz-Prado
| | - Jorge Eduardo Vásconez
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | | | - Diana Morales-Jadán
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | | | - Ismar A. Rivera-Olivero
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Felipe Andrade
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador
| | - Tannya Lozada
- Decanato de Investigación y Vinculación, Universidad de Las Américas, Quito, Ecuador
| | - Miguel Angel Garcia-Bereguiain
- One Health Research Group, Faculty of Health Sciences, Universidad de Las Américas, Quito, Ecuador,Universidad Latina de Costa Rica, San Jose, Costa Rica,Miguel Angel Garcia-Bereguiain
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Vallejo-Janeta AP, Morales-Jadan D, Paredes-Espinosa MB, Coronel B, Galvis H, Bone-Guano HR, Amador Rodriguez B, Gomez Abeledo G, Freire-Paspuel B, Ortiz-Prado E, Rivera-Olivero I, Henriquez-Trujillo AR, Lozada T, Bereguiain MAG. Sustained COVID-19 community transmission and potential super spreading events at neglected afro-ecuadorian communities assessed by massive RT-qPCR and serological testing of community dwelling population. Front Med (Lausanne) 2022; 9:933260. [PMID: 36059834 PMCID: PMC9433781 DOI: 10.3389/fmed.2022.933260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 07/18/2022] [Indexed: 11/06/2022] Open
Abstract
Background Neglected ethnic minorities from underserved rural populations in Latin America are highly vulnerable to coronavirus disease 2019 (COVID-19) due to poor health infrastructure and limited access to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis. Esmeraldas is a mainly rural province of the Coastal Region of Ecuador characterized by a high presence of Afro-Ecuadorian population living under poverty conditions. Objective We herein present a retrospective analysis of the surveillance SARS-CoV-2 testing in community-dwelling population from Esmeraldas carried out by our university laboratory in collaboration with regional health authorities during the first week of October 2020, in a region where no public SARS-CoV-2 detection laboratory was available at that time. Results A total number of 1,259 people were tested for SARS-CoV-2 by Reverse Transcription quantitative Polimerasa Chain Reaction (RT-qPCR), resulting in an overall infection rate of 7.7% (97/1259, 95% CI: [6.32–9.35%]) for SARS-CoV-2, up to 12.1% in some communities. Interestingly, community-dwelling super spreaders with viral loads over 108 copies/ml represented 6.2% of the SARS-CoV-2-infected population. Furthermore, anti-SARS-CoV-2 IgG serological tests were applied to the same study group, yielding an overall seroprevalence of 11.68% (95% CI: [9.98–13.62%]) but as high as 24.47% at some communities. Conclusion These results support active COVID-19 community transmission in Esmeraldas province during the first semester of the COVID-19 pandemic as it has been shown for other rural communities in the Ecuadorian Coastal Region.
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Affiliation(s)
| | | | | | - Barbara Coronel
- “UDLA-COVID-19 Team”, Universidad de Las Américas, Quito, Ecuador
| | - Heberson Galvis
- “UDLA-COVID-19 Team”, Universidad de Las Américas, Quito, Ecuador
| | | | | | | | | | | | | | | | - Tannya Lozada
- Decanato de Investigación y Vinculación, Universidad de Las Américas, Quito, Ecuador
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Sansone NMS, Boschiero MN, Ortega MM, Ribeiro IA, Peixoto AO, Mendes RT, Marson FAL. Severe Acute Respiratory Syndrome by SARS-CoV-2 Infection or Other Etiologic Agents Among Brazilian Indigenous Population: An Observational Study from the First Year of Coronavirus Disease (COVID)-19 Pandemic. LANCET REGIONAL HEALTH. AMERICAS 2022; 8:100177. [PMID: 35018359 PMCID: PMC8739500 DOI: 10.1016/j.lana.2021.100177] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Indigenous peoples are vulnerable to pandemics, including to the coronavirus disease (COVID)-19, since it causes high mortality and specially, the loss of elderly Indigenous individuals. Methods The epidemiological data of severe acute respiratory syndrome (SARS) by SARS-CoV-2 infection or other etiologic agents (OEA) among Brazilian Indigenous peoples during the first year of COVID-19 pandemic was obtained from a Brazilian Ministry of Health open-access database to perform an observational study. Considering only Indigenous individuals diagnosed with SARS by COVID-19, the epidemiology data were also evaluated as risk of death. The type of sample collection for virus screening, demographic profile, clinical symptoms, comorbidities, and clinical evolution were evaluated. The primary outcome was considered the death in the Brazilian Indigenous individuals and the secondary outcome, the characteristics of Brazilian Indigenous infected by SARS-CoV-2 or OEA, as the need for intensive care unit admission or the need for mechanical ventilation support. The statistical analysis was done using Logistic Regression Model. Alpha of 0.05. Findings A total of 3,122 cases of Indigenous individuals with SARS in Brazil were reported during the first year of the COVID-19 pandemic. Of these, 1,994 were diagnosed with COVID-19 and 730/1,816 (40.2%) of them died. The death rate among individuals with SARS-CoV-2 was three-fold increased when compared to the group of individuals with OEA. Several symptoms (myalgia, loss of smell, and sore throat) and comorbidities (cardiopathy, systemic arterial hypertension, and diabetes mellitus) were more prevalent in the COVID-19 group when compared to Indigenous individuals with OEA. Similar profile was observed considering the risk of death among the Indigenous individuals with COVID-19 who presented several symptoms (oxygen saturation <95%, dyspnea, and respiratory distress) and comorbidities (renal disorders, cardiopathy, and diabetes mellitus). The multivariate analysis was significant in differentiating between the COVID-19-positive and non-COVID-19 patients [X2(7)=65.187; P-value<0.001]. Among the patients’ features, the following contributed in relation to the diagnosis of COVID-19: age [≥43 years-old [y.o.]; OR=1.984 (95%CI=1.480-2.658)]; loss of smell [OR=2.373 (95%CI=1.461-3.854)]; presence of previous respiratory disorders [OR=0.487; 95%CI=0.287-0.824)]; and fever [OR=1.445 (95%CI=1.082-1.929)]. Also, the multivariate analysis was able to predict the risk of death [X2(9)=293.694; P-value<0.001]. Among the patients’ features, the following contributed in relation to the risk of death: male gender [OR=1.507 (95%CI=1.010-2.250)]; age [≥60 y.o.; OR=3.377 (95%CI=2.292-4.974)]; the need for ventilatory support [invasive mechanical ventilation; OR=24.050 (95%CI=12.584-45.962) and non-invasive mechanical ventilation; OR=2.249 (95%CI=1.378-3.671)]; dyspnea [OR=2.053 (95%CI=1.196-3.522)]; oxygen saturation <95% [OR=1.691 (95%CI=1.050-2.723)]; myalgia [OR=0.423 (95%CI=0.191-0.937)]; and the presence of kidney disorders [OR=3.135 (95%CI=1.144-8.539)]. Interpretation The Brazilian Indigenous peoples are in a vulnerable situation during the COVID-19 pandemic and presented an increased risk of death due to COVID-19. Several factors were associated with enhanced risk of death, as male sex, older age (≥60 y.o.), and need for ventilatory support; also, other factors might help to differentiate SARS by COVID-19 or by OEA, as older age (≥43 y.o.), loss of smell, and fever. Funding Fundação de Amparo à Pesquisa do Estado de São Paulo (Foundation for Research Support of the State of São Paulo; #2021/05810-7).
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Key Words
- %, Percentage
- 95%CI, 95% Confidence Interval
- COVID-19
- COVID-19, Coronavirus Disease (2019)
- Ethnicity
- H1N1, H1N1 Strain of the Flu (Influenzae) virus
- HRCT, High-Resolution Computed Tomography
- ICU, Intensive Care Unit
- Indigenous
- Intensive Care Unit
- MV, Mechanical Ventilation
- NA, Not Applicable
- OEA, Other Etiologic Agents
- OR, Odds Ratio
- Pandemic
- RT-PCR, Real Time-Polymerase Chain Reaction
- Race
- Respiratory Disease
- SAH, Systemic Arterial Hypertension
- SARS, Severe Acute Respiratory Syndrome
- SARS-CoV, Severe Acute Respiratory Syndrome Coronavirus
- SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2
- SIVEP-Gripe, Information System for Epidemiological Surveillance of Influenza (Sistema de Informação de Vigilância Epidemiológica da Gripe)
- SUS, Sistema Único de Saúde (Brazilian Public Health System)
- Severe Acute Respiratory Syndrome
- Virus
- y.o., Years Old
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Affiliation(s)
- Nathália M S Sansone
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Matheus N Boschiero
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil
| | - Manoela M Ortega
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Isadora A Ribeiro
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
| | - Andressa O Peixoto
- Laboratory of Translational Medicine, Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas. Campinas, SP, Brazil
| | - Roberto T Mendes
- Laboratory of Translational Medicine, Center for Investigation in Pediatrics, School of Medical Sciences, University of Campinas. Campinas, SP, Brazil
| | - Fernando A L Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, SP, Brazil.,Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, SP, Brazil
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9
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Zambrano-Mila MS, Freire-Paspuel B, Orlando SA, Garcia-Bereguiain MA. SARS-CoV-2 infection in free roaming dogs from the Amazonian jungle. One Health 2022; 14:100387. [PMID: 35402682 PMCID: PMC8979833 DOI: 10.1016/j.onehlt.2022.100387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 03/23/2022] [Accepted: 04/01/2022] [Indexed: 11/24/2022] Open
Abstract
During the ongoing COVID-19 pandemic, there were several reports of SARS-CoV-2 transmission from human to animals, mostly to companion cats and dogs but also to free ranging wild species like minks and deers. Under this scenario, SARS-CoV-2 surveillance in domestic animals to assess the risk of transmission between species have been suggested by the OIE. Here we present a case report of SARS-CoV-2 infection in free roaming dogs, found at a rural indigenous community from the Ecuadorian Amazonia. Oral and nasal swabs samples were collected from three dogs found during a COVID-19 surveillance intervention in Amazonian indigenous communities where severe COVID-19 outbreaks were suspected. Total RNA was extracted from dog samples and detection of SARS-CoV-2 gene targets N, ORF1ab and S was performed. The three dogs tested positive for at least two SARS-CoV-2 viral targets. Moreover, there was a high SARS-CoV-2 infection rate of 87.2% within this community. Given that 17.1% of SARS-CoV-2 positive individuals had an ultra high load greater than 108 copies/ml, transmission from humans to dogs likely occurred. To our knowledge, this study is the first report of SARS-CoV-2 positive free roaming dogs. Also, as those animals were found in the Amazonian forest, SARS-CoV-2 transmission to wild mammals is a potential concern. Given the high presence of free roaming dogs associated to rural and indigenous communities in South America, the potential role of these domestic animals on COVID-19 spread would deserve further surveillance studies involving SARS-CoV-2 detection by PCR and molecular epidemiology based on genome sequencing to confirm human to dog transmission.
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10
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Santander-Gordon D, Iturralde GA, Freire-Paspuel B, Zambrano-Mila MS, Morales-Jadan D, Vallejo-Janeta PA, Coronel B, Galvis H, Jaramillo-Vivanco T, Bilvao CD, Paredes-Espinosa MB, Rodriguez AS, Laglaguano JC, Herrera H, Tito-Alvarez AM, Ortiz-Prado E, Rivera-Olivero IA, Henriquez-Trujillo AR, Lozada T, Garcia-Bereguiain MA. Crucial contribution of the universities to SARS-CoV-2 surveillance in Ecuador: Lessons for developing countries. One Health 2021; 13:100267. [PMID: 34056057 PMCID: PMC8146272 DOI: 10.1016/j.onehlt.2021.100267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 05/13/2021] [Accepted: 05/17/2021] [Indexed: 11/12/2022] Open
Abstract
COVID-19 pandemic has challenged public health systems worldwide, particularly affecting developing countries in Latin America like Ecuador. In this report, we exposed the fundamental role of the Ecuadorian universities to improve COVID-19 surveillance in the country, with an overall contribution over 15% of the total SARS-CoV-2 RT-PCR tests done. We highlight the role of our university during the first semester of the COVID-19 pandemic, contributing to a massive free SARS-CoV-2 testing up to almost 10% of the total diagnosis completed in the country, mainly focus on underserved urban, rural and indigenous communities. Finally, we described our contribution to a high quality and low-cost SARS-CoV-2 RT-PCR diagnostic in Ecuador.
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Affiliation(s)
- Daniela Santander-Gordon
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Gabriel A. Iturralde
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Byron Freire-Paspuel
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Marlon S. Zambrano-Mila
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Diana Morales-Jadan
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
| | - Paolo A. Vallejo-Janeta
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Barbara Coronel
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Heberson Galvis
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Tatiana Jaramillo-Vivanco
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Christian D. Bilvao
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Maria Belen Paredes-Espinosa
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Angel S. Rodriguez
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Juan C. Laglaguano
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Henry Herrera
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Ana M. Tito-Alvarez
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
- Carrera de Enfermería, Facultad de Ciencias de la Salud, Universidad de Las Américas, Quito, Ecuador
| | | | | | | | - Tannya Lozada
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
| | - Miguel Angel Garcia-Bereguiain
- Laboratorio de Diagnóstico de SARS-CoV-2, Dirección General de Investigación, Universidad de Las Américas, Quito, Ecuador
- One Health Research Group, Universidad de Las Américas, Quito, Ecuador
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11
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Perceived Risks of Infection, Hospitalization, and Death From COVID-19 at the Equator: Ecuador and Kenya. Disaster Med Public Health Prep 2021; 17:e34. [PMID: 34392868 PMCID: PMC8460420 DOI: 10.1017/dmp.2021.268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study's goal was to determine the perceived risks of infection as well as the perceived risks of hospitalization and death from COVID-19 in Ecuador and Kenya. It also assessed the factors associated with the risk-related perceptions. METHODS Cross-sectional studies with samples from the adult populations in both countries were conducted to assess the perceived risks of contracting COVID-19. Data were collected online using the Qualtrics platform (Qualtrics, Provo, Utah, United States) from samples of 1050 heads of households, aged 18 years or older, in each country. A total of 3 statistical analyses were conducted: summary statistics, correlation, and linear regression. RESULTS The average perceived risks of COVID-19 infection, hospitalization, and death in the Kenyan sample were 27.1%, 43.2%, and 17.2%, respectively, and the values for the Ecuadorian sample were 34%, 32.8%, and 23.3%, respectively. The Pearson's correlation coefficients between the risk measures in each country were less than 0.38. Risk measures were associated with several sociodemographic variables (e.g., income, gender, location), but not with age. CONCLUSIONS The perceived risks of COVID-19 infection, hospitalization, and death in Kenya and Ecuador were significantly higher relative to the statistics reported; however, no strong association existed between perceived risk and age, which is a key factor in adverse health outcomes, including death, among COVID-19 infected individuals.
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12
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Henriquez-Trujillo AR, Ortiz-Prado E, Rivera-Olivero IA, Nenquimo N, Tapia A, Anderson M, Lozada T, Garcia-Bereguiain MA. COVID-19 outbreaks among isolated Amazonian indigenous people, Ecuador. Bull World Health Organ 2021; 99:478-478A. [PMID: 34248216 PMCID: PMC8243033 DOI: 10.2471/blt.20.283028] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | - Esteban Ortiz-Prado
- One Health Research Group, Universidad de Las Américas, Via a Nayón S/N.170125, Quito, Ecuador
| | - Ismar A Rivera-Olivero
- One Health Research Group, Universidad de Las Américas, Via a Nayón S/N.170125, Quito, Ecuador
| | | | - Andrés Tapia
- Nacionalidad Kichwa de Pastaza and Confederation of Indigenous Nationalities of the Ecuadorian Amazon, Puyo, Ecuador
| | | | - Tannya Lozada
- One Health Research Group, Universidad de Las Américas, Via a Nayón S/N.170125, Quito, Ecuador
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