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Romero García C, Iftimi A, Briz-Redón Á, Zanin M, Otero M, Ballester M, de Andrés J, Landoni G, de las Marinas D, Catalá Bauset JC, Mandingorra J, Conca J, Correcher J, Ferrer C, Lozano M. Trends in Incidence and Transmission Patterns of COVID-19 in Valencia, Spain. JAMA Netw Open 2021; 4:e2113818. [PMID: 34143191 PMCID: PMC8214162 DOI: 10.1001/jamanetworkopen.2021.13818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Limited information on the transmission and dynamics of SARS-CoV-2 at the city scale is available. OBJECTIVE To describe the local spread of SARS-CoV-2 in Valencia, Spain. DESIGN, SETTING, AND PARTICIPANTS This single-center epidemiological cohort study of patients with SARS-CoV-2 was performed at University General Hospital in Valencia (population in the hospital catchment area, 364 000), a tertiary hospital. The study included all consecutive patients with COVID-19 isolated at home from the start of the COVID-19 pandemic on February 19 until August 31, 2020. EXPOSURES Cases of SARS-CoV-2 infection confirmed by the presence of IgM antibodies or a positive polymerase chain reaction test result on a nasopharyngeal swab were included. Cases in which patients with negative laboratory results met diagnostic and clinical criteria were also included. MAIN OUTCOMES AND MEASURES The primary outcome was the characterization of dissemination patterns and connections among the 20 neighborhoods of Valencia during the outbreak. To recreate the transmission network, the inbound and outbound connections were studied for each region, and the relative risk of infection was estimated. RESULTS In total, 2646 patients were included in the analysis. The mean (SD) age was 45.3 (22.5) years; 1203 (46%) were male and 1442 (54%) were female (data were missing for 1); and the overall mortality was 3.7%. The incidence of SARS-CoV-2 cases was higher in neighborhoods with higher household income (β2 [for mean income per household] = 0.197; 95% CI, 0.057-0.351) and greater population density (β1 [inhabitants per km2] = 0.228; 95% CI, 0.085-0.387). Correlations with meteorological variables were not statistically significant. Neighborhood 3, where the hospital and testing facility were located, had the most outbound connections (14). A large residential complex close to the city (neighborhood 20) had the fewest connections (0 outbound and 2 inbound). Five geographically unconnected neighborhoods were of strategic importance in disrupting the transmission network. CONCLUSIONS AND RELEVANCE This study of local dissemination of SARS-COV-2 revealed nonevident transmission patterns between geographically unconnected areas. The results suggest that tailor-made containment measures could reduce transmission and that hospitals, including testing facilities, play a crucial role in disease transmission. Consequently, the local dynamics of SARS-CoV-2 spread might inform the strategic lockdown of specific neighborhoods to stop the contagion and avoid a citywide lockdown.
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Affiliation(s)
- Carolina Romero García
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
- Division of Research Methodology, European University, Valencia, Spain
| | - Adina Iftimi
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | | | - Massimiliano Zanin
- Instituto de Física Interdisciplinar y Sistemas Complejos (CSIC-UIB), Palma de Mallorca, Spain
| | - Maria Otero
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
| | - Mayte Ballester
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
| | - José de Andrés
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
- Anesthesia Unit, Department of Surgical Specialties, Valencia University Medical School, Valencia, Spain
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), San Raffaele Scientific Institute, Milan, Italy
- Faculty of Medicine, Vita-Salute San Raffaele University, Milan, Italy
| | | | | | - Jesus Mandingorra
- Department of Information Technology, University General Hospital, Universidad Católica de Valencia, Valencia, Spain
- Universidad Católica de Valencia. Valencia, Spain
| | - José Conca
- Department of Information Technology, University General Hospital, Universidad Católica de Valencia, Valencia, Spain
| | - Juan Correcher
- Department of Statistics and Operations Research, University of Valencia, Valencia, Spain
| | - Carolina Ferrer
- Department of Anesthesia, Critical Care and Pain Unit, University General Hospital, Valencia, Spain
| | - Manuel Lozano
- Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine Department, Universitat de Valencia, Valencia, Spain
- Epidemiology and Environmental Health Joint Research Unit, Foundation for the Promotion of Health and Biomedical Research of Valencia Region, Universitat Jaume I−Universitat de Valencia, Valencia, Spain
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