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Ledesma JR, Papanicolas I, Stoto MA, Chrysanthopoulou SA, Isaac CR, Lurie MN, Nuzzo JB. Pandemic preparedness improves national-level SARS-CoV-2 infection and mortality data completeness: a cross-country ecologic analysis. Popul Health Metr 2024; 22:12. [PMID: 38879515 PMCID: PMC11179302 DOI: 10.1186/s12963-024-00333-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 06/11/2024] [Indexed: 06/19/2024] Open
Abstract
BACKGROUND Heterogeneity in national SARS-CoV-2 infection surveillance capabilities may compromise global enumeration and tracking of COVID-19 cases and deaths and bias analyses of the pandemic's tolls. Taking account of heterogeneity in data completeness may thus help clarify analyses of the relationship between COVID-19 outcomes and standard preparedness measures. METHODS We examined country-level associations of pandemic preparedness capacities inventories, from the Global Health Security (GHS) Index and Joint External Evaluation (JEE), on SARS-CoV-2 infection and COVID-19 death data completion rates adjusted for income. Analyses were stratified by 100, 100-300, 300-500, and 500-700 days after the first reported case in each country. We subsequently reevaluated the relationship of pandemic preparedness on SARS-CoV-2 infection and age-standardized COVID-19 death rates adjusted for cross-country differentials in data completeness during the pre-vaccine era. RESULTS Every 10% increase in the GHS Index was associated with a 14.9% (95% confidence interval 8.34-21.8%) increase in SARS-CoV-2 infection completion rate and a 10.6% (5.91-15.4%) increase in the death completion rate during the entire observation period. Disease prevention (infections: β = 1.08 [1.05-1.10], deaths: β = 1.05 [1.04-1.07]), detection (infections: β = 1.04 [1.01-1.06], deaths: β = 1.03 [1.01-1.05]), response (infections: β = 1.06 [1.00-1.13], deaths: β = 1.05 [1.00-1.10]), health system (infections: β = 1.06 [1.03-1.10], deaths: β = 1.05 [1.03-1.07]), and risk environment (infections: β = 1.27 [1.15-1.41], deaths: β = 1.15 [1.08-1.23]) were associated with both data completeness outcomes. Effect sizes of GHS Index on infection completion (Low income: β = 1.18 [1.04-1.34], Lower Middle income: β = 1.41 [1.16-1.71]) and death completion rates (Low income: β = 1.19 [1.09-1.31], Lower Middle income: β = 1.25 [1.10-1.43]) were largest in LMICs. After adjustment for cross-country differences in data completeness, each 10% increase in the GHS Index was associated with a 13.5% (4.80-21.4%) decrease in SARS-CoV-2 infection rate at 100 days and a 9.10 (1.07-16.5%) decrease at 300 days. For age-standardized COVID-19 death rates, each 10% increase in the GHS Index was with a 15.7% (5.19-25.0%) decrease at 100 days and a 10.3% (- 0.00-19.5%) decrease at 300 days. CONCLUSIONS Results support the pre-pandemic hypothesis that countries with greater pandemic preparedness capacities have larger SARS-CoV-2 infection and mortality data completeness rates and lower COVID-19 disease burdens. More high-quality data of COVID-19 impact based on direct measurement are needed.
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Affiliation(s)
- Jorge R Ledesma
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI, 02912, USA.
| | - Irene Papanicolas
- Department of Health Services, Policy and Practice, Brown University School of Public Health, 121 S Main St, Providence, RI, 02912, USA
| | - Michael A Stoto
- Department of Health Management and Policy, School of Health, Georgetown University, 3700 Reservoir Road, N.W., Washington, DC, 20057, USA
| | - Stavroula A Chrysanthopoulou
- Department of Biostatistics, Brown University School of Public Health, 121 S Main St, Providence, RI, 02912, USA
| | - Christopher R Isaac
- Nuclear Threat Initiative, 1776 Eye Street, NW, Suite 600, Washington, DC, 20006, USA
| | - Mark N Lurie
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI, 02912, USA
- International Health Institute, Brown University School of Public Health, 121 S Main St, Providence, RI, 02912, USA
- Population Studies and Training Center, Brown University, 68 Waterman St., Box 1836, Providence, RI, 02912, USA
| | - Jennifer B Nuzzo
- Department of Epidemiology, Brown University School of Public Health, 121 S Main St, Providence, RI, 02912, USA
- Pandemic Center, Brown University School of Public Health, 121 S Main St, Providence, RI, 02912, USA
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Dynamics of SARS-CoV-2 Variants of Concern in Vaccination Model City in the State of Sao Paulo, Brazil. Viruses 2022; 14:v14102148. [PMID: 36298703 PMCID: PMC9609010 DOI: 10.3390/v14102148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/02/2022] [Accepted: 09/09/2022] [Indexed: 12/02/2022] Open
Abstract
From a country with one of the highest SARS-CoV-2 morbidity and mortality rates, Brazil has implemented one of the most successful vaccination programs. Brazil's first model city vaccination program was performed by the CoronaVac vaccine (Sinovac Biotech) in the town of Serrana, São Paulo State. To evaluate the vaccination effect on the SARS-CoV-2 molecular dynamics and clinical outcomes, we performed SARS-CoV-2 molecular surveillance on 4375 complete genomes obtained between June 2020 and April 2022 in this location. This study included the period between the initial SARS-CoV-2 introduction and during the vaccination process. We observed that the SARS-CoV-2 substitution dynamics in Serrana followed the viral molecular epidemiology in Brazil, including the initial identification of the ancestral lineages (B.1.1.28 and B.1.1.33) and epidemic waves of variants of concern (VOC) including the Gamma, Delta, and, more recently, Omicron. Most probably, as a result of the immunization campaign, the mortality during the Gamma and Delta VOC was significantly reduced compared to the rest of Brazil, which was also related to lower morbidity. Our phylogenetic analysis revealed the evolutionary history of the SARS-CoV-2 in this location and showed that multiple introduction events have occurred over time. The evaluation of the COVID-19 clinical outcome revealed that most cases were mild (88.9%, 98.1%, 99.1% to Gamma, Delta, and Omicron, respectively) regardless of the infecting VOC. In conclusion, we observed that vaccination was responsible for reducing the death toll rate and related COVID-19 morbidity, especially during the gamma and Delta VOC; however, it does not prevent the rapid substitution rate and morbidity of the Omicron VOC.
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