[Response capacity to the COVID-19 pandemic in Latin America and the Caribbean]

Exploring Prehospital Data for Pandemic Preparedness: A Western Brazilian Amazon Case Study on COVID-19

BACKGROUND

The timely management of rapidly evolving epidemiological scenarios caused by disease outbreaks is crucial to prevent devastating consequences. However, delayed laboratory diagnostics can hamper swift health policy and epidemic response, especially in remote regions such as the western Brazilian Amazon. The aim of the article is to analyze the impact of the COVID-19 pandemic on the volume and characteristics of emergency medical services (EMS) in Manaus, focusing on how the pandemic affected sensitive indicators such as response time and the use of advanced life support ambulances. Additionally, the study seeks to understand how changes in prehospital EMS patterns, triggered by the pandemic, could be utilized as health surveillance tools, enabling a more rapid response in epidemic scenarios.

METHODS

This retrospective, descriptive study included data from the SAMU (Serviço de Atendimento Móvel de Urgência) medical records between January and June 2020.

RESULTS

A total of 45,581 calls resulted in mobile units being dispatched during this period. These patients were predominantly male (28,227, 61.9%), with a median age of 47 years (IQR 30-67). The median response time significantly increased during the pandemic, reaching a median of 45.9 min (IQR 30.6-67.7) (p < 0.001). EMS calls were reduced for trauma patients and increased for other medical emergencies, especially respiratory conditions, concomitantly to an escalation in the number of deaths caused by SARS and COVID-19 (p < 0.001). The employment of advanced life support ambulances was higher during the pandemic phase (p = 0.0007).

CONCLUSION

The COVID-19 pandemic resulted in a temporary disorder in the volume and reason for EMS calls in Manaus. Consequently, sensitive indicators like the response time and the employment of advanced life support ambulances were negatively affected. Sudden prehospital EMS pattern changes could play an important role in health surveillance systems, allowing for earlier establishment of countermeasures in epidemics. The impact of the COVID-19 pandemic on prehospital EMS and its role in health surveillance should be further explored.

Intersectoral collaboration in the COVID-19 response in Latin America and the Caribbean

World Health Organization (WHO) / Pan American Health Organization (PAHO) encouraged the utilization of whole-of-society and whole-of-government strategic approaches to increase countries' resilience towards mitigating the impact of the COVID-19 pandemic. Strategies included the implementation of multi-sectoral, multi-partner and multi-stakeholder planning, coordination, consultation, and action. We reviewed the experiences of three Latin American and Caribbean countries, related to the implementation of collaborative strategies in tackling COVID-19, specifically the nature of the collaboration, the dynamics and the stakeholders involved.A systematic literature review identified relevant publications and content analysis was conducted to determine the collaborative strategies. Colombia, Costa Rica, and Trinidad and Tobago were selected as case studies since they were from different LAC subregions and because of the accessibility of relevant literature.In the three countries, the pandemic response was coordinated by a national executive committee, led by the Ministry of Health. Intersectoral collaboration was evident in each, with the key stakeholders being public sector agencies, the private/corporate sector, private/non-profit, academic institutions, and international agencies. It was used primarily to facilitate data-driven, evidenced-informed decision-making and guidelines; to expand clinical care capacity and strengthen the national medical response; and to provide support for the most vulnerable populations.While the institutionalization of intersectoral collaboration can be recommended for the health sector beyond the pandemic, research is needed to evaluate the impact of specific collaborative strategies as well as barriers and facilitators.

Health Behavior and Attitudes During the COVID-19 Pandemic Among Vulnerable and Underserved Latinx in the Southwest USA

The COVID-19 pandemic highlighted deep-rooted health disparities, particularly among Latinx immigrants living on the Mexico-US border. This article investigates differences between populations and adherence to COVID-19 preventive measures. This study investigated whether there are differences between Latinx recent immigrants, non-Latinx Whites, and English-speaking Latinx in their attitudes and adherence to COVID-19 preventive measures. Data came from 302 participants who received a free COVID-19 test at one of the project sites between March and July 2021. Participants lived in communities with poorer access to COVID-19 testing. Choosing to complete the baseline survey in Spanish was a proxy for being a recent immigrant. Survey measures included the PhenX Toolkit, COVID-19 mitigating behaviors, attitudes toward COVID-19 risk behaviors and mask wearing, and economic challenges during the COVID-19 pandemic. With multiple imputation, ordinary least squares (OLS) regression was used to analyze between-group differences in mitigating attitudes and behaviors toward COVID-19 risk. Adjusted OLS regression analyses showed that Latinx surveyed in Spanish perceived COVID-19 risk behaviors as more unsafe (b = 0.38, p = .001) and had stronger positive attitudes toward mask wearing (b = 0.58, p = .016), as compared to non-Latinx Whites. No significant differences emerged between Latinx surveyed in English and non-Latinx Whites (p > .05). Despite facing major structural, economic, and systemic disadvantages, recent Latinx immigrants showed more positive attitudes toward public health COVID-19 mitigating measures than other groups. The findings have implications for future prevention research about community resilience, practice, and policy.

Resilient health systems for already resilient countries? Pandemic discourses in the post-COVID-19 era

This study aimed to reconstruct and analyze the discourses of the pandemic in the post-COVID-19 era. The methodology was based on a critical review of the scientific literature on the pandemic, selecting 80 non-biomedical, clinical, or pharmacological articles published in journals indexed in Scopus or Web of Science from a sample of the 500 most cited scientific articles on the pandemic in Google Scholar. The theoretical approach was based on the debates on predictability, unpredictability, determination, and indeterminacy in the health and social sciences. As a result, six theses on the pandemic were identified and analyzed: a) the thesis of the unpredictability of pandemics; b) the thesis of pandemic denial; c) the thesis of the pandemic as a failure in predictability systems; d) the thesis of the prevention of catastrophic events with timely interventions; e) the thesis of the structural postponement of predictive care by non-developed countries; and f) the environmentalist-health thesis, of foreseeing a critical phase for the planet and humanity. We concluded on the limits of resilience as the center in preparing Latin American health systems in the post-pandemic.

Phylodynamic of SARS-CoV-2 during the second wave of COVID-19 in Peru

At over 0.6% of the population, Peru has one of the highest SARS-CoV-2 mortality rate in the world. Much effort to sequence genomes has been done in this country since mid-2020. However, an adequate analysis of the dynamics of the variants of concern and interest (VOCIs) is missing. We investigated the dynamics of the COVID-19 pandemic in Peru with a focus on the second wave, which had the greatest case fatality rate. The second wave in Peru was dominated by Lambda and Gamma. Analysis of the origin of Lambda shows that it most likely emerged in Peru before the second wave (June-November, 2020). After its emergence it reached Argentina and Chile from Peru where it was locally transmitted. During the second wave in Peru, we identify the coexistence of two Lambda and three Gamma sublineages. Lambda sublineages emerged in the center of Peru whereas the Gamma sublineages more likely originated in the north-east and mid-east. Importantly, it is observed that the center of Peru played a prominent role in transmitting SARS-CoV-2 to other regions within Peru.

Spatio-temporal multidisciplinary analysis of socio-environmental conditions to explore the COVID-19 early evolution in urban sites in South America

This study aimed to analyse how socio-environmental conditions affected the early evolution of COVID-19 in 14 urban sites in South America based on a spatio-temporal multidisciplinary approach. The daily incidence rate of new COVID-19 cases with symptoms as the dependent variable and meteorological-climatic data (mean, maximum, and minimum temperature, precipitation, and relative humidity) as the independent variables were analysed. The study period was from March to November of 2020. We inquired associations of these variables with COVID-19 data using Spearman's non-parametric correlation test, and a principal component analysis considering socio economic and demographic variables, new cases, and rates of COVID-19 new cases. Finally, an analysis using non-metric multidimensional scale ordering by the Bray-Curtis similarity matrix of meteorological data, socio economic and demographic variables, and COVID-19 was performed. Our findings revealed that the average, maximum, and minimum temperatures and relative humidity were significantly associated with rates of COVID-19 new cases in most of the sites, while precipitation was significantly associated only in four sites. Additionally, demographic variables such as the number of inhabitants, the percentage of the population aged 60 years and above, the masculinity index, and the GINI index showed a significant correlation with COVID-19 cases. Due to the rapid evolution of the COVID-19 pandemic, these findings provide strong evidence that biomedical, social, and physical sciences should join forces in truly multidisciplinary research that is critically needed in the current state of our region.

A systematic review of the impact of corruption in Latin America during the spread of the first wave of COVID-19

As the Covid-19 pandemic crisis raged in Latin America, numerous acts of corruption affected containment strategies and weakened institutional systems. A systematic review was conducted during the first wave of contagion in 2020 to analyse the relationship between corruption and Covid-19 in Latin American countries, highlighting its components and the institutions involved. Following the PRISMA guidelines, scientific databases and prepublications were searched using the terms (((SARS-CoV-2) OR (Covid-19)) AND ((Corruption [Mesh]) AND (Latin America))). Seventy-two studies were included in the initial search, 36 in MEDLINE/PubMed, 20 in Scielo, and 11 prepublications. Of the 25 eligible studies, none met the required standard for inclusion. Although corruption is endemic in Latin America, its levels and impact during the first wave of Covid-19 contagion have not been quantified.

COVID19 in Latin America: informal settlements and the politics of urbicide

Informal settlements in Latin America express pandemic idiosyncrasies, calling global attention to historical problems related to a specific urbanization pattern. This article stresses COVID19 implications in the main urban planning canon: the notion of densification as an urban solution. Traditionally invisible social groups and territories acquire relevance, but now as a source of biological risk. Urban density appears as a contradictory trigger point, outlining new debates about informal settlements and their metrics. Evidence shows that trends in health discourse are striving to legitimize and enhance "urbicides" in this scenario, already underway through State action or inaction.

Acceptance towards COVID-19 vaccination in Latin America and the Caribbean: A systematic review and meta-analysis

INTRODUCTION

Vaccination represents an important strategy to mitigate COVID-19 related morbidity and mortality by protecting against severe forms of the disease and reducing hospitalization and death rates. In this sense, the objective of this study is to estimate the prevalence of Vaccination Intention (VI) against COVID-19 in Latin America and Caribbean (LAC).

METHODS

We conducted a systematic review with a comprehensive search strategy for the following databases: PubMed, Scopus and Web of Science. A random-effect model meta-analysis was carried out using observational studies assessing the intention to vaccines against COVID-19 in LAC countries. The Clopper-Pearson method was used to estimate 95% Confidence Intervals. The quality assessment was developed using the Newcastle-Ottawa Scale adapted for cross-sectional studies. A subgroup analysis by study location and a sensitivity analysis were developed.

RESULTS

Nineteen cross-sectional studies were included. Five meta-analyzes were performed according to the target population of the included studies. The VI in the general population of LAC was 78.0% (95%CI: 74.0%-82.0%). The VI for non-pregnant women was 78.0% (95%CI: 58.0%-99.0%), for elderly population was 63.0% (95%CI: 59.0%-69.0%), for pregnant women was 69.0% (95%CI: 61.0%-76.0%) and for health-personnel was 83.0% (95% CI: 71.0%-96.0%). The sensitivity analysis for general population meta-analysis that included only low risk of bias studies showed a 77.0% VI (95%CI: 73.0%-82.0%) and for non-pregnant women, 85.0% VI (95%CI: 79.0%-90.0%).

CONCLUSION

Despite the high prevalence of VI in general population found in our study, VI prevalence from elderly people and pregnant women are lower than other population groups and overall population.

COVID-19 seen from a syndemic perspective: Impact of unhealthy habits and future perspectives to combat these negative interactions in Latin America

COVID-19 has to this point led to more than 5 million deaths and has imposed numerous measures restricting populations worldwide, including Latin America (LA). However, analyzing COVID-19 from the perspective of a syndemic, it demonstrates the relationship between the interaction of multiple comorbidities and the increase of contagion in people who are socially vulnerable. The number of deaths by COVID-19 in LA is strongly associated with multi-morbidities (diabetes, obesity, sedentary, smoking, among others) and disproportionately attacks communities located in poorer, low-income regions and ethnic minorities. This review aims to revisit the relationship between COVID-19 and both unhealthy living habits (i.e., sedentary lifestyle, poor nutritional habits, overweight and obesity, smoking) and cardiovascular disease in Latin American countries. In addition, this review aims to introduce strategies and policies that combat social inequalities and enable healthy living behaviors in LA countries. If LA countries do not work on public policies that decrease multi-morbidities and social inequalities, we will be unable to eliminate COVID-19, as well as possible other outbreaks that may arise in the future.

The urgent need for metallo-β-lactamase inhibitors: an unattended global threat

Due to their superior tolerability and efficacy, β-lactams are the most potent and prescribed class of antibiotics in the clinic. The emergence of resistance to those antibiotics, mainly due to the production of bacterial enzymes called β-lactamases, has been partially solved by the introduction of β-lactamase inhibitors, which restore the activity of otherwise obsolete molecules. This solution is limited because currently available β-lactamase inhibitors only work against serine β-lactamases, whereas metallo-β-lactamases continue to spread, evolve, and confer resistance to all β-lactams, including carbapenems. Furthermore, the increased use of antibiotics to treat secondary bacterial pneumonia in severely sick patients with COVID-19 might exacerbate the problem of antimicrobial resistance. In this Personal View, we summarise the main advances accomplished in this area of research, emphasise the main challenges that need to be solved, and the importance of research on inhibitors for metallo-B-lactamases amidst the current pandemic.

Understanding and addressing COVID-19 vaccine hesitancy in low and middle income countries and in people with severe mental illness: Overview and recommendations for Latin America and the Caribbean

Despite the speedy development of vaccines for COVID-19, their rollout has posed a major public health challenge, as vaccine hesitancy (VH) and refusal are high. Addressing vaccine hesitancy is a multifactorial and context-dependent challenge. This perspective focuses on VH in the world region of Latin America and the Caribbean (LAC) and includes people suffering from severe mental illness, therefore covering populations and subpopulations often neglected in scientific literature. We present an overview of VH in LAC countries, discussing its global and historical context. Vaccine uptake has shown to widely vary across different subregions of LAC. Current data points to a possible correlation between societal polarization and vaccination, especially in countries going through political crises such as Brazil, Colombia, and Venezuela. Poor accessibility remains an additional important factor decreasing vaccination rollout in LAC countries and even further, in the whole Global South. Regarding patients with severe mental illness in LAC, and worldwide, it is paramount to include them in priority groups for immunization and monitor their vaccination coverage through public health indicators.

Socio-Demographic Variables, Fear of COVID-19, Anxiety, and Depression: Prevalence, Relationships and Explanatory Model in the General Population of Seven Latin American Countries

The COVID-19 pandemic has gravely impacted Latin America. A model was tested that evaluated the contribution of socio-demographic factors and fear of COVID-19 on anxiety and depression in samples of residents in seven Latin American countries (Argentina, Ecuador, Mexico, Paraguay, Uruguay, Colombia, and El Salvador). A total of 4,881 individuals, selected by convenience sampling, participated in the study. Moderate and severe levels of depressive symptoms and anxiety were identified, as well as a moderate average level of fear of COVID-19. In addition, it was observed that about a quarter of the participants presented symptoms of generalized anxiety disorder and a major depressive episode. Fear of COVID-19 significantly and positively predicted anxiety and depressive symptoms, whereas the effects of socio-demographic variables are generally low [χ2(287) = 5936.96, p < 0.001; RMSEA = 0.064 [0.062, 0.065]; CFI = 0.947; and SRMR = 0.050]. This suggests the need for the implementation of preventive actions in the general population of these countries, with the aim of reducing the prevalence of depressive, anxious and fearful symptoms related to COVID-19.

Investigating regional excess mortality during 2020 COVID-19 pandemic in selected Latin American countries

In this paper, we measure the effect of the 2020 COVID-19 pandemic wave at the national and subnational levels in selected Latin American countries that were most affected: Brazil, Chile, Ecuador, Guatemala, Mexico, and Peru. We used publicly available monthly mortality data to measure the impacts of the pandemic using excess mortality for each country and its regions. We compare the mortality, at national and regional levels, in 2020 to the mortality levels of recent trends and provide estimates of the impact of mortality on life expectancy at birth. Our findings indicate that from April 2020 on, mortality exceeded its usual monthly levels in multiple areas of each country. In Mexico and Peru, excess mortality was spreading through many areas by the end of the second half of 2020. To a lesser extent, we observed a similar pattern in Brazil, Chile, and Ecuador. We also found that as the pandemic progressed, excess mortality became more visible in areas with poorer socioeconomic and sanitary conditions. This excess mortality has reduced life expectancy across these countries by 2-10 years. Despite the lack of reliable information on COVID-19 mortality, excess mortality is a useful indicator for measuring the effects of the coronavirus pandemic, especially in the context of Latin American countries, where there is still a lack of good information on causes of death in their vital registration systems.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1186/s41118-021-00139-1.

Poverty and survival from COVID-19 in Mexico

BACKGROUND

Recent evidence points to the relevance of poverty and inequality as factors affecting the spread and mortality of the COVID-19 pandemic in Latin America. This study aimed to determine whether COVID-19 patients living in Mexican municipalities with high levels of poverty have a lower survival compared with those living in municipalities with low levels.

METHODS

Retrospective cohort study. Secondary data was used to define the exposure (multidimensional poverty level) and outcome (survival time) among patients diagnosed with COVID-19 between 27 February and 1 July 2020. Crude and adjusted hazard ratios (HR) from Cox regression were computed.

RESULTS

Nearly 250 000 COVID-19 patients were included. Mortality was 12.3% reaching 59.3% in patients with ≥1 comorbidities. Multivariate survival analyses revealed that individuals living in municipalities with extreme poverty had 9% higher risk of dying at any given time proportionally to those living in municipalities classified as not poor (HR 1.09; 95% CI 1.06-1.12). The survival gap widened with the follow-up time up to the third to fourth weeks after diagnosis.

CONCLUSION

Evidence suggests that the poorest population groups have a lower survival from COVID-19. Thus, combating extreme poverty should be a central preventive strategy.

COVID-19 Mortality Rate and Its Incidence in Latin America: Dependence on Demographic and Economic Variables

The pandemic caused by COVID-19 has left millions infected and dead around the world, with Latin America being one of the most affected areas. In this work, we have sought to determine, by means of a multiple regression analysis and a study of correlations, the influence of population density, life expectancy, and proportion of the population in vulnerable employment, together with GDP per capita, on the mortality rate due to COVID-19 in Latin American countries. The results indicated that countries with higher population density had lower numbers of deaths. Population in vulnerable employment and GDP showed a positive influence, while life expectancy did not appear to significantly affect the number of COVID-19 deaths. In addition, the influence of these variables on the number of confirmed cases of COVID-19 was analyzed. It can be concluded that the lack of resources can be a major burden for the vulnerable population in combating COVID-19 and that population density can ensure better designed institutions and quality infrastructure to achieve social distancing and, together with effective measures, lower death rates.

Precautionary Behaviors during the Second and Third Phases of the COVID-19 Pandemic: Comparative Study in the Latin American Population

The population's behavioral responses to containment and precautionary measures during the COVID-19 pandemic have played a fundamental role in controlling the contagion. A comparative analysis of precautionary behaviors in the region was carried out. A total of 1184 people from Mexico, Colombia, Chile, Cuba, and Guatemala participated through an online survey containing a questionnaire on sociodemographic factors, precautionary behaviors, information about COVID-19, concerns, maintenance of confinement, and medical symptoms associated with COVID-19. Cubans reported the highest scores for information about COVID-19. Colombians reported less frequent usage of precautionary measures (e.g., use of masks), but greater adherence to confinement recommendations in general, in contrast to the low levels of these behaviors in Guatemalans. Chileans reported greater pandemic-related concerns and the highest number of medical symptoms associated with COVID-19. These findings allow a partial characterization of the Latin American population's responses during the second and third phases of the COVID-19 pandemic and highlight the importance of designing and managing public health policies according to the circumstances of each population when facing pandemics.

Eating habits, lifestyle behaviors and stress during the COVID-19 pandemic quarantine among Peruvian adults

BACKGROUND AND AIMS

The coronavirus disease 2019 (COVID-19) outbreak has led to an unprecedented public health crisis. In Peru, although the quarantine is no longer mandatory, it was during the first months of 2020. To date, no studies have assessed the impact of the COVID-19 on the eating patterns and lifestyle context in the country. We aimed to describe the eating habits, lifestyle behaviors and stress during the COVID-19 pandemic quarantine among Peruvian adults.

METHODS

We conducted a cross-sectional study. We used an online survey to collect information regarding eating habits, self-perceived stress and sedentary lifestyle among adults over 18 years of age residing in Lima-Peru and who complied with strict home quarantine. We presented our data according to the weight variation of the participants.

RESULTS

A total of 686 were finally included in the study. The 82.9% were female, the median BMI was 25.97 kg/m2 (IQR: 23.37-29.41) and 68.2% reported a significant variation in their weight (38.9% increased and 29.3% lost weight). All bad habits were significantly associated with weight gain, except for prolonged fasting. Additionally, a sitting time longer than usual (p = 0.001), being in front of a screen for more than five hours in the last week (p = 0.002), and most of the stressful scenarios were significantly associated with weight gain.

CONCLUSION

Almost four out of ten participants gained weight during the quarantine. This was associated with unhealthy eating habits, physical inactivity, and stressful scenarios.

Public health matters: why is Latin America struggling in addressing the pandemic?

This article examines how Argentina, Brazil, Chile, Colombia, Mexico, and Peru addressed the COVID-19 pandemic and the effectiveness of these policy responses from the date each country declared a sanitary emergency, between middle and late March 2020 to the most recent available measurement on 23 September 2020. To analyze how governments responded to the COVID-19 pandemic in these six Latin American countries, we use an index of government response, created by the University of Oxford. To explore the effects of these governmental mitigation policies on reducing social mobility, we use Google mobility reports. We also analyze how these policies may have influenced COVID-19 mortality rates. Overall, the results showed that both timelier and more stringent implementation of the public policies analyzed to address the COVID-19 pandemic seem to be associated with higher mobility reductions and lower mortality rates. We draw five policy lessons from the way each country implemented these mitigation policies. KEY MESSAGE: Timelier and more stringent implementation of these public policies may contribute to a higher mobility reduction in several public spaces and to lower mortality rates. The effectiveness of the closure and containment policies in each Latin American country seem to depend on the degree of compliance of their respective populations and to their socioeconomic living conditions. Economic and social policies of income support and debt relief provided by governments allowed people to comply with closure and containment policies. Health systems should maintain high levels of policy stringency together with effective surveillance through testing policy and contact tracing.