Assessing pandemic preparedness, response, and lessons learned from the COVID-19 pandemic in four south American countries: agenda for the future.

Introduction: The COVID-19 pandemic emerged in a context that lacked adequate prevention, preparedness, and response (PPR) activities, and global, regional, and national leadership. South American countries were among world's hardest hit by the pandemic, accounting for 10.1% of total cases and 20.1% of global deaths. Methods: This study explores how pandemic PPR were affected by political, socioeconomic, and health system contexts as well as how PPR may have shaped pandemic outcomes in Argentina, Brazil, Colombia, and Peru. We then identify lessons learned and advance an agenda for improving PPR capacity at regional and national levels. We do this through a mixed-methods sequential explanatory study in four South American countries based on structured interviews and focus groups with elite policy makers. Results: The results of our study demonstrate that structural and contextual barriers limited PPR activities at political, social, and economic levels in each country, as well as through the structure of the health care system. Respondents believe that top-level government officials had insufficient political will for prioritizing pandemic PPR and post-COVID-19 recovery programs within their countries' health agendas. Discussion: We recommend a regional COVID-19 task force, post-pandemic recovery, social and economic protection for vulnerable groups, improved primary health care and surveillance systems, risk communication strategies, and community engagement to place pandemic PPR on Argentina, Brazil, Colombia, and Peru and other South American countries' national public health agendas.

Effectiveness and adherence to closed face shields in the prevention of COVID-19 transmission: a non-inferiority randomized controlled trial in a middle-income setting (COVPROSHIELD).

BACKGROUND: The use of respiratory devices can mitigate the spread of diseases such as COVID-19 in community settings. We aimed to determine the effectiveness of closed face shields with surgical face masks to prevent SARS-CoV-2 transmission in working adults during the COVID-19 pandemic in Bogotá, Colombia. METHODS: An open-label non-inferiority randomized controlled trial that randomly assigned participants to one of two groups: the intervention group was instructed to wear closed face shields with surgical face masks, and the active control group was instructed to wear only surgical face masks. The primary outcome was a positive reverse transcription polymerase chain reaction test, IgG/IgM antibody test for SARS-CoV-2 detection, or both during and at the end of the follow-up period of 21 days. The non-inferiority limit was established at - 5%. RESULTS: A total of 316 participants were randomized, 160 participants were assigned to the intervention group and 156 to the active control group. In total, 141 (88.1%) participants in the intervention group and 142 (91.0%) in the active control group completed the follow-up. PRIMARY OUTCOME: a positive SARS-CoV-2 test result was identified in one (0.71%) participant in the intervention group and three (2.1%) in the active control group. In the intention-to-treat analysis, the absolute risk difference was - 1.40% (95% CI [- 4.14%, 1.33%]), and in the per-protocol analysis, the risk difference was - 1.40% (95% CI [- 4.20, 1.40]), indicating non-inferiority of the closed face shield plus face mask (did not cross the non-inferiority limit). CONCLUSIONS: The use of closed face shields and surgical face masks was non-inferior to the surgical face mask alone in the prevention of SARS-CoV-2 infection in highly exposed groups. Settings with highly active viral transmission and conditions such as poor ventilation, crowding, and high mobility due to occupation may benefit from the combined use of masks and closed face shields to mitigate SARS-CoV-2 transmission. TRIAL REGISTRATION: ClinicalTrials.gov NCT04647305 . Registered on November 30, 2020.

Factors Associated With SARS-CoV-2 Infection in Bogotá, Colombia: Results From a Large Epidemiological Surveillance Study.

BACKGROUND: Epidemiologic surveillance of COVID-19 is essential to collect and analyse data to improve public health decision making during the pandemic. There are few initiatives led by public-private alliances in Colombia and Latin America. The CoVIDA project contributed with RT-PCR tests for SARS-CoV-2 in mild or asymptomatic populations in Bogotá. The present study aimed to determine the factors associated with SARS-CoV-2 infection in working adults. METHODS: COVID-19 intensified sentinel epidemiological surveillance study, from April 18, 2020, to March 29, 2021. The study included people aged 18 years or older without a history of COVID-19. Two main occupational groups were included: healthcare and essential services workers with high mobility in the city. Social, demographic, and health-related factors were collected via phone survey. Afterwards, the molecular test was conducted to detect SARS-CoV-2 infection. FINDINGS: From the 58,638 participants included in the study, 3,310 (5·6%) had a positive result. A positive result was associated with the age group (18-29 years) compared with participants aged 60 or older, participants living with more than three cohabitants, living with a confirmed case, having no affiliation to the health system compared to those with social health security, reporting a very low socioeconomic status compared to those with higher socioeconomic status, and having essential occupations compared to healthcare workers. INTERPRETATION: The CoVIDA study showed the importance of intensified epidemiological surveillance to identify groups with increased risk of infection. These groups should be prioritised in the screening, contact tracing, and vaccination strategies to mitigate the pandemic. FUNDING: The CoVIDA study was funded through donors managed by the philanthropy department of Universidad de los Andes.