Cost-effectiveness of COVID-19 vaccination in Latin America and the Caribbean: an analysis in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru.

OBJECTIVE: Our study analyzes the cost-effectiveness of the COVID-19 vaccination campaigns in Argentina, Brazil, Chile, Colombia, Costa Rica, Mexico, and Peru. METHODS: Using a previously published SVEIR model, we analyzed the impact of a vaccination campaign (2021) from a national healthcare perspective. The primary outcomes were quality adjusted life years (QALYs) lost and total costs. Other outcomes included COVID-19 cases, hospitalizations, deaths, and life years. We applied a discount rate of 3% for health outcomes. We modeled a realistic vaccination campaign in each country (the realistic country-specific campaign). Additionally, we assessed a standard campaign (similar, "typical" for all countries), and an optimized campaign (similar in all countries with higher but plausible population coverage). One-way deterministic sensitivity analyses were performed. FINDINGS: Vaccination was health improving as well as cost-saving in almost all countries and scenarios. Our analysis shows that vaccination in this group of countries prevented 573,141 deaths (508,826 standard; 685,442 optimized) and gained 5.07 million QALYs (4.53 standard; 6.03 optimized). Despite the incremental costs of vaccination campaigns, they had a total net cost saving to the health system of US$16.29 billion (US$16.47 standard; US$18.58 optimized). The realistic (base case) vaccination campaign in Chile was the only scenario, which was not cost saving, but it was still highly cost-effective with an ICER of US$22 per QALY gained. Main findings were robust in the sensitivity analyses. INTERPRETATION: The COVID-19 vaccination campaign in seven Latin American and Caribbean countries -that comprise nearly 80% of the region- was beneficial for population health and was also cost-saving or highly cost-effective.

Virtual participatory mapping of nature-based solutions in the Grande de Tárcoles River basin, Costa Rica: Connecting diverse knowledge systems in a context of physical immobility.

Co-design processes are of key importance in planning and implementing Nature-based Solutions (NBS), but require boundary management between diverse holders of local, practical and scientific knowledge. Participatory and map-based planning tools, such as Geodesign workshops, can facilitate such boundary management through mobilising knowledge holders, and translating and negotiating between different perspectives. The COVID-19 pandemic hindered physical mobility, but offered an, albeit unintended, opportunity to explore new ways of virtual mobility for facilitating boundary management in NBS co-design through digital participatory tools. This short communication aims to demonstrate how a spatial planning process for NBS can be facilitated in an online context. We draw on an international case study for co-designing NBS in Costa Rica, conducted during the severe lock-down restriction of the COVID-19 pandemic. This novel approach showcases how physical presence and movement is replaced by virtual mobility enabled through an online geographic map-based environment that allowed participants to communicate their opinions and co-create local and regional NBS actions. The case study included developing and testing a co-design tool to understand and map local perceptions of social-ecological problems, and an actual co-design process for siting NBS options and jointly exploring their implications. We present two levels of the process: 1) the adaptation of the co-design tool, and 2) the use and usefulness of the co-design tool. Our evaluation shows that the tool served its purpose well and provided useful support to local stakeholders. We recommend to test further strategical combinations of in-person and virtual methods in NBS co-design processes to improve NBS planning and implementation.

Excess mortality from COVID 19 in Costa Rica: a registry based study using Poisson regression.

Background: Official death toll related to COVID-19 has been considerably underestimated in reports from some Latin American countries. This study aimed to analyze the mortality associated with the COVID-19 pandemic in Costa Rica between March 2020 and December 2021. Methods: A registry based study based on 2017-2021 data from the National Institute of Statistics and Census was designed (N = 128,106). Excess deaths were defined by the WHO as "the difference in the total number of deaths in a crisis compared to those expected under normal conditions"; and were estimated using a Poisson regression, and mortality and years of potential life lost (YPLL) rates were calculated. Findings: The COVID-19 pandemic represented 15% of the deaths in Costa Rica between March 2020 and December 2021. The mortality rate related to COVID-19 was 83 per 100,000 person-years. Between March and July 2020 (low-incidence period), observed number of deaths was 9%-lower than expected, whereas it was 15% and 24% higher than expected between July 2020 and March 2021 (high incidence period - no vaccination), and between March 2021 and December 2021 (high incidence period - progressive vaccination) respectively. Between July 2020 and December 2021, excess deaths observed and COVID-19 deaths reported were comparable (7461 and 7620 respectively). Nevertheless, there were more deaths than expected for conditions that predispose to COVID-19 deaths. YPLL and mortality rates increased with age, but significant excess deaths were observed in all age-groups older than 30-39 years. No large differences were noted by districts' socioeconomic characteristics although excess death rate was lower in rural compared to urban areas. Interpretation: Reporting of deaths was only slightly underestimated. In the pre-vaccination period, mortality rate and YPLL rates increased with age, being highest in people aged 60 years or older and justifying the decision to initially prioritize vaccination of older individuals. Funding: The study was supported by the University of Costa Rica and the Agencia Costarricense de Investigaciones Biomédicas - Fundación Inciensa.

An implementation of a multilayer network model for the Covid-19 pandemic: A Costa Rica study.

We present a numerical implementation for a multilayer network to model the transmission of Covid-19 or other diseases with a similar transmission mechanism. The model incorporates different contact types between individuals (household, social and sporadic networks) and includes an SEIR type model for the transmission of the virus. The algorithm described in this paper includes the main ideas of the model used to give public health authorities an additional tool for the decision-making process in Costa Rica by simulating extensive possible scenarios and projections. We include two simulations: a study of the effect of restrictions on the transmission of the virus and a Costa Rica case study that was shared with the Costa Rican health authorities.

Actividad física para el adulto y adulto mayor: programa institucional de la Universidad de Costa Rica / Physical activity for adults and seniors adults: the institutional program of Universidad de Costa Rica

Matamoros Sánchez, M. (2022). Actividad física para el adulto y adulto mayor: programa institucional de la Universidad de Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 20(2), 1-14. Este artículo tiene como fin evidenciar la evolución del Módulo de Movimiento Humano (MMH) del PIAM y el impacto que ha causado en la atención de la persona adulta mayor (PAM). Es en Toulouse, Francia, a inicios de los años 70, que nace la primera universidad para personas mayores, y es gracias al Dr. Alfonso Trejos Willis que, desde hace 35 años, existe el Programa Institucional para la Persona Adulta y Adulta Mayor de la Universidad de Costa Rica (PIAM). Apoyada en la premisa de la ''educación a lo largo de la vida", la Universidad da a la ciudadanía una valiosa devolución al brindar oportunidades a este grupo etario. A través del tiempo, el Programa atraviesa una transformación que responde a las necesidades y cambios sociales de la población costarricense, donde se visualiza la importancia de mantener activas a las personas adultas y adultas mayores. Así, surge el Módulo de Movimiento Humano (MMH), a cargo de facilitadores que ofrecen sus cursos ad honorem. En este módulo, para atender a la población adulta mayor, grupo considerado en riesgo debido a la pandemia ocasionada por la enfermedad COVID-19, se adaptaron los cursos a la virtualidad para su oferta.

Matamoros Sánchez, M. (2022). Physical activity for adults and seniors adults: the institutional program of Universidad de Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 20(2), 1-14. The purpose of this article is to present the evolution of the Human Movement Module (HMM) of the IPSA and the impact this has had on the attention to senior adults (SA). The first university for senior adults originated in Toulouse, France, in the early 70's, and it is thanks to Dr. Alfonso Trejos Willis that the Institutional Program for Adults and Senior Adults (IPSA) has existed for 35 years at Universidad de Costa Rica. Based on the premise of ''education throughout life," the University offers to Costa Rican citizens a valuable return in opening opportunities to this age group. Over time, the Program underwent a transformation in response to the needs and social changes of the Costa Rican population, in which the importance of keeping adults and senior adults active is expressed. As a result, the Human Movement Module (HMM) emerged, headed by facilitators that offer their courses pro bono. In this module, the courses were adapted to a virtual format in order to make them available to the senior adult population, a group that has been considered at risk due to the COVID-19 pandemic.

Matamoros Sánchez, M. (2022). Atividade física para adultos e idosos: programa institucional da Universidade da Costa Rica. PENSAR EN MOVIMIENTO: Revista de Ciencias del Ejercicio y la Salud, 20(2), 1-14. Este artigo tem como objetivo destacar a evolução do Módulo de Movimento Humano (MMH) do Programa Institucional para Adultos e Idosos (PIAM, por suas siglas em espanhol) e o impacto gerado no cuidado da pessoa idosa (PI). É em Toulouse, França, no início dos anos 70, que nasceu a primeira universidade para idosos, e é graças ao Dr. Alfonso Trejos Willis que, há 35 anos, existe o Programa Institucional para Adultos e Idosos da Universidade de Costa Rica (PIAM). Apoiada pela premissa da "educação ao longo da vida", a Universidade proporciona aos cidadãos um retorno valioso, proporcionando oportunidades a essa faixa etária. Com o tempo, o Programa passa por uma transformação que responde às necessidades e mudanças sociais da população costarriquenha, onde se visualiza a importância de manter os adultos e idosos ativos. Assim, surge o Módulo de Movimento Humano (MMH), responsável por facilitadores que oferecem seus cursos ad honorem. Neste módulo, para atender a população idosa, grupo considerado em risco devido à pandemia causada pela doença COVID-19, os cursos foram adaptados à virtualidade para sua oferta.

Patient satisfaction regarding biosecurity protocols in the face of COVID-19, Faculty of Dentistry, University of Costa Rica / Satisfacción de los pacientes respecto a los protocolos de bioseguridad ante el COVID-19, Facultad de Odontología, Universidad de Costa Rica

Abstract Biosecurity protocols are particularly important in dental practice. The aim of this research was to determine the level of patient satisfaction regarding biosecurity protocols used in the School of Dentistry of the University of Costa Rica, to avoid COVID-19 infections during dental care. A survey was sent by email to all patients who received dental consultations at the School of Dentistry between April and September 2021. They were asked about sociodemographic variables (sex, age range, approved educational level, and place of origin), as well as whether they considered safe the protocols used during the dental consultation to avoid COVID-19 infections. Descriptive statistics were performed proving the absolute and relative frequency of the socio-demographic variables and the satisfaction of patients with the protocols used. A Chi-square test was used to determine if there was a difference in patient satisfaction with biosecurity protocols to avoid COVID-19 infections during dental care and sociodemographic variables. 95.9% of the respondents considered the biosafety protocols used to be safe and there was no statistically significant difference between patient satisfaction with the protocols and sociodemographic variables. A large majority of patients who come to the UCR School of Dentistry are satisfied with the biosecurity protocols used to avoid COVID-19 infections during dental care.

Resumen Los protocolos de bioseguridad son muy importante en la consulta odontológica. El objetivo de esta investigación fue conocer el nivel de satisfacción de los pacientes respecto a los protocolos de bioseguridad utilizados en la Facultad de Odontología para evitar los contagios por COVID-19 durante la atención dental. Se envió una encuesta por medio del correo electrónico a todos los pacientes que recibieron consulta dental en la Facultad de Odontología entre abril y setiembre del 2021. Se les consultó sobre variables sociodemográficas (sexo, rango de edad, nivel educativo aprobado y lugar de procedencia), así como si consideraban seguros los protocolos empleados durante la consulta dental para evitar los contagios por COVID-19. Se realizó estadística descriptiva estableciendo la frecuencia absoluta y relativa de las variables sociodemográficas y la satisfacción de los pacientes con los protocolos empleados en la Facultad. Se utilizó la prueba de chi cuadrado para determinar si existía diferencia en la satisfacción de los pacientes respecto a los protocolos de bioseguridad para evitar los contagios por COVID-19 durante la atención dental y las variables sociodemográficos. El 95.9% de los encuestados consideró seguros los protocolos de bioseguridad empleados y no hubo diferencia estadísticamente significativa entre la satisfacción de los pacientes con los protocolos y las variables sociodemográficas. Una gran mayoría de los pacientes que acuden a la Facultad de Odontología UCR están satisfechos con los protocolos de bioseguridad empleados para evitar los contagios por COVID-19 durante la atención dental.

Efecto de la intervención ''escuelas activas móviles'' en tiempos de pandemia sobre la percepción de la autoeficacia, disfrute y el nivel de actividad física en la niñez costarricense y panameña / Effect of the "Active Mobile Schools" Intervention in Times of Pandemic on the Perception of Self-Efficacy, Enjoyment, and the Level of Physical Activity in Costa Rican and Panamanian Children

Resumen Objetivo: El propósito de esta investigación fue examinar el efecto de la intervención escuelas activas móviles sobre la autoeficacia, el disfrute y la percepción del nivel de actividad física, en la niñez costarricense y panameña en tiempos de pandemia por COVID-19. Metodología: La población estudiada en esta investigación fueron 55 niñas y niños de primer ciclo de dos escuelas públicas de Panamá y Costa Rica, de edades entre 7 y 9 años. Resultados: Los principales hallazgos de este estudio fueron que la intervención afectó positivamente (mejoras pre-post) a las tres variables dependientes, pero solo en la autoeficacia el efecto fue estadísticamente significativo (con magnitud moderada). En el disfrute y en el nivel de actividad física el efecto fue pequeño. No se presentaron diferencias entre países, pero sí se encontró una tendencia de un deterioro de los sujetos participantes de los grupos control, en las tres variables, especialmente en los participantes panameños. Conclusiones: Se concluye con este estudio que esta intervención mostró que utilizando un modelo multinivel en tiempos de pandemia se logró mejorar la percepción de autoeficacia, y mantener los niveles de disfrute y actividad física en la población participante; al contrario del grupo control, que mostró un deterioro de las tres variables en los infantes.

Abstract Objective: This research aimed to examine the effect of the Active Mobile Schools intervention on self-efficacy, enjoyment, and the perception of the level of physical activity in Costa Rican and Panamanian children during the COVID-19 pandemic. Methodology: The research sample comprised 55 girls and boys, aged between 7 and 9 years, from two public schools in Panama and Costa Rica. Results: The study mainly found that the intervention positively affected (pre-post improvements) the three dependent variables, but only in self-efficacy was the effect statistically significant (with moderate magnitude). In enjoyment and level of physical activity, the effect was small. There were no differences between countries, but a trend of deterioration was found in the participants of the control groups, in the three variables, especially in the Panamanian participants. Conclusions: The study leads to the conclusion that this intervention showed that using a multilevel model in times of pandemic, it was possible to improve the perception of self-efficacy and maintain levels of enjoyment and physical activity in the participating population, unlike the control group that showed a deterioration of the three variables in the infants.

Resumo Objetivo: O objetivo dessa pesquisa é examinar o efeito da intervenção das Escolas Ativas Móveis sobre a autoeficácia, o prazer e o nível percebido de atividade física nas crianças costarriquenhas e panamenhas em épocas da pandemia da COVID-19. Metodologia: A população estudada nessa pesquisa foi de 55 crianças do ensino fundamental de duas escolas públicas no Panamá e na Costa Rica, com idades compreendidas entre 7 e 9 anos. Resultados: As principais conclusões desse estudo indicam que a intervenção afetou positivamente (melhorias pré-pós) nas três variáveis dependentes, mas somente em autoeficácia o efeito foi estatisticamente significativo (com magnitude moderada). Para o prazer e o nível de atividade física, o efeito foi pequeno. Não houve diferenças entre os países, mas houve uma tendência de deterioração dos participantes dos grupos de controle em todas as três variáveis, especialmente nos participantes panamenhos. Conclusões: Conclui-se com esse estudo que essa intervenção mostrou que o uso de um modelo multinível em tempos de pandemia foi capaz de melhorar a percepção de autoeficácia, e manter os níveis de prazer e atividade física na população participante; ao contrário do grupo de controle, que mostrou uma deterioração das três variáveis nas crianças.

Pineapple Agro-Industrial Biomass to Produce Biomedical Applications in a Circular Economy Context in Costa Rica.

Pineapple is a highly demanded fruit in international markets due to its unique appearance and flavor, high fiber content, vitamins, folic acid, and minerals. It makes pineapple production and processing a significant source of income for producing countries, such as Costa Rica. This review collects bibliographic information dating back to the beginnings of pineapple production in Costa Rica to the state of the market today. It details the impacts of its production chain and proposes a biorefinery as a solution to environmental problems. Besides the potentiality of new sustainable markets to contribute to the post-COVID-19 economy in Costa Rica is highlighted. The general characteristics of pineapple by-products -cellulose, hemicellulose, lignin, and other high-value products like bromelain y saponin- are described, as well as the primary processes for their ex-traction via biorefinery and main applications in the medical field. Finally, a brief description of the main works in the literature involving modeling and simulation studies of pineapple by-products properties is included.

First Pediatric Case of Autoimmune Encephalitis Associated With COVID-19 in Costa Rica.

Very few COVID-19-associated autoimmune encephalitis cases have been documented in children. This case report focuses on a previously healthy four-year-old girl who presented to the emergency room of the National Children's Hospital in Costa Rica in a postictal state due to a tonic-clonic seizure that progressed to status epilepticus. She had no previous history of fever or associated trauma. She was considered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) positive by epidemiological linkage four weeks prior to the event, and her immunoglobulin G (IgG) levels for SARS-CoV-2 were positive. She presented with generalized decrease in muscle strength, she couldn't even walk, also dyskinetic movements in upper extremities, language impairment, frequent seizures, retrograde amnesia, and orolingual dyskinesias. An extensive diagnostic workup was performed, including bacterial and viral panel in cerebrospinal fluid, however the only positive result was the IgG for SARS-CoV-2. Electroencephalogram (EEG) and magnetic resonance imaging (MRI) findings were compatible with autoimmune encephalitis.  An antibody panel was performed, which was negative in cerebrospinal fluid and positive for anti-gamma-aminobutyric acid (GABA)/b1 in serum. She received three antiseizure drugs, plasmapheresis, intravenous gamma-globulin, methylprednisolone, and rituximab, which partially improved her condition. She currently has refractory epilepsy, memory problems, loss of language skills, and neuropsychiatric dysfunction. To our knowledge, this is the first case of autoimmune encephalitis secondary to SARS-COV-2 infection in a pediatric patient in Costa Rica.

Trends in premature mortality from diabetes mellitus in Costa Rica in the period 2000-2020.

OBJECTIVES: To analyze the temporal trends of premature mortality from diabetes in Costa Rica in the period 2000-2020, at a national level and by province, and the effect of the COVID-19 pandemic on diabetes mortality during the year 2020. METHODS: We studied the temporal trends of mortality from diabetes in Costa Rica in the period between 2000 and 2020. Age-standardized mortality rates and corresponding 95% confidence intervals were calculated for each year, sex and province. RESULTS: We analyzed the data of 17,968 deceased persons. The mean age was 72.5 years (range 1 to 109 years), and 51.5% of the population (n = 9253) was younger than 75 years. In both men and women, we observed a significant decrease in mortality from 2000 to 2014, followed by the opposite trend from 2014 to 2020, with average yearly increases of 13.9% in men and 11.6% in women. CONCLUSIONS: Premature mortality from diabetes has been growing from 2014. The COVID-19 pandemic changed the mortality pattern, increasing premature diabetes deaths in Costa Rica in 2020.

Estimating vaccine effectiveness against SARS-CoV-2 infection, hospitalization and death from ecologic data in Costa Rica.

BACKGROUND: Clinical trials and individual-level observational data in Israel demonstrated approximately 95% effectiveness of mRNA-based vaccines against symptomatic SARS-CoV-2 infection. Individual-level data are not available in many countries, particularly low- and middle- income countries. Using a novel Poisson regression model, we analyzed ecologic data in Costa Rica to estimate vaccine effectiveness and assess the usefulness of this approach. METHODS: We used national data from December 1, 2020 to May 13, 2021 to ascertain incidence, hospitalizations and deaths within ecologic units defined by 14 age groups, gender, 105 geographic areas, and day of the epidemic. Within each unit we used the proportions of the population with one and with two vaccinations, primarily tozinameran. Using a non-standard Poisson regression model that included an ecologic-unit-specific rate factor to describe rates without vaccination and a factor that depended on vaccine effectiveness parameters and proportions vaccinated, we estimated vaccine effectiveness. RESULTS: In 3.621 million persons aged 20 or older, there were 125,031 incident cases, 7716 hospitalizations, and 1929 deaths following SARS-CoV-2 diagnosis; 73% of those aged ≥ 75 years received two doses. For one dose, estimated effectiveness was 59% (95% confidence interval 53% to 64%) for SARS-CoV-2 incidence, 76% (68% to 85%) for hospitalizations, and 63% (47% to 80%) for deaths. For two doses, the respective estimates of effectiveness were 93% (90% to 96%), 100% (97% to 100%), and 100% (97% to 100%). CONCLUSIONS: These effectiveness estimates agree well with findings from clinical trials and individual-level observational studies and indicate high effectiveness in the general population of Costa Rica. This novel statistical approach is promising for countries where ecologic, but not individual-level, data are available. The method could also be adapted to monitor vaccine effectiveness over calendar time.

Behavioral factors and SARS-CoV-2 transmission heterogeneity within a household cohort in Costa Rica.

Variability in household secondary attack rates (SAR) and transmission risks factors of SARS-CoV-2 remain poorly understood. To characterize SARS-CoV-2 transmission in a household setting, we conducted a household serologic study of SARS-CoV-2 in Costa Rica, with SARS-CoV-2 index cases selected from a larger prospective cohort study and their household contacts were enrolled. A total of 719 household contacts of 304 household index cases were enrolled from November 21, 2020, through July 31, 2021. Demographic, clinical, and behavioral information was collected from the index cases and their household contacts. Blood specimens were collected from contacts within 30-60 days of index case diagnosis; and serum was tested for presence of spike and nucleocapsid SARS-CoV-2 IgG antibodies. Evidence of SARS-CoV-2 prior infections among household contacts was defined based on the presence of both spike and nucleocapsid antibodies. To avoid making strong assumptions that the index case was the sole source of infections among household contacts, we fitted a chain binomial model to the serologic data, which allowed us to account for exogenous community infection risk as well as potential multi-generational transmissions within the household. Overall seroprevalence was 53% (95% confidence interval (CI) 48% - 58%) among household contacts The estimated household secondary attack rate (SAR) was 32% (95% CI 5% - 74%) and the average community infection risk was 19% (95% CI 14% - 26%). Mask wearing by the index case was associated with the household transmission risk reduction by 67% (adjusted odds ratio = 0.33 with 95% CI: 0.09-0.75) and sleeping in a separate bedroom from the index case reduced the risk of household transmission by 78% (adjusted odds ratio = 0.22 with 95% CI 0.10-0.41). The estimated distribution of household secondary attack rates was highly heterogeneous across index cases, with 30% of index cases being the source for 80% of secondary cases. Modeling analysis suggests behavioral factors were important drivers of the observed SARS-CoV-2 transmission heterogeneity within the household.

Informe anual 2021. Costa Rica: Respuesta a la COVID-19 y preparación para el futuro

En el 2022 se celebra el 120.º aniversario de la Organización Panamericana de la Salud (OPS). En calidad de organismo independiente especializado en salud del sistema interamericano, la OPS brinda cooperación técnica a sus Estados Miembros para abordar las enfermedades transmisibles y no transmisibles y sus causas, fortalecer los sistemas de salud y responder a situaciones de emergencia y desastres en toda la Región de las Américas. Asimismo, como Oficina Regional de la Organización Mundial de la Salud para la Región de las Américas, participa en los equipos de las Naciones Unidas en los países, colaborando con otros organismos, fondos y programas del sistema de las Naciones Unidas para contribuir al logro de los Objetivos de Desarrollo Sostenible a nivel de país. A nivel subregional, la OPS trabaja con los mecanismos de integración para que la salud y sus determinantes tengan un lugar en la agenda política. En el informe anual correspondiente al 2021 se presenta la cooperación técnica de la OPS en los países y territorios en este período, con la aplicación de las estrategias de cooperación en los países, la respuesta a sus necesidades y prioridades, y el desarrollo de las actividades en el marco de los mandatos regionales y mundiales de la OPS y los Objetivos de Desarrollo Sostenible. En consonancia con el tema general de "responder a la COVID-19 y prepararse para el futuro", se ponen de relieve las medidas que ha adoptado la OPS con respecto a la pandemia de COVID-19 y sus esfuerzos continuos en áreas prioritarias como las emergencias de salud, los sistemas y servicios de salud, las enfermedades transmisibles, las enfermedades no transmisibles y la salud mental, la salud a lo largo del curso de vida y la equidad en la salud. También se presenta un resumen financiero del bienio 2020-2021.

Clinical Profiles at the Time of Diagnosis of SARS-CoV-2 Infection in Costa Rica During the Pre-vaccination Period Using a Machine Learning Approach.

The clinical manifestations of COVID-19, caused by the SARS-CoV-2, define a large spectrum of symptoms that are mainly dependent on the human host conditions. In Costa Rica, more than 169,000 cases and 2185 deaths were reported during the year 2020, the pre-vaccination period. To describe the clinical presentations at the time of diagnosis of SARS-CoV-2 infection in Costa Rica during the pre-vaccination period, we implemented a symptom-based clustering using machine learning to identify clusters or clinical profiles at the population level among 18,974 records of positive cases. Profiles were compared based on symptoms, risk factors, viral load, and genomic features of the SARS-CoV-2 sequence. A total of 18 symptoms at time of diagnosis of SARS-CoV-2 infection were reported with a frequency > 1%, and those were used to identify seven clinical profiles with a specific composition of clinical manifestations. In the comparison between clusters, a lower viral load was found for the asymptomatic group, while the risk factors and the SARS-CoV-2 genomic features were distributed among all the clusters. No other distribution patterns were found for age, sex, vital status, and hospitalization. In conclusion, during the pre-vaccination time in Costa Rica, the symptoms at the time of diagnosis of SARS-CoV-2 infection were described in clinical profiles. The host co-morbidities and the SARS-CoV-2 genotypes are not specific of a particular profile, rather they are present in all the groups, including asymptomatic cases. In addition, this information can be used for decision-making by the local healthcare institutions (first point of contact with health professionals, case definition, or infrastructure). In further analyses, these results will be compared against the profiles of cases during the vaccination period. Supplementary Information: The online version contains supplementary material available at 10.1007/s43657-022-00058-x.

A multilayer network model of Covid-19: Implications in public health policy in Costa Rica.

Successful partnerships between researchers, experts, and public health authorities have been critical to navigate the challenges of the Covid-19 pandemic worldwide. In this collaboration, mathematical models have played a decisive role in informing public policy, with findings effectively translated into public health measures that have shaped the pandemic in Costa Rica. As a result of interdisciplinary and cross-institutional collaboration, we constructed a multilayer network model that incorporates a diverse contact structure for each individual. In July 2020, we used this model to test the effect of lifting restrictions on population mobility after a so-called "epidemiological fence" imposed to contain the country's first big wave of cases. Later, in August 2020, we used it to predict the effects of an open and close strategy (the Hammer and Dance). Scenarios constructed in July 2020 showed that lifting restrictions on population mobility after less than three weeks of epidemiological fence would produce a sharp increase in cases. Results from scenarios in August 2020 indicated that the Hammer and Dance strategy would only work with 50% of the population adhering to mobility restrictions. The development, evolution, and applications of a multilayer network model of Covid-19 in Costa Rica has guided decision-makers to anticipate implementing sanitary measures and contributed to gain valuable time to increase hospital capacity.

Informality, Social Citizenship, and Wellbeing among Migrant Workers in Costa Rica in the Context of COVID-19.

Costa Rica is home to 557,000 migrants, whose disproportionate exposure to precarious, dangerous, and informal work has resulted in persistent inequities in health and wellbeing in the midst of the COVID-19 pandemic. We used a novel multimodal grounded approach synthesizing documentary film, experiential education, and academic research to explore socioecological wellbeing among Nicaraguan migrant workers in Costa Rica. Participants pointed to the COVID-19 pandemic as exacerbating the underlying conditions of vulnerability, such as precarity and informality, dangerous working conditions, social and systemic discrimination, and additional burdens faced by women. However, the narrative that emerged most consistently in shaping migrants' experience of marginalization were challenges in obtaining documentation-both in the form of legal residency and health insurance coverage. Our results demonstrate that, in spite of Costa Rica's acclaimed social welfare policies, migrant workers continue to face exclusion due to administrative, social, and financial barriers. These findings paint a rich picture of how multiple intersections of precarious, informal, and dangerous working conditions; social and systemic discrimination; gendered occupational challenges; and access to legal residency and health insurance coverage combine to prevent the full achievement of a shared minimum standard of social and economic security for migrant workers in Costa Rica.

[Management and impact of interventions to reduce COVID-19 cases in Costa RicaGestão e impacto das medidas de intervenção para reduzir os casos de COVID-19 na Costa Rica]. / Gestión e impacto de las medidas de intervención para la reducción de casos por COVID-19 en Costa Rica.

Objective: Assess the impact of interventions introduced in Costa Rica during 2020 and 2021 to control the COVID-19 pandemic. Methods: A Bayesian Poisson regression model was used, incorporating control or intervention measures as independent variables in the changes in reported case numbers per epidemiological week. Results: The results showed the relative and combined impact of containment policies and measures on the reduction of cases: mainly vehicular traffic restrictions, use of masks, and implementation of health guidelines and protocols. Evidence of impact was optimized and made available for decision-making by the country's health and emergency authorities. Several iterations were generated for constant monitoring of variations in impact at four different moments in the pandemic's spread. Conclusion: The simultaneous implementation of different mitigation measures in Costa Rica has been a driving force in reducing the number of COVID-19 cases.

Objetivo: Avaliar o impacto das intervenções realizadas na Costa Rica durante 2020 e 2021 para o controle da pandemia de COVID-19. Método: Foi utilizado um modelo Bayesiano de regressão de Poisson que incorporou as medidas de controle ou intervenção como variáveis independentes sobre a variação do número de casos por semana epidemiológica. Resultados: Os resultados evidenciaram o efeito relativo e conjunto que as políticas ou medidas de contenção tiveram na redução de casos, principalmente as restrições a veículos, o uso de máscaras e a implementação de diretrizes e protocolos de saúde. As evidências dos efeitos foram otimizadas e disponibilizadas às autoridades sanitárias e de emergência do país para auxiliar na tomada de decisão. Diversas iterações foram geradas para o monitoramento constante da variação nos efeitos em quatro momentos distintos do avanço da pandemia. Conclusão: A aplicação simultânea de diferentes medidas de mitigação na Costa Rica tem sido um agente promotor da diminuição de casos de COVID-19.

The Effectiveness of Pfizer-BioNTech and Oxford-AstraZeneca Vaccines to Prevent Severe COVID-19 in Costa Rica: Nationwide, Ecological Study of Hospitalization Prevalence.

BACKGROUND: The Costa Rican COVID-19 vaccination program has used Pfizer-BioNTech and Oxford-AstraZeneca vaccines. Real-world estimates of the effectiveness of these vaccines to prevent hospitalizations range from 90%-98% for two doses and from 70%-91% for a single dose. Almost all of these estimates predate the Delta variant. OBJECTIVE: The aim of this study is to estimate the dose-dependent effectiveness of COVID-19 vaccines to prevent severe illness in real-world conditions in Costa Rica, after the Delta variant became dominant. METHODS: This observational study is a secondary analysis of hospitalization prevalence. The sample is all 3.67 million adult residents living in Costa Rica by mid-2021. The study is based on public aggregated data of 5978 COVID-19-related hospital records from September 14, 2021, to October 20, 2021, and 6.1 million vaccination doses administered to determine hospitalization prevalence by dose-specific vaccination status. The intervention retrospectively evaluated is vaccination with Pfizer-BioNTech (78%) and Oxford-AstraZeneca (22%). The main outcome studied is being hospitalized. RESULTS: Vaccine effectiveness against hospitalization (VEH) was estimated as 93.4% (95% CI 93.0-93.9) for complete vaccination and 76.7% (95% CI 75.0-78.3) for single-dose vaccination among adults of all ages. VEH was lower and more uncertain among older adults aged ≥58 years: 92% (95% CI 91%-93%) for those who had received full vaccination and 64% (95% CI 58%-69%) for those who had received partial vaccination. Single-dose VEH declined over time during the study period, especially in the older age group. Estimates were sensitive to possible errors in the population count used to determine the residual number of unvaccinated people when vaccine coverage is high. CONCLUSIONS: The Costa Rican COVID-19 vaccination program that administered Pfizer-BioNTech and Oxford-AstraZeneca vaccines seems to be highly effective at preventing COVID-19-related hospitalization after the Delta variant became dominant. Even a single dose seems to provide some degree of protection, which is good news for people whose second dose of the Pfizer-BioNTech vaccine was postponed several weeks to more rapidly increase the number of people vaccinated with a first dose. Timely monitoring of vaccine effectiveness is important to detect eventual failures and motivate the public to get vaccinated by providing information regarding the effectiveness of the vaccines.

Gestión e impacto de las medidas de intervención para la reducción de casos por COVID-19 en Costa Rica

[RESUMEN]. Objetivo. Evaluar el impacto de las intervenciones introducidas en Costa Rica durante 2020 y 2021 para el control de la pandemia por COVID-19. Método. Se empleó un modelo bayesiano de regresión de Poisson que incorporó las medidas de control o intervención como variables independientes sobre la modificación de la cantidad de casos por semana epidemiológica. Resultados. Los resultados evidenciaron el efecto relativo y conjunto que han tenido las políticas o medidas de contención en la reducción de casos, principalmente la restricción vehicular, el uso de mascarillas y la puesta en práctica de los lineamientos y protocolos sanitarios. Las evidencias de los efectos se optimizaron y se pusieron a disposición para la toma de decisiones de las autoridades sanitarias y de emergencia del país. Se generaron varias iteraciones para el monitoreo constante de la variación en los efectos en cuatro momentos distintos del avance de la pandemia. Conclusión. La aplicación simultánea de distintas medidas de mitigación en Costa Rica ha sido un agente promotor de la disminución de casos de COVID-19.

[ABSTRACT]. Objective. Assess the impact of interventions introduced in Costa Rica during 2020 and 2021 to control the COVID-19 pandemic. Methods. A Bayesian Poisson regression model was used, incorporating control or intervention measures as independent variables in the changes in reported case numbers per epidemiological week. Results. The results showed the relative and combined impact of containment policies and measures on the reduction of cases: mainly vehicular traffic restrictions, use of masks, and implementation of health guidelines and protocols. Evidence of impact was optimized and made available for decision-making by the country’s health and emergency authorities. Several iterations were generated for constant monitoring of variations in impact at four different moments in the pandemic’s spread. Conclusion. The simultaneous implementation of different mitigation measures in Costa Rica has been a driving force in reducing the number of COVID-19 cases.

[RESUMO]. Objetivo. Avaliar o impacto das intervenções realizadas na Costa Rica durante 2020 e 2021 para o controle da pandemia de COVID-19. Método. Foi utilizado um modelo Bayesiano de regressão de Poisson que incorporou as medidas de controle ou intervenção como variáveis independentes sobre a variação do número de casos por semana epidemiológica. Resultados. Os resultados evidenciaram o efeito relativo e conjunto que as políticas ou medidas de contenção tiveram na redução de casos, principalmente as restrições a veículos, o uso de máscaras e a implementação de diretrizes e protocolos de saúde. As evidências dos efeitos foram otimizadas e disponibilizadas às autoridades sanitárias e de emergência do país para auxiliar na tomada de decisão. Diversas iterações foram geradas para o monitoramento constante da variação nos efeitos em quatro momentos distintos do avanço da pandemia. Conclusão. A aplicação simultânea de diferentes medidas de mitigação na Costa Rica tem sido um agente promotor da diminuição de casos de COVID-19.

Insights into the mutation T1117I in the spike and the lineage B.1.1.389 of SARS-CoV-2 circulating in Costa Rica.

Emerging mutations and genotypes of the SARS-CoV-2 virus, responsible for the COVID-19 pandemic, have been reported globally. In Costa Rica during the year 2020, a predominant genotype carrying the mutation T1117I in the spike (S:T1117I) was previously identified. To investigate the possible effects of this mutation on the function of the spike, i.e. the biology of the virus, different bioinformatic pipelines based on phylogeny, natural selection, and co-evolutionary models, molecular docking, and epitopes prediction were implemented. Results of the phylogeny of sequences carrying the S:T1117I worldwide showed a polyphyletic group, with the emergence of local lineages. In Costa Rica, the mutation is found in the lineage B.1.1.389 and it is suggested to be a product of positive/adaptive selection. Different changes in the function of the spike protein and more stable interaction with a ligand (nelfinavir drug) were found. Only one epitope out 742 in the spike was affected by the mutation, with some different properties, but suggesting scarce changes in the immune response and no influence on the vaccine effectiveness. Jointly, these results suggest a partial benefit of the mutation for the spread of the virus with this genotype during the year 2020 in Costa Rica, although possibly not strong enough with the introduction of new lineages during early 2021 which became predominant later. In addition, the bioinformatic analyses used here can be applied as an in silico strategy to eventually study other mutations of interest for the SARS-CoV-2 virus and other pathogens.