Three-quarters attack rate of SARS-CoV-2 in the Brazilian Amazon during a largely unmitigated epidemic

Buss, Lewis; Prete, Carlos A.; Abrahim, Cláudia M. M.; Mendrone, Alfredo; Salomon, Tassila; Almeida‐Neto, Cesar de; França, Rafael F O; Belotti, Maria C. T. D.; Carvalho, Maria P S S; Costa, Allyson Guimarães; Crispim, Myuki A. E.; Ferreira, Simone Aparecida; Fraiji, Nelson Abrahim; Gurzenda, Susie; Whittaker, Charles; Kamaura, Leonardo Tadashi; Takecian, Pedro Losco; Peixoto, Pedro S.; Oikawa, Márcio K.; Nishiya, Anna S.; Rocha, Vanderson; Salles, Nanci Alves; Santos, Andreza Aruska de Souza; Silva, Martirene A da; Custer, Brian; Parag, Kris V; Barral‐Netto, Manoel; Kraemer, Moritz U. G.; Pereira, Rafael H. M.; Pybus, Oliver G.; Busch, Michael P.; Castro, Márcia C.; Dye, Christopher; Nascimento, Vítor H.; Faria, Nuno Rodrigues; Sabino, Éster Cerdeira

doi:10.1126/science.abe9728

Cited by 467 publications

(523 citation statements)

References 39 publications

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“…In the USA the prevalence of seropositivity was 19.1% in New York City in the month of April (30), and at the same time it was 4.65% in California (31). High seropositivity rates (respectively 22%, 42% and 66%) have been reported in April 2020 in Guilan, Iran and in July 2020 both in Bergamo, Italy and in Manaus, Brazil (32, 33, 34).…”

Section: Discussionmentioning

confidence: 99%

Rapid increase of SARS-CoV-2 seroprevalence during the 2020 pandemic year in the population of the city of Tirana, Albania

Sulçebe

Ylli

Cenko

et al. 2021

Preprint

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Introduction: While the identification of anti SARS-CoV-2 antibodies has been used to measure the hidden circulation of the COVID-19 in communities, there are few publications on the dynamics of SARS-CoV-2 seroprevalence during both waves of 2020. This study provides original data about the change in proportion of individuals showing immune response to COVID-19 between beginning of July and end of December 2020. Methods: The study was conducted in two rounds, 27 June -3 July, and 21-28 December 2020, using two independently selected samples of individuals 20-70 years old. Study participants were randomly selected from lists of the inhabitants of the catchment communities of four primary health care centers in Tirana City. Serological testing was performed by an ELISA method which determines IgG class antibodies anti S1 protein of SARS-CoV-2 virus. The validity of the method was tested in a sample of blood donors sera of 2018. Results: The proportion of individuals classified as seropositive during the first round, in early July was 7.5% (95% CI: 4.3% - 10.7%). The proportion rose sharply in the second round, by late December 2020, reaching 48.2% (95% CI: 44.8% - 51.7%). The same increasing pattern was observed in all studied categories. No statistical significance was found between men and women and between age categories. The prevalence of seropositive individuals was always significantly higher among those who reported symptoms and those who had done the molecular test. Conclusion: The ratio of total infected cases over confirmed cases was estimated to be higher than 10 to 1 in Albania. The rapid increase in SARS-CoV-2 seroprevalence observed in Tirana City may have been facilitated by a number of factors, including the very low infection exposure during the period March - May 2020, and the consecutive high susceptibility in population. Despite the observed high seroprevalence, one month after the study, COVID-19 incidence continued to increase in Tirana.

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Section: Discussionmentioning

confidence: 99%

Rapid increase of SARS-CoV-2 seroprevalence during the 2020 pandemic year in the population of the city of Tirana, Albania

Sulçebe

Ylli

Cenko

et al. 2021

Preprint

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“…The rst lineage replacement started after the rst epidemic peak and was a gradual process of nearly ve months during which lineage B.1. A study of blood donors conducted in Manaus estimated that the rst wave of SARS-CoV-2 infected 76% (95% CI 67-98) of the city's population by October 2020, suggesting that herd immunity had already been reached 6 . Assuming that reinfection is rare and that immunity against infection did not signi cantly wane by December 2020, a second COVID-19 wave would not be expected so early.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 epidemic in the Brazilian state of Amazonas was driven by long-term persistence of endemic SARS-CoV-2 lineages and the recent emergence of the new Variant of Concern P.1

Naveca

Nascimento

Souza

et al. 2021

Preprint

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The Northern Brazilian state of Amazonas is one of the most heavily affected country regions by the COVID-19 epidemic and experienced two exponential growing waves in early and late 2020. Through a genomic epidemiology study based on 250 SARS-CoV-2 genomes from different Amazonas municipalities sampled between March 2020 and January 2021 we revealed that the first exponential growth phase was driven mostly by the dissemination of lineage B.1.195 which was gradually replaced by lineage B.1.1.28. The second wave coincides with the emergence of the variant of concern (VOC) P.1 which evolved from a local B.1.1.28 clade in late November and rapidly replaced the parental lineage in less than two months. Our findings support that successive lineage replacements in Amazonas were driven by a complex combination of variable levels of social distancing measures and the emergence of a more transmissible VOC P.1 virus. These data provide unique insights to understanding the mechanisms that underlie the COVID-19 epidemic waves and the risk of disseminating SARS-CoV-2 VOC P.1 in Brazil and potentially worldwide.

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“…The resurgence of cases in Manaus was described as follows: "from the second week of August there has been a small increase in the number of cases which, at the time of writing, has begun to decline (page 3)" (241). In addition, the peak seroprevalence in blood donors in Manaus was 51.8% in June, while another study of household seroprevalence in Manaus on May 14-21 found this to be 12.7% (the respective numbers for São Paulo were closer, at 6.9 and 3.3% in the two serosurveys) (241,242). Even correcting for a possible lower sensitivity of capillary blood used in the household survey does not explain the difference, as the corrected seroprevalence might be up to 19.3% (243).…”

Section: Content Of the Call For Adjusting Covid-19 Response Prioritiesmentioning

confidence: 92%

“…This also applies to a more recent review finding 17 cases of reinfection reported of whom 3 were hospitalized and the one died (238). Regarding Manaus, the high seroprevalence likely reflected the special situation of a relatively homogeneous cohort of people in overcrowded low socioeconomic urban situations, with reliance on crowded long riverboat travel; now there seems to be a different demographic cohort of young wealthy individuals being exposed (239)(240)(241). The resurgence of cases in Manaus was described as follows: "from the second week of August there has been a small increase in the number of cases which, at the time of writing, has begun to decline (page 3)" (241).…”

Section: Content Of the Call For Adjusting Covid-19 Response Prioritiesmentioning

confidence: 99%

COVID-19: Rethinking the Lockdown Groupthink

Joffe

2021

Front. Public Health

101

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The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has caused the Coronavirus Disease 2019 (COVID-19) worldwide pandemic in 2020. In response, most countries in the world implemented lockdowns, restricting their population's movements, work, education, gatherings, and general activities in attempt to “flatten the curve” of COVID-19 cases. The public health goal of lockdowns was to save the population from COVID-19 cases and deaths, and to prevent overwhelming health care systems with COVID-19 patients. In this narrative review I explain why I changed my mind about supporting lockdowns. The initial modeling predictions induced fear and crowd-effects (i.e., groupthink). Over time, important information emerged relevant to the modeling, including the lower infection fatality rate (median 0.23%), clarification of high-risk groups (specifically, those 70 years of age and older), lower herd immunity thresholds (likely 20–40% population immunity), and the difficult exit strategies. In addition, information emerged on significant collateral damage due to the response to the pandemic, adversely affecting many millions of people with poverty, food insecurity, loneliness, unemployment, school closures, and interrupted healthcare. Raw numbers of COVID-19 cases and deaths were difficult to interpret, and may be tempered by information placing the number of COVID-19 deaths in proper context and perspective relative to background rates. Considering this information, a cost-benefit analysis of the response to COVID-19 finds that lockdowns are far more harmful to public health (at least 5–10 times so in terms of wellbeing years) than COVID-19 can be. Controversies and objections about the main points made are considered and addressed. Progress in the response to COVID-19 depends on considering the trade-offs discussed here that determine the wellbeing of populations. I close with some suggestions for moving forward, including focused protection of those truly at high risk, opening of schools, and building back better with a economy.

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Three-quarters attack rate of SARS-CoV-2 in the Brazilian Amazon during a largely unmitigated epidemic

Cited by 467 publications

References 39 publications

Rapid increase of SARS-CoV-2 seroprevalence during the 2020 pandemic year in the population of the city of Tirana, Albania

Rapid increase of SARS-CoV-2 seroprevalence during the 2020 pandemic year in the population of the city of Tirana, Albania

COVID-19 epidemic in the Brazilian state of Amazonas was driven by long-term persistence of endemic SARS-CoV-2 lineages and the recent emergence of the new Variant of Concern P.1

COVID-19: Rethinking the Lockdown Groupthink

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