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Using RT-PCR Testing to Assess the Effectiveness of Outbreak Control Efforts in Sao Paulo State, the Epicenter of COVID-19 Pandemic in Brazil, according to Socioeconomic Vulnerabilities

By Tatiane Cristina Moraes de Sousa, Natalia de Paula Moreira, Jose Krieger, Isabel Seelaender C. Rosa, Marcela Zamudio, Maria Amelia S M Veras, Brigina Kemp, Lorena Barberia

Posted 03 Nov 2020
medRxiv DOI: 10.1101/2020.10.29.20221960

Background The testing of infected persons with SARS-CoV-2 is one of the cornerstones of an effective strategy deployed for pandemic control. The public health diagnostic effort is particularly important in regions with a critical transmission scenario and in vulnerable populations in these districts, such as Sao Paulo state, the Brazilian epicenter of the COVID-19 pandemic. Methods We developed an RT-PCR testing intensity effort index (RT-PCR TIEI) composed of seven indicators to assess the survelliance efforts in the Sao Paulo State. We used dynamic time-series cross-sectional models to analyze the association between the RT-PCR TIEI, the population living under high socioeconomic vulnerability levels, dependent on public health service (SUS), per capita income, and population density. Results On average, the RT-PCR TIEI score was 21.07. In the long-run, the RT-PCR TIEI is negatively associated with socioeconomic vulnerability (p-value=0.000, 95% CI -0.887, -0.811), with a higher proportion of the population dependent on SUS (p-value= 0.000, 95% CI -0.871, -0.805), per capita income (p-value= 0.000, 95% CI -0.849,-0.792) and with population density (p-value=0.000, 95% CI -0.853; -0.801). Conclusion Testing efforts declined as the pandemic advanced, and the the lowest RT-PCR TIEI values were found in the most socioeconomic vulnerable RHDs. Local public laboratory presence was a predictor of a higher score. Thus, the low testing RT-PCR efforts and local laboratory inequalities affected surveillance capability, especially for socioeconomic vulnerable populations.

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