STRATEGY FOR THE CONTAINMENT, MITIGATION, AND SUPPRESSION
OF THE COVID-19 PANDEMIC IN FRAGILIZED COMMUNITIES ON THE
PERIPHERY OF A LARGE BRAZILIAN CITY.
Azevedo V F 1, Peruffo LCB 1, Nogueira GM 1, Novakoski GKO 1, Hajar FN
1, Rafael LK 1, Brugnari RGO 2, Vanzela LE 2, Larocca SB 3
1- Federal University of Paraná
2- Universidade Positivo
3- Edumed Clinical Research Center
INTRODUCTION.Prevention measures are highly important to poor
communities because surveillance and access to health care may be
limited.OBJECTIVES We aimed establish measures to contain and suppress
the spread of COVID-19, associating education, active case tracking, and
humanitarian aid in two needy communities in Brazil. The adherence to the
measures and evolution of the number of cases were verified during the
project.MATERIALS AND METHODS.The target population consisted of
approximately 1300 participants(350 families). A collection of epidemiological
data was performed in family members registered for the project. Rapid tests
were performed on people who had symptoms and their contacts. Scientific
information through audio-visual materials,educational pamphlets written in
colloquial language, food parcels,masks,hygiene and cleaning materials were
provided directly to family nuclei. RESULTS The common needs faced by
families were food inputs and/or ready-to-eat food, mentioned by 91.4% (233) of
the people, and hygienic and cleaning materials, mentioned by 30.6% (78) of
the people. Only 34.9% (84) of families had 70% rubbing alcohol or hand
sanitizer gel at home.The most frequently cited sources of information on
COVID-19 were television [cited by 82.4% (210) of the people]; social media
[25.5% (65)]; friends, neighbours, or family members [13.7% (35)]; and radio
[11.4% (29)] .A total of 83.7% (175) stated that the actions helped them to avoid
leaving the community.CONCLUSIONS Community isolation may be the best
way to contain the spread of pandemics in fragile populations with low socio-
economic status.Educational actions combined with rapid testing and
humanitarian aid were objective forms to promote community isolation.
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NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
INTRODUCTION
The COVID-19 pandemic is an ongoing pandemic of an acute
respiratory disease caused by the new severe acute respiratory syndrome
coronavirus (SARS-CoV-2).
[1]
The disease was first identified in Wuhan, Hubei
Province, People's Republic of China, on 1 December, 2019, and the first case
was reported on 31 December of the same year.
[2,3]
It is believed that the virus
has a zoonotic origin because the first confirmed cases were mainly linked to
the Huanan Wholesale Market, which also sold live animals.
[4-6]
On 11 March
2020, the World Health Organization declared the outbreak a pandemic.
[7.8]
In Brazil, the emergency alert was raised to level 2 (out of 3) on 28
January 2020, meaning it was considered an ‘imminent danger’ to the country.
[9]
The notification of cases of COVID-19 is managed by the Integrated Health
Surveillance Platform of Ministry of Health. We currently have had 3,501,975
cases and 112,304 deaths in Brazil.
[10]
Prevention measures are highly important to poor communities because
surveillance and access to health care may be limited.
[11]
However, preventive
measures such as frequent hand hygiene and social distancing are suboptimal
in these populations. The lack of water and cleaning products hinders frequent
hand washing and sanitizing of objects.
[12-14]
A modelling study concluded that
social distancing in a respiratory virus pandemic is 60 to 70% less effective in
reducing the attack rate in an underdeveloped population than in a developed
population.
[15]
This lower effectiveness is attributed to greater numbers of
people in the same household, which imply a higher proportion of intradomicile
transmissions of the virus - which are not prevented by social distancing – out of
the total transmissions.
[15]
In addition, low-income individuals may be more
averse to social distancing due to the need to work to provide food for their
families, their lower flexibility in finding/changing jobs, their fear of losing their
jobs, and their lack of formal jobs with working conditions set by law.
[12] [16,17]
The lack of knowledge about the disease may also cause lower adherence to
prevention measures. Knowledge about the disease is positively correlated with
education and the adoption of prevention practices for both COVID-19
[18]
and
other diseases caused by respiratory viruses.
[19.20]
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There are several strategies to control an outbreak: containment,
mitigation, and suppression. The containment measures are performed in the
early stages of the outbreak and aim to locate and quarantine cases of
infection, in addition to vaccination and other measures to control the infection
to stop it spreading to the rest of the population. When it is no longer possible to
contain the spread of the disease, the measures focus on delaying and
mitigating its effects on society and the health system. Containment and
mitigation measures can be performed simultaneously.
[21]
Suppression
measures require that more extreme measures be taken to reverse the
pandemic by decreasing the reproductive number to less than 1.
[22]
Part of the management of an outbreak of an infectious disease consists
of trying to reduce the epidemiological peak, a process called ‘flattening the
epidemiological curve’.
[23]
This reduces the risk of overburdening health
services and gives more time for new vaccines and treatments to be developed.
Among the non-pharmacological interventions that control the outbreak are
personal prevention measures, such as washing hands, wearing face masks,
and voluntary quarantine; community prevention measures, such as closing
schools and cancelling events that gather large numbers of people;
environmental measures, such as cleaning and disinfecting surfaces; and
measures that promote social adherence to these interventions.
[24]
Among the
suppression measures taken in some countries are quarantines of several
cities, travel bans,
[25]
mass screening, financial support for infected individuals
so they isolate themselves, fines for those who break isolation, criminalization of
stocking up on medical materials,
[26]
and compulsory reporting of flu-like
symptoms.
OVERALL OBJECTIVES
This study aimed establish measures to contain and suppress the spread
of COVID-19, associated with education, active case tracking, and humanitarian
aid in two needy communities in the metropolitan region of Curitiba, Brazil,
involving medical students from the Federal University of Paraná (UFPR) and
volunteers. It also aimed to verify the effects of these measures on the outcome
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.(which was not certified by peer review)preprint
The copyright holder for thisthis version posted September 29, 2020. ; https://doi.org/10.1101/2020.09.28.20203174doi: medRxiv preprint
of adherence to the measures and evolution of the number of cases detected
during the project. The general idea was to conduct a programme that could be
globally reproduced and applied in any pandemic outbreak in fragile
communities based on two basic and non-exclusive principles: education and
humanitarian aid.
MATERIALS AND METHODS
The target population of the present interventional study consisted of
needy populations from the periphery of the municipalities of Curitiba (Caximba
neighbourhood) and Araucária (Jardim Israelense neighbourhood), totalling 350
families (approximately 1,300 participants).
The Caximba community is located south of Curitiba. It has a population
of predominantly European origin and an area of 8.22 km
2
.
[27]
In 1989, a
sanitary landfill was created in this region, which received waste from Curitiba
and the metropolitan region.
[28]
After the landfill stopped being used in mid-
2009, ‘Vila 29 de Outubro’ was formed, the largest village in the region of the
Caximba neighbourhood. Considered an irregular settlement area, since the
land belongs to the Institute of Waters of Paraná, the community was built on
flooded land, without basic sanitation.
[29]
At least 1.1 thousand families inhabit
these places unfit for dwelling.
[30]
The Caximba neighbourhood has 767 households, with an average of
3.29 inhabitants per household. This makes this community more crowded than
Curitiba, which has an average of 2.76 inhabitants per household.
[27]
Thus, the
site highlights the risk of spreading infectious diseases. In addition, only 4.44%
of the households of this neighbourhood are connected to the general sewage
network, raising the propensity to spread diseases that involve intestinal
transmission.
[27]
In the Capela Velha neighbourhood of Araucária, there are two large
communities that were formed by land invasion: the Jardim Israelense
community and 21 de Outubro community. Capela Velha is to the northwest
Araucária and has approximately 25,000 inhabitants, 3.1% of whom are over 65
years old.
[31]
The 21 de Outubro community was established in a portion of the
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Jardim Israelense affected by flooding near the Passaúna River dam. More than
300 families lived in this flooded portion until the Jardim Arvoredo II subdivision
was completed, enabling approximately 170 families to be relocated.
[32]
Data
from the Department of Planning of the Araucária city hall show the poverty of
the region: 60% of the residents have an income between one and two
minimum wages and 13% of the residents an income below that amount.
[33]
The patient care, educational procedures, and collection were done by
students enrolled in health and medical courses of the medical schools of
Curitiba and other volunteers.
The following procedures were performed:
1) Collection of epidemiological data from the studied populations as
well as data on their knowledge of COVID-19
2) Performance of rapid tests on people from the community who had
symptoms (suspicions) and their contacts. The tests were
immunochromatography (intravenous blood collection and local
verification of IgG/IgM positivity), which is indicated for patients with
more than 10 days of symptoms suggestive of COVID-19, and RT-
PCR, which is indicated for people with suspected active COVID-19
for less than 7 days.
3) Provision of scientific information and answering the population's
questions through audio-visual materials and educational pamphlets
written in colloquial language, produced by the group of volunteers
and distributed in the course of their activities.
4) Provision of food parcels, masks, hygiene, and cleaning materials
directly to family nuclei to reduce the need for residents to go outside
the community in search of humanitarian aid.
A questionnaire was applied in the form of a direct interview in the case
of people with restricted or non-existent access to the Internet. For others, the
questionnaire was published on the Google Forms platform, and its content was
divided into three blocks:
. CC-BY-NC-ND 4.0 International licenseIt is made available under a
is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.(which was not certified by peer review)preprint
The copyright holder for thisthis version posted September 29, 2020. ; https://doi.org/10.1101/2020.09.28.20203174doi: medRxiv preprint