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Will the poor bear the brunt of coronavirus in Latin America and the Caribbean?

May 6, 2020

Different socio-economic conditions and lack of clean water may change the dynamics of COVID-19 transmission in Latin America and the Caribbean.

A new study by researchers affiliated with the Smithsonian Tropical Research Institute (STRI), The University of Oklahoma, Panama’s government research center INDICASAT-AIP and Johns Hopkins University, suggests that impoverished people in Latin American and the Caribbean (LAC) may experience higher COVID-19 infection as a result of poor sanitation, access to clean water and inadequate health care systems.

“We provide evidence that socio-economic conditions, especially with respect to access to abundant, clean water and sanitation, are likely to fundamentally alter the transmission in Latin America,” write the authors of the study published as a viewpoint article in PLOS Neglected Tropical Diseases. Models for the transmission of the virus developed in Asia, Europe and North America may not apply in Latin America where there is a larger group of people who lack reliable water supplies.

“Our story is simple, said Matthew Miller, research associate at STRI, professor at the University of Oklahoma and adjunct scientist at INDICASAT-AIP, “the socio-economic dynamics of Latin America suggest that COVID-19 transmission might not change in the region. Surprisingly, Panama, although warm and humid and relatively rich, does not do well when it comes to the WASH index, a measure of access to abundant clean water and improved sanitation. And this may lead to increased transmission.”

José Loaiza, research associate at STRI, research scientist at INDICASAT-AIP and professor of entomology at the University of Panama, collecting mosquito larvae. His research considers infectious disease as a system incorporating the health of humans and wildlife in the environment (One Health). He combines field studies with laboratory studies of disease-causing organisms, their vectors and their hosts to better understand disease ecology and spread.
Credit: Sean Mattson.

Although this is a respiratory disease, many patients have gastrointestinal symptoms. Fecal-oral spread may play a larger role in areas where it is difficult to maintain good hygiene. The World Bank estimates that 36 million people in Latin America lack access to clean water. Coronavirus can remain infectious for weeks in water stored at room temperature. 

Rather than predicting disease spread based on traditional models for airborne respiratory diseases, models for diseases spread by fecal-oral contamination, such as cholera, may be more relevant.

Matthew Miller, research associate at STRI, professor at the University of Oklahoma and adjunct scientist at INDICASAT-AIP, working in the bird collection at the Naos Marine and Molecular laboratory in Panama. Birds can be vectors of viral diseases. His research interests include understanding the consequences of biological diversity in the spread of emerging disease in the Americas.
Credit: Sean Mattson

“People living in socio-economically challenged neighborhoods are particularly vulnerable to COVID-19 because a large proportion of the population is exposed to a high burden of disease, lack of clean, potable water and sanitation, poor housing infrastructure and limited access to qualified health care facilities to manage the disease,” said Jose Loaiza, research associate at STRI, research scientist at INDICASAT-AIP and professor of entomology at the University of Panama.

Despite predictions that virus transmission may be slowed in the tropics because they survive for shorter periods on surfaces under hot and humid conditions, the authors suggest that any tropical climate effect may be limited by the common practice of indoor air-conditioning. And, while it is hot and dry in Latin America in March and April, cooler, rainy season weather means that peak flu season in Latin America and the Caribbean is May through October. 

The environmental and socio-economic conditions in Latin America and the Caribbean differ greatly from the initial COVID-19 hotspots in temperate-zone cities. How will limited access to clean water and adequate sanitation change the way that the disease spreads as it continues to move around the world?
Credit: Sean Mattson

“As we point out, the COVID-19 epidemic is entering a new phase--out of western Europe and the United States and into the Latin American region, one that may be even less equipped to face COVID-19, as troubling as that statement is,” write the authors.

“Panama took early strict measures to control the transmission of COVID-19, which have helped decrease the spread of the disease,” said Oris Sanjur, Associate Director for Science Administration at STRI (not a co-author). “However, the curve hasn’t flattened yet. Based on this paper, other factors should be considered as models for COVID-19 transmission are developed for Latin America.”

COVID-19 in Latin America: Novel transmission dynamics for a global pandemic? PLOS Neglected Tropical Diseases.

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