Department of Political Science, University of São Paulo, Avenida Professor Luciano Gualberto, 315 - Sala 2067 - Cidade Universitária, São Paulo, SP, 05508-900, Brazil.
Conselho de Secretários Municipais de Saúde - SP, Avenida Angélica, 2466, - 17° floor - Consolação, São Paulo, SP, 01228200, Brazil.
Glob Health Res Policy. 2022 Aug 17;7(1):27. doi: 10.1186/s41256-022-00260-4.
Surveillance efforts are essential to pandemic control, especially where the state is the primary health provider, such as Brazil. When public health testing guidelines limit molecular tests, there are reductions in detection efforts aimed at early recognition, isolation, and treatment of those infected with the virus. This study evaluates the effectiveness of surveillance policies to control the COVID-19 pandemic in São Paulo.
We conducted an interrupted time series analysis with a segmented regression model to analyze if changes in the state's guidelines improved RT-PCR testing outcomes in Brazil's most affluent and largest state, São Paulo. Anonymized daily data on the RT-PCR tests conducted in public laboratories belonging to the state-wide network from March 1, 2020 to June 5, 2021 were extracted from the Sao Paulo State open-source database, while the data on the genomic sequences were obtained from GISAID. We then aggregated these data for the 17 regional health departments in the state to evaluate regional-level outcomes.
The public health system restricted RT-PCR testing to hospitalized cases in the first months. Testing was expanded to permit symptomatic testing of non-hospitalized persons only in July 2020, but a statistically significant increase in surveillance efforts was not observed. Case definition was expanded to allow case confirmation based on clinical, laboratory and image data criteria other than an RT-PCR test without increasing the testing effort for asymptomatic suspicious cases in September 2020. There was an increase in the mean volume of testing in each RHD, but the test positivity rate increased due to insufficient testing expansion. Results also show an uneven improvement in testing outcomes following these changes across the state's regional health departments.
Evidence suggests that lower RT-PCR testing and genomic surveillance efforts are associated with areas characterized by a higher population concentration and a greater population reliance on the public health system. Our results highlight the need to structure health surveillance and information systems for disease control and prevention in emergency settings considering local demographics and vulnerabilities. In high prevalence settings, efforts at identifying and including vulnerable populations in routine and enhanced surveillance programs during COVID-19 must be significantly improved.
监测工作对于大流行的控制至关重要，特别是在国家是主要医疗服务提供者的情况下，例如巴西。当公共卫生检测指南限制分子检测时，用于早期识别、隔离和治疗感染病毒的人的检测工作就会减少。本研究评估了监测政策在控制巴西圣保罗州 COVID-19 大流行方面的有效性。
我们采用截断时间序列分析和分段回归模型进行分析，以评估该州指南的变化是否改善了巴西最富裕和最大的州圣保罗的 RT-PCR 检测结果。从 2020 年 3 月 1 日至 2021 年 6 月 5 日，从圣保罗州开源数据库中提取了属于全州网络的公共实验室进行的 RT-PCR 检测的匿名每日数据，而基因组序列数据则从 GISAID 获得。然后，我们将这些数据汇总到该州的 17 个地区卫生部门，以评估地区层面的结果。
公共卫生系统在最初的几个月将 RT-PCR 检测仅限于住院病例。仅在 2020 年 7 月，才将检测扩展到允许对非住院人员进行症状性检测，但并未观察到监测工作的统计学显著增加。2020 年 9 月，将病例定义扩大到允许根据临床、实验室和图像数据标准而非 RT-PCR 检测来确认病例，而无需增加对无症状疑似病例的检测，但这并未增加对无症状疑似病例的检测量。每个地区卫生部门的检测量平均值都有所增加，但由于检测扩展不足，检测阳性率有所增加。结果还表明，在全州的地区卫生部门中，这些变化后的检测结果改善程度参差不齐。
证据表明，较低的 RT-PCR 检测和基因组监测工作与人口密度较高和对公共卫生系统依赖程度较高的地区有关。我们的结果强调，在紧急情况下，必须根据当地人口统计数据和脆弱性来构建疾病控制和预防的卫生监测和信息系统。在高流行地区，必须显著改善在 COVID-19 期间识别和将脆弱人群纳入常规和强化监测计划的工作。
