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Serologic Evidence for Early SARS-CoV-2 Circulation in Lima, Peru, 2020.

Andres Moreira-Soto1,2, Maria Paquita García3, Gloria Arotinco-Garayar3

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Early undetected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) circulation in Peru contributed to high COVID-19 mortality. Accurate diagnostic confirmation is crucial for understanding pandemic spread and improving outbreak management.

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Area of Science:

  • Virology
  • Epidemiology
  • Public Health

Background:

  • Peru experienced the highest COVID-19 per-capita mortality in early 2021.
  • Factors contributing to high mortality include socioeconomic inequality, healthcare system unpreparedness, and surveillance limitations.
  • Early, undetected SARS-CoV-2 circulation could significantly exacerbate mortality rates.

Purpose of the Study:

  • To investigate the timing of SARS-CoV-2 introduction and circulation in Peru.
  • To assess the role of early, undetected viral spread in Peru's high COVID-19 mortality.
  • To emphasize the importance of diagnostic confirmation in tracking pandemic trajectories.

Main Methods:

  • Serological testing for SARS-CoV-2 antibodies in 1,441 individuals with fever (August 2019-May 2021).
  • Utilized chemiluminescence immunoassay, surrogate virus neutralization test, plaque-reduction neutralization test (PRNT), and avidity testing.
  • Employed a susceptible, exposed, infected, and recovered (SEIR) mathematical model to estimate the effective reproduction number.

Main Results:

  • No early samples (January-March 2020) were confirmed by PRNT, unlike samples from April 2020 onwards (P <0.0001).
  • SARS-CoV-2 antibody detection rate was 0.9% in mid-April 2020, suggesting circulation began in early-middle March 2020.
  • Increased antibody avidity and SEIR model results indicated SARS-CoV-2 circulation onset in late February/March 2020.

Conclusions:

  • Early introduction and circulation of SARS-CoV-2 in Peru preceded official detection, contributing to high mortality.
  • Accurate diagnostic confirmation is vital for understanding disease spread and pandemic dynamics.
  • This study underscores the necessity of early detection and precise testing for effective infectious disease outbreak management.