Successful containment of COVID-19 in a Brazilian archipelago

By Aradhana SubramanianNov 8 2020

The ongoing COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first identified in late December 2019 in Wuhan, China. The outbreak was declared a "Public Health Emergency of International Concern" in January 2020 and a pandemic in March 2020. As of today, more than 50 million cases have been confirmed, with more than 1.25 million deaths attributed to COVID-19 worldwide. The paramount area of concern is the transmission of the novel coronavirus. This is especially relevant to Brazil, the country with the third-largest number of COVID-19 cases globally, standing at over 5.66 million cases.

Epidemiologists believe that viral transmission can be closely monitored in islands as the population is small and has a relatively smaller area. A group of 21 islands about 350 kilometers off Brazil's northeast coast is Fernando de Noronha Archipelago (FNA). The team of researchers in May 2020, headed by Ligia Regina Franco Sansigolo Kerr and Prof Costa Mendes, aimed to discuss and report the various control measures taken by FNA authorities in order to reduce the spread of SARS-CoV-2 virus in the Fernando de Noronha Archipelago (FNA). Their research is published on the preprint server medRxiv*.

Study: Fernando de Noronha: how an island controlled the community transmission of COVID-19 in Brazil. Image Credit: Diego Grandi / Shutterstock

Fernando de Archipelago:

The islands' official population is about 3,000, all living on the main island covering 17 km2. Being situated in Brazil's state of Pernambuco, FNA is a World Heritage Site, with tourism being the main economic activity. FNA also has an airport bringing in around 38 flights weekly, bringing in approximately 452 passengers every day.

"We have started taking preventive measures to manage COVID-19 pandemic here much before the state was hit with its first COVID-19 positive case in early March 2020" the administrative general of FNA says.

The study

The research team collected data about the COVID-19 pandemic in FNA by documenting data from epidemiological bulletins and also conducted a cohort study with questionnaires and testing of COVID-19 using RT-PCR kits in intervals of 60, 120, 180, and 360 days from May 22, 2020, for the people belonging to FNA. The team looked at the socioeconomic factors and reported the government's control measures and its implications in the FNA region.

Prevalence of COVID-19 in FNA

Only 5.1% cases were reported, and the research group from their survey estimates that about 5.6 times more cases occurred on the island went unreported. On comparing the national survey of 133 cities report published in May 2020, Mozart's team predicts that FNA would have had the country's ninth highest prevalence rate.

Control Measures

From the survey conducted, the team noticed that the FNA government followed the WHO protocols such as testing, isolation, and social distancing very religiously. The study showed few exceptional measures such as contact tracing for all the positive cases was identified, testing was made compulsory for travelers before, and after coming into the island, the wrist band usage to distinguish positive cases that cannot be removed without the approval from health surveillance system and the residents can venture out to get basic necessities only after authorization from an application in the smartphone.  Schools in FNA were closed until further notice, and the FNA government has strengthened primary healthcare facilities by building a hospital in FNA itself to avoid travel to the mainland and mitigate the COVID-19 spread.

Even after the control measures taken by the FNA government, there was a high transmission rate. The researchers note that the removal of masks when with family and friends, food and other products being imported, and an influx of staff for primary healthcare from other cities outside the island could be the reason for the high transmission rate.

Influence of COVID-19 pandemic on the economy

The team conducted detailed research on the influence of the COVID-19 pandemic on the economy through their survey. FNA's main economic activity, tourism, was affected as the government imposed strict air travel rules, drastically reducing the number of flights from 38 to 1 flight per week. This increased the unemployment rate to around 46.4% on the island, with many citizens having to switch to informal work due to food insecurity.

Conclusion

The measures taken by the FNA administration were partly successful in curtailing the spread of COVID-19 in three months from the date of the first reported COVID-19 case in FNA. The success rate of nearly halting the COVID-19 spread attributed to the government's measures and low population size even though many islands such as Puerto Rico in the US with a low population could not succeed in the containment of spread. "The sustenance of this exemplification remains an enormous challenge since the island has to open up again for its largely dependent economic activity of tourism in order to address the gloomy situation of unemployment and food security in FNA, the researchers said, "We will continue to monitor the situation to advise the authorities."