An effective COVID-19 response in South America: the Uruguayan Conundrum

Moreno, P.; Moratorio, G. A.; Iraola, G.; Fajardo, A.; Aldunate, F.; Pereira, M.; Perbolianachis, P.; Costabile, A.; Lopez-Tort, F.; Simon, D.; Salazar, C.; Ferres, I.; Diaz-Viraque, F.; Abin, A.; Bresque, M.; Fabregat, M.; Maidana, M.; Rivera, B.; Cruces, M.; Rodriguez, J.; Scavone, P.; Alegretti, M.; Nabon, A.; Gagliano, G.; Rosa, R.; Henderson, E.; Bidegain, E.; Zarantonelli, L.; Piattoni, C.; Greif, G.; Francia, M.; Robello, C.; Duran, R.; Brito, G.; Bonnecarrere, V.; Sierra, M.; Colina, R.; Marin, M.; Cristina, J.; Erlich, R.; Paganini, F.; Cohen, H.; Radi, R.; Barbeito, L.; Badano, J.

Background: South America has become the new epicenter of the COVID-19 pandemic with more than 1.1M reported cases and >50,000 deaths (June 2020). Conversely, Uruguay stands out as an outlier managing this health crisis with remarkable success. Methods: We developed a molecular diagnostic test to detect SARS-CoV-2. This methodology was transferred to research institutes, public hospitals and academic laboratories all around the country, creating a COVID-19 diagnostic lab network. Uruguay also implemented active epidemiological surveillance following the Test, Trace and Isolate (TETRIS) strategy coupled to real-time genomic epidemiology. Results: Three months after the first cases were detected, the number of positive individuals reached 826 (23 deaths, 112 active cases and 691 recovered). The Uruguayan strategy was based in a close synergy established between the national health authorities and the scientific community. In turn, academia rapidly responded to develop national RT-qPCR tests. Consequently, Uruguay was able to perform ~1,000 molecular tests per day in a matter of weeks. The COVID-19 diagnostic lab network performed more than 54% of the molecular tests in the country. This, together with real-time genomics, were instrumental to implement the TETRIS strategy, helping to contain domestic transmission of the main outbreaks registered so far. Conclusions: Uruguay has successfully navigated the first trimester of the COVID-19 health crisis in South America. A rapid response by the scientific community to increase testing capacity, together with national health authorities seeking out the support from the academia were fundamental to successfully contain, until now, the COVID-19 outbreak in the country.