Is Colombia an example of successful containment of the COVID-19 2020 pandemic? A critical analysis of the epidemiological data. March to July 2020

la Hoz-Restrepo, Fernando de; Alvis-Zakzuk, Nelson J.; la Hoz-Gomez, Juan Fernando De; la Hoz-Gomez, Alejandro De; Corral, Luz Gómez Del; Alvis-Guzmán, Nelson

BACKGROUND/OBJECTIVE: Colombia detected its first COVID-19 case on March 2nd, 2020. From March 22nd to April 25th, it implemented a national lock down that, apparently, allowed the country to keep a low incidence and mortality rate up to mid-May. Forced by the economic losses the government opened many commercial activities, which was followed by an increase in cases and deaths. This paper presents a critical analysis of the Colombian surveillance data in order to identify strengths and pitfalls of the control measures. METHODS: Descriptive analysis of Polymerase Chain Reaction (PCR) confirmed cases between March and July 25th. Data was described according to the level of measurement. Incidence and mortality rates of COVID-19 were estimated by age, sex, and geographical areas. Sampling rates for suspected cases were estimated by geographical areas, and the potential for case underestimation was assessed using sampling differences. RESULTS: By July 25, Colombia (50,372,424 habitants) has reported 240,745 cases and 8,269 deaths (case fatality ratio 3.4%). It has analyzed 1,370,271 samples (27,405 samples per million people) with a positivity ratio of 17%. Sampling rates per million vary by region, from 2,664 to 158,681 per million and, consequently, incidence and mortality rate also vary. Due to geographical variations in surveillance capacity, Colombia may have overlooked up to 82% of the actual cases. CONCLUSION: Colombia has a lower case and mortality incidence compared to other South American countries. This may be an effect of the lock down but also, at some extent, to geographical differences in surveillance capacity. Indigenous populations with little health infrastructure have been hit the hardest.