Increased vulnerability to SARS-CoV-2 infection among indigenous people living in the urban area of Manaus

  1. Gemilson Soares Pontes
  2. Jean de Melo Silva
  3. Renato Pinheiro-Silva
  4. Anderson Nogueira Barbosa
  5. Luciano Cardenes Santos
  6. Antônio de Pádua Quirino Ramalho
  7. Carlos Eduardo de Castro Alves
  8. Danielle Furtado da Silva
  9. Leonardo Calheiros de Oliveira
  10. Allyson Guimarães da Costa
  11. Ana Carla Bruno

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Abstract

The COVID-19 pandemic threatens indigenous peoples living in suburban areas of large Brazilian cities and has thus far intensified their pre-existing socio-economic inequalities. We evaluated the epidemiological situation of SARS-CoV-2 infection among residents of the biggest urban multiethnic indigenous community of the Amazonas state, Brazil. Blood samples of 280 indigenous people living in the surrounding area of Manaus were tested for the presence of anti-SARS-CoV-2 IgA or IgG antibodies. The risk factors and sociodemographic information were assessed through an epidemiological questionnaire. We found a total positivity rate of 64.64% (95% CI 59.01–70.28) for SARS-CoV-2 infection. IgA and IgG were detected in 55.71% (95% CI 49.89–61.54) and 60.71% (95% CI 54.98–66.45) of the individuals, respectively. Over 80% of positive individuals were positive for both IgA and IgG.No significant difference in positivity rates between genders or age groups was observed. Moreover, the age group ≥ 60 years old showed the highest antibody ratios (IgA mean ratio = 3.080 ± 1.623; IgG mean ratio = 4.221 ± 1.832), while the age groups 13–19 and 20–29 showed the lowest IgA (mean ratio = 2.268 ± 0.919) and IgG ratios (mean ratio = 2.207 ± 1.246), respectively. Individuals leaving the home more frequently were at higher risk of infection (Odds ratio (OD) 2.61; 95% CI 1.00–1.49; p = 0.048). Five or more individuals per household increased fivefold the risk of virus transmission (OR 2.56; 95% CI 1.09–6.01; p = 0.019). The disproportionate dissemination of SARS-CoV-2 infection observed among the study population might be driven by typical cultural behavior and socioeconomic inequalities. Despite the pandemic threat, this population is not being targeted by public policies and appears to be chronically invisible to the Brazilian authorities.

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  1. Version published to 10.1038/s41598-021-96843-1
  2. ScreenIT

    SciScore for 10.1101/2021.04.05.21254937: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: All individuals signed the informed consent form before taking part in this study.
    Randomization2.2 Study design and Population: Between October 10 and 14, 2020, we randomly recruited indigenous residents in the community of Parque das Tribos, the biggest multiethnic urban indigenous community in Manaus.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Antibodies
    SentencesResources
    2.3 Serological analysis: Serum samples from the study population were tested for SARS-CoV-2 IgA and IgG antibodies (Abs) through an enzyme-linked immunosorbent assay (Anti-SARS-CoV-2 IgA/IgG ELISA-euroimmun, Germany), which was performed according to the manufacturer’s instructions.
    SARS-CoV-2
    suggested: None
    IgA
    suggested: None
    IgG
    suggested: None
    Anti-SARS-CoV-2 IgA/IgG
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Despite the limitation of our data, this study indicates that indigenous peoples living in urban areas are being dramatically affected by SARS-CoV-2, especially because of their poor socioeconomic conditions and lack of access to adequate health assistance. This population is fighting a double battle due to the fact that a) in the Brazilian national health system (SUS), their indigenous identity is not recognized by the patient management system and b) They cannot be assisted by SESAI because they are outside their villages or reservations. Both situations reinforce the invisibility of these populations. Thus, we need coordinated national actions that prioritize ethnic vulnerable groups in the battle against COVID-19. We need public policies that promote health, adequate housing and sanitation for these populations. Otherwise, indigenous people living in urban areas are doomed to suffer on unprecedented levels during the current pandemic.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2021.04.05.21254937v1 on medRxiv