key: cord-0734376-bfmiq1mw authors: Rodriguez-Morales, Alfonso J.; Gallego, Viviana; Escalera-Antezana, Juan Pablo; Méndez, Claudio A.; Zambrano, Lysien I.; Franco-Paredes, Carlos; Suárez, Jose A.; Rodriguez-Enciso, Hernan D.; Balbin-Ramon, Graciela Josefina; Savio-Larriera, Eduardo; Risquez, Alejandro; Cimerman, Sergio title: COVID-19 in Latin America: The implications of the first confirmed case in Brazil date: 2020-02-29 journal: Travel Med Infect Dis DOI: 10.1016/j.tmaid.2020.101613 sha: 1d321f94b4aafa3465879810990c0a4835b84e0f doc_id: 734376 cord_uid: bfmiq1mw nan passenger flights scheduled to 103 destinations in 30 countries, and 52 domestic flights, connecting not only with major cities in Latin America but also with direct flights to North America, Europe, Africa and the Middle East (Dubai). There are also buses that offer a service to and from the metropolitan centers of Paraguay, Argentina, Uruguay and Bolivia. Brazil also connects with the countries of Chile, Argentina and Bolivia through some rail connections. The main seaport of Brazil is in Rio de Janeiro, where many international cruises also arrive. Thus, over the course of the next few days, a significant expansion in the region would be possible. The healthcare systems in this region are already fragile [7] . Moreover, fragmentation and segmentation are ongoing challenges for most of these vulnerable systems. Multiple social and economic issues are ongoing and will impact the situation, including the massive exodus from Venezuela to many countries in the region. This human migration is associated with other infectious diseases, such as malaria or measles [8] . The burden that will be imposed on the region, if and when COVID-19 spreads, would be an additional challenge for the healthcare systems and economies in the region, as we faced with Zika and even the Chikungunya outbreaks [9] . For example, there is concern about the availability of intensive care units, that are necessary for at least 20-25% of patients hospitalized with COVID-19-also, the availability of specific diagnostic tests, particularly the real-time RT-PCR is a crucial challenge for early detection of COVID-19 importation and prevention of onward transmission. Even maybe in some countries, cases have been not diagnosed due to lack of availability of specific tests. Are Latin American healthcare systems sufficiently prepared? Probably not, but in general, this is the same in other regions of the world, such as in many parts of Asia and Africa [10] . Although most countries in Latin America are trying to step up their preparedness to detect and cope with COVID-19 outbreaks, it will be essential to intensify inter-continental and intra-continental, communication and health workforce training. In the Latin American region, there is a large heterogeneity of political and social development, economic growth, and political capacities. 2019 spreading measles, diphtheria, and vector-borne diseases, such as malaria, over the region [11] [12] [13] , the impact of a COVID-19 outbreak will be more devastating than in the more developed economies, such as Brazil or Mexico. Most of the countries in the region are remembering the lessons learned during SARS (2003) and pandemic influenza (2009). Protocols already developed during those crises, including laboratory and patient management, may prove useful in this new situation. Good communication strategies for preventive measures in the population, and in neighboring countries in addition to Brazil, will be essential and this response should be aligned with the recommendations of the WHO. In Latin America, the Pan-American Health Organization (PAHO/ WHO) recent epidemiological alert for measles shows that from January 1, 2019 to January 24, 2020, 20,430 confirmed cases of measles were reported, including 19 deaths, in 14 countries: Argentina, Bahamas, Brazil, Chile, Colombia, Costa Rica, Cuba, Curaçao, Mexico, Peru, Uruguay and Venezuela. Brazil contributed 88% of the total confirmed cases in the Americas [14] . In the first 4 weeks of 2020, a staggering 125,514 cases of measles were notified. The dengue incidence rate is 12.86 cases/100,000 inhabitants in the region for the ongoing year, including 27 deaths, 12,891 cases confirmed by laboratory and 498 cases classified as severe dengue (0.4%). Countries like Bolivia, Honduras, Mexico and Paraguay have reported an increase of double or triple the number of cases of dengue compared to the same period from the previous year [15] . In this complex epidemiological scenario, we are about to witness a syndemic [16] of measles, dengue, and COVID-19, among others, unfold. The World Health Organization (WHO) has published guidelines encouraging the provision of information to health professionals and the general public. Resources, intensified surveillance, and capacity building should be urgently prioritized in countries with a moderate risk that might be ill-prepared to detect imported cases and to limit onward transmission, as has already occurred in Brazil. [For the moment of proofs correction of this Editorial -Mar. 1, 2020-, 2 cases have been confirmed in Brazil, but also new 5 confirmed cases were also reported in Mexico (2°country that reported cases), 6 in Ecuador (3°) and 1 in Dominican Republic (4°), summarizing 14 cases in Latin America]. AJRM conceived the idea of the Editorial and wrote the first draft. The rest of the authors reviewed and improved the second draft. All authors approved the final version. Conceptualization: AJRM. Writing-original draft preparation: AJRM. Writing-review, and editing: All the authors. None. Approval was not required. None of the authors has any conflict of interest to declare.All authors report no potential conflicts. All authors have submitted the Form for Disclosure of Potential. Going global -travel and the 2019 novel coronavirus COVID-19 -brasil (11) (SP, ex-Itália), primeiro caso provável ProMEDmail Sao Paulo State Health Secretary. Plan of response of the Sao Paulo state for the human infection due to novel Coronavirus Informativo da Sociedade Brasileira de Infectologia: primeiro caso confirmado de doença pelo novo Coronavírus (COVID-19) no Brasil -26/02/2020 The next big threat to global health? 2019 novel coronavirus (2019-nCoV): what advice can we give to travellers? -interim recommendations Zika and microcephaly in Latin America: an emerging threat for pregnant travelers The Lancet. 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