Abstract
BackgroundNon-pharmaceutical interventions (NPIs) have been implemented worldwide to curb COVID-19 spread. Belarus is a rare case of a country with a relatively modern healthcare system, where highly limited NPIs have been enacted. Thus, investigation of Belarusian COVID-19 dynamics is essential for the local and global assessment of the impact of NPI strategies.MethodsWe integrate genomic epidemiology and surveillance methods to investigate the spread of SARS-CoV-2 in Belarus in 2020. We utilize phylodynamics, phylogeography, and probabilistic bias inference to study the virus import and export routes, the dynamics of the effective reproduction number, and the incidence of SARS-CoV-2 infection.ResultsHere we show that the estimated cumulative number of infections by June 2020 exceeds the confirmed case number by a factor of ~4 (95% confidence interval (2; 9)). Intra-country SARS-CoV-2 genomic diversity originates from at least 18 introductions from different regions, with a high proportion of regional transmissions. Phylodynamic analysis indicates a moderate reduction of the effective reproductive number after the introduction of limited NPIs, but its magnitude is lower than for developed countries with large-scale NPIs. On the other hand, the effective reproduction number estimate is comparable with that for the neighboring Ukraine, where NPIs were broader.ConclusionsThe example of Belarus demonstrates how countries with relatively low outward population mobility continue to be integral parts of the global epidemiological environment. Comparison of the effective reproduction number dynamics for Belarus and other countries reveals the effect of different NPI strategies but also emphasizes the role of regional Eastern European sociodemographic factors in the virus spread.
Highlights
Non-pharmaceutical interventions (NPIs) have been implemented worldwide to curb COVID-19 spread
The observed Belarusian SARS-CoV-2 sequences belong to 11 genomic lineages
The genome that was sampled on February 23, 2021, belongs to B.1.1.7 lineage that emerged in the UK in November 2020 and had been rapidly spreading toward fixation[42]
Summary
We integrate genomic epidemiology and surveillance methods to investigate the spread of SARS-CoV-2 in Belarus in 2020. The SARS-CoV-2 genomic data for analysis were downloaded from GISAID21 on March 15, 2021. The Belarusian dataset consists of 41 full-length genomes sampled between March 2020 and February 2021. Specimen and their metadata were originally collected by the Republican Research and Practical Center for Epidemiology and Microbiology (RRPCEM, 40 specimens) and Gomel State Medical University (1 specimen) in surveillance settings. One sequence was obtained from a citizen of Azerbaijan who was tested in Belarus to be allowed to return to his home country. This sequence is marked as Azerbaijanian in GISAID but is considered as Belarusian here. Numbers of new cases and conducted tests were collected from the official Telegram channel of the Ministry of Health of the Republic of Belarus[22]
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