# Signatures of the Venezuelan Humanitarian Crisis in the First Wave of COVID-19: Fuel Shortages and Border Migration

^{1}

^{2}

^{3}

^{4}

^{5}

^{6}

^{7}

^{*}

## Abstract

**:**

## 1. Introduction

## 2. Materials and Methods

#### 2.1. Spatial Epidemiology and Modeling

#### 2.2. Model Parametrization and Initialization

#### 2.3. Identifying the Drivers of Contagion

## 3. Results

#### 3.1. Low Connectivity, Migrants and the Development of the Epidemic

#### 3.2. NPIs, Gasoline, Mobility and Contagion

## 4. Discussion

## Author Contributions

## Funding

## Acknowledgments

## Conflicts of Interest

## Appendix A

#### Appendix A.1. Delayed Start of First Epidemic Wave

**Figure A1.**Biweekly changes in confirmed cases of COVID-19 per million people in South American countries. The highest biweekly changes indicate when the initial growth phase occurred in each country. Venezuela lagged behind most countries in the region. Figure adapted from Our World Data [32] (accessed on 30 May 2021).

#### Appendix A.2. Under-Reporting

**Figure A2.**RT-PCR testing in Venezuela. The grey bars indicate the total number of tests carried out and the green line estimates the percent positivity. The red dotted line corresponds to the positivity recommended by the WHO for an adequate case tracing.

#### Appendix A.3. Model Description

**Figure A3.**Daily infections with SARS-CoV-2 in Venezuela during the first 285 days. Gray bars are the number of cases confirmed with RT-PCR and reported by health authorities. The lines and shades are the mean and 50% confidence intervals of daily infections documented in non-border (red) and border (green) states predicted by the SEI metapopulation model, assuming that only 25% of all cases are documented.

## References

- Paniz-Mondolfi, A.E.; Sordillo, E.M.; Márquez-Colmenarez, M.C.; Delgado-Noguera, L.A.; Rodriguez-Morales, A.J. The arrival of SARS-CoV-2 in Venezuela. Lancet
**2020**, 395, e85–e86. [Google Scholar] [CrossRef] - Burki, T. COVID-19 in Latin America. Lancet Infect. Dis.
**2020**, 20, 547–548. [Google Scholar] [CrossRef] - Yapur, N. Venezuela’s Access to Vaccines Imperiled By Seized Virus Tests. Bloomberg
**2020**. Available online: https://www.bloomberg.com/news/articles/2021-01-21/venezuela-s-access-to-vaccines-imperiled-by-seized-virus-tests (accessed on 25 May 2021). - Instituto de Investigaciones Económicas y Sociales, UCAB. Indicadores Sociales INSO-ENCOVI. 2020. Available online: https://insoencovi.ucab.edu.ve/indicador-de-empleo/ (accessed on 25 May 2021).
- Grillet, M.E.; Hernández-Villena, J.V.; Llewellyn, M.S.; Paniz-Mondolfi, A.E.; Tami, A.; Vincenti-Gonzalez, M.F.; Marquez, M.; Mogollon-Mendoza, A.C.; Hernandez-Pereira, C.E.; Plaza-Morr, J.D. Venezuela’s humanitarian crisis, resurgence of vector-borne diseases, and implications for spillover in the region. Lancet Infect. Dis.
**2019**, 19, e149–e161. [Google Scholar] [CrossRef] [Green Version] - OCHA. Venezuela Junio 2020: Informe de situación. Última actualizacióon: Agosto 13. 2020. Available online: https://reports.unocha.org/es/country/venezuela-bolivarian-republic-of/ (accessed on 15 May 2021).
- Daniels, J.P. Venezuelan migrants “struggling to survive” amid COVID-19. Lancet
**2020**, 395, 1023. [Google Scholar] [CrossRef] - Gu, Y. Estimating True Infections: A Simple Heuristic to Measure Implied Infection Fatality Rate. 2020. Available online: https://covid19-projections.com/estimating-true-infections/ (accessed on 10 August 2020).
- Abbott, S.; Hellewell, J.; Thompson, R.N.; Sherratt, K.; Gibbs, H.P.; Bosse, N.I.; Munday, J.D.; Meakin, S.; Doughty, E.L.; Chun, J.Y.; et al. Estimating the time-varying reproduction number of SARS-CoV-2 using national and subnational case counts [version 2; peer review: 1 approved with reservations]. Wellcome Open Res.
**2020**, 5, 112. [Google Scholar] [CrossRef] - Li, R.; Pei, S.; Chen, B.; Song, Y.; Zhang, T.; Yang, W.; Shaman, J. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science
**2020**, 368, 489–493. [Google Scholar] [CrossRef] [PubMed] [Green Version] - Balcan, D.; Colizza, V.; Gonçalves, B.; Hu, H.; Ramasco, J.J.; Vespignani, A. Multiscale mobility networks and the spatial spreading of infectious diseases. Proc. Natl. Acad. Sci. USA
**2009**, 106, 21484–21489. [Google Scholar] [CrossRef] [PubMed] [Green Version] - ACFIMAN. Estado Actual de la Epidemia de la COVID-19 en Venezuela y sus Posibles Trayectorias Bajo Varios Escenarios. 2020. Available online: https://acfiman.org/wp-content/uploads/2020/10/informe-final-COVID-19-1.pdf (accessed on 25 May 2021).
- Du, Z.; Xu, X.; Wu, Y.; Wang, L.; Cowling, B.J.; Meyers, L.A. Serial interval of COVID-19 among publicly reported confirmed cases. Emerg. Infect. Dis.
**2020**, 26, 1341. [Google Scholar] [CrossRef] [PubMed] - Jombart, T.; van Zandvoort, K.; Russell, T.W.; Jarvis, C.I.; Gimma, A.; Abbott, S.; Clifford, S.; Funk, S.; Gibbs, H.; Liu, Y.; et al. Inferring the number of COVID-19 cases from recently reported deaths. Wellcome Open Res.
**2020**, 5, 78. [Google Scholar] [CrossRef] [PubMed] - Trujillo, V.E.C.; Méndez, J.S.C. Measures for the management of SARS-CoV-2 in Venezuela: An analysis from the data. DE Caracas
**2020**, 128, 273. [Google Scholar] - Kang, D.; Choi, H.; Kim, J.H.; Choi, J. Spatial epidemic dynamics of the COVID-19 outbreak in China. Int. J. Infect. Dis.
**2020**, 94, 96–102. [Google Scholar] [CrossRef] [PubMed] - Feng, Y.; Li, Q.; Tong, X.; Wang, R.; Zhai, S.; Gao, C.; Lei, Z.; Chen, S.; Zhou, Y.; Wang, J.; et al. Spatiotemporal spread pattern of the COVID-19 cases in China. PLoS ONE
**2021**, 15, e0244351. [Google Scholar] [CrossRef] - Chen, Y.; Li, Q.; Karimian, H.; Chen, X.; Li, X. Spatio-temporal distribution characteristics and influencing factors of COVID-19 in China. Sci. Rep.
**2021**, 11, 3717. [Google Scholar] [CrossRef] [PubMed] - Diesel Shortage Once again Paralyzes Venezuela. 2021. Available online: https://www.archyde.com/diesel-shortage-once-again-paralyzes-venezuela-international/ (accessed on 25 May 2021).
- Venezuela Travel Restrictions. 2020. Available online: https://travelbans.org/south-america/venezuela/ (accessed on 25 May 2021).
- Venezuela: Inflation Rate from 1985 to 2022. 2021. Available online: https://www.statista.com/statistics/371895/inflation-rate-in-venezuela/ (accessed on 25 May 2021).
- Badr, H.S.; Du, H.; Marshall, M.; Dong, E.; Squire, M.M.; Gardner, L.M. Association between mobility patterns and COVID-19 transmission in the USA: A mathematical modelling study. Lancet Infect. Dis.
**2020**, 20, 1247–1254. [Google Scholar] [CrossRef] - Nouvellet, P.; Bhatia, S.; Cori, A.; Ainslie, K.E.; Baguelin, M.; Bhatt, S.; Boonyasiri, A.; Brazeau, N.F.; Cattarino, L.; Cooper, L.V. Reduction in mobility and COVID-19 transmission. Nat. Commun.
**2021**, 12, 1–9. [Google Scholar] [CrossRef] [PubMed] - OAS. Situation Report: Venezuelan Migration and Refugee Crisis; Oficina de la Secretaría General de la OEA para la Crisis de Migrantes y Refugiados Venezolanos: Washington, DC, USA, 2020. [Google Scholar]
- Phung, P.; Keegan, K.; Ricard, J.; Arevalo, M.; Vinck, P. Evaluation of the UNHCR Regional Refugee Response to the Venezuela Situation; Office of the United Nations High Commissioner for Refugees: Genève, Switzerland, 2020. [Google Scholar]
- Salyer, S.J.; Maeda, J.; Sembuche, S.; Kebede, Y.; Tshangela, A.; Moussif, M.; Ihekweazu, C.; Mayet, N.; Abate, E.; Ouma, A.O. The first and second waves of the COVID-19 pandemic in Africa: A cross-sectional study. Lancet
**2021**, 397, 1265–1275. [Google Scholar] [CrossRef] - Watson, O.; Abdelmagid, N.; Ahmed, A.; Ahmed Abd Elhameed, A.; Whittaker, C.; Brazeau, N.; Hamlet, A.; Walker, P.; Hay, J.; Ghani, A. Report 39: Characterising COVID-19 Epidemic Dynamics and Mortality under-Ascertainment in Khartoum, Sudan; Imperial College London: London, UK, 2020. [Google Scholar] [CrossRef]
- Mwananyanda, L.; MacLeod, W.; Kwenda, G.; Pieciak, R.; Mupila, Z.; Mupeta, F.; Forman, L.; Ziko, L.; Etter, L.; Thea, D. COVID-19 deaths detected in a systematic post-mortem surveillance study in Africa. medRxiv
**2020**. [Google Scholar] [CrossRef] - Besson, E.S.K.; Norris, A.; Ghouth, A.S.B.; Freemantle, T.; Alhaffar, M.; Vazquez, Y.; Reeve, C.; Curran, P.J.; Checchi, F. Excess mortality during the COVID-19 pandemic in Aden governorate, Yemen: A geospatial and statistical analysis. BMJ Global Health
**2020**, 6, e004564. [Google Scholar] [CrossRef] [PubMed] - Loureiro, C.L.; Jaspe, R.C.; D´ Angelo, P.; Zambrano, J.L.; Rodriguez, L.; Alarcon, V.; Delgado, M.; Aguilar, M.; Garzaro, D.; Rangel, H.R. SARS-CoV-2 genetic diversity in Venezuela: Predominance of D614G variants and analysis of one outbreak. PLoS ONE
**2021**, 16, e0247196. [Google Scholar] [CrossRef] [PubMed] - Saravia, A. In Venezuela, Politics Overshadow COVAX Shipment and Vaccine Rollout. 2021. Available online: https://www.devex.com/news/in-venezuela-politics-overshadow-covax-shipment-and-vaccine-rollout-99636 (accessed on 13 May 2021).
- Roser, M.; Ritchie, H.; Ortiz-Ospina, E.; Hasell, J. Coronavirus Pandemic (COVID-19). 2020. Available online: https://ourworldindata.org/coronavirus (accessed on 30 May 2021).

**Figure 1.**(

**a**) Official record of daily infections in Venezuela detected by RT-PCR between 13 March and 21 December and (

**b**) effective reproductive numbers estimated (green) and projected (gray) from incidence data adjusted for positivity (Figure A2), with a seven-day sliding window using the EpiNow2 package [9]. Dark, intermediate and light colored curves correspond to 50%, 90% and 95% percent confidence intervals. Dark grey windows show the periods during which less than 30% of stations had no gasoline. Blue bands indicate when stay-at-home orders were in place, and the color transparency the approximate level of compliance.

**Figure 2.**COVID-19 cumulative cases (incidence) per state in Venezuela from March to August (

**a**) and December (

**b**) 2020. Heatmap of daily reported infections (legend color bar) across states (

**c**). State numbers in the map correspond to state names in the heatmap.

**Figure 3.**Frequency of daily movements between states used in the simulations with the SEI metapopulation model, derived from the Gravity function and calibrated against observed dynamics. The volume of daily movements within Venezuela was orders of magnitude smaller than from Colombia and Brazil.

**Figure 4.**Time series and wavelet power spectra of the residence time (

**a**,

**b**) and the effective reproduction number (

**c**,

**d**) between mid-June and mid-December 2020. The colors for power values range from dark blue (low values) to orange (high values). Strong signals with periods of 7 and 15 days are observed in the excess residence time (

**b**). A weak and interrupted signal with a period of 15 days is shown for the effective reproductive number (

**d**). The black lines correspond to the maxima of the undulations of the wavelet power spectrum. Right: the two global spectra corresponding to each analysis.

**Figure 5.**Drivers of contagion in Venezuela. (

**a**) Excess time spent at home relative to pre-pandemic (Google Mobility) decreases with the availability of gasoline according to $\mathit{y}=0.2536*{\mathit{x}}^{-0.5487}$. This dependence was stronger when gasoline availability dropped below 30% (orange area), than when it was above this threshold (green area). (

**b**) When gasoline availability decreased below 30%, the effective reproductive number decreased significantly with the excess time spent at home (${R}^{2}=0.29$, ${F}_{(1,13)}=4.91$, $p=0.046$). (

**c**) When gasoline was available in more than 30% of stations, the effective reproductive number no longer showed a significant relationship with excess time spent at home (${R}^{2}=0.07$, ${F}_{(1,13)}=1.12$, $p=0.278$). Two outliers with ${R}_{t}>2$ were omitted from the analysis.

**Table 1.**Epidemiological parameters, initial conditions and range of daily movements used for simulations within the metapopulation SEI model.

Parameter | Values |
---|---|

Transmission rate ($\beta $, days${}^{-1}$) | ${R}_{t}/D$ |

Latency period (Z, days) | 3.9 |

Infectious period (D) | 5 |

Reporting fraction ($\alpha $) | 0.15 |

Initial seeds Distrito Capital (${I}_{o},{U}_{o}$) | 120, 240 |

Initial seeds Miranda (${I}_{o},{U}_{o}$) | 100, 200 |

Maximum daily local travelers ($\theta $, days${}^{-1}$) | 100–5000 |

Daily travelers from Colombia | 3500–10,000 |

Daily travelers from Brazil | 500–2000 |

Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |

© 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).

## Share and Cite

**MDPI and ACS Style**

Lampo, M.; Hernández-Villena, J.V.; Cascante, J.; Vincenti-González, M.F.; Forero-Peña, D.A.; Segovia, M.J.; Hampson, K.; Castro, J.; Grillet, M.E.
Signatures of the Venezuelan Humanitarian Crisis in the First Wave of COVID-19: Fuel Shortages and Border Migration. *Vaccines* **2021**, *9*, 719.
https://doi.org/10.3390/vaccines9070719

**AMA Style**

Lampo M, Hernández-Villena JV, Cascante J, Vincenti-González MF, Forero-Peña DA, Segovia MJ, Hampson K, Castro J, Grillet ME.
Signatures of the Venezuelan Humanitarian Crisis in the First Wave of COVID-19: Fuel Shortages and Border Migration. *Vaccines*. 2021; 9(7):719.
https://doi.org/10.3390/vaccines9070719

**Chicago/Turabian Style**

Lampo, Margarita, Juan V. Hernández-Villena, Jaime Cascante, María F. Vincenti-González, David A. Forero-Peña, Maikell J. Segovia, Katie Hampson, Julio Castro, and Maria Eugenia Grillet.
2021. "Signatures of the Venezuelan Humanitarian Crisis in the First Wave of COVID-19: Fuel Shortages and Border Migration" *Vaccines* 9, no. 7: 719.
https://doi.org/10.3390/vaccines9070719