Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020
Background: Colombia detected its first coronavirus disease 2019 (COVID-19) case on March 2, 2020. From March 22 to April 25, it implemented a national lockdown that, apparently, allowed the country to keep a low incidence and mortality rate up to mid-May. Forced by the economic losses, the governme...
- Autores:
-
DE LA HOZ RESTREPO, FERNANDO
De la Hoz, Juan
De la Hoz Gomez, Alejandro
Gómez Del Corral, Luz
Alvis-Guzmán, Nelson
Alvis Zakzuk, Nelson J.
- Tipo de recurso:
- Article of journal
- Fecha de publicación:
- 2020
- Institución:
- Corporación Universidad de la Costa
- Repositorio:
- REDICUC - Repositorio CUC
- Idioma:
- eng
- OAI Identifier:
- oai:repositorio.cuc.edu.co:11323/7996
- Acceso en línea:
- https://hdl.handle.net/11323/7996
https://doi.org/10.1016/j.ijid.2020.08.017
https://repositorio.cuc.edu.co/
- Palabra clave:
- SARS-Cov-2
COVID-19
Epidemiology
Colombia
Pandemic
Lockdown
- Rights
- openAccess
- License
- CC0 1.0 Universal
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dc.title.spa.fl_str_mv |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 |
title |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 |
spellingShingle |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 SARS-Cov-2 COVID-19 Epidemiology Colombia Pandemic Lockdown |
title_short |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 |
title_full |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 |
title_fullStr |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 |
title_full_unstemmed |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 |
title_sort |
Is Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020 |
dc.creator.fl_str_mv |
DE LA HOZ RESTREPO, FERNANDO De la Hoz, Juan De la Hoz Gomez, Alejandro Gómez Del Corral, Luz Alvis-Guzmán, Nelson Alvis Zakzuk, Nelson J. |
dc.contributor.author.spa.fl_str_mv |
DE LA HOZ RESTREPO, FERNANDO De la Hoz, Juan De la Hoz Gomez, Alejandro Gómez Del Corral, Luz Alvis-Guzmán, Nelson |
dc.contributor.author.none.fl_str_mv |
Alvis Zakzuk, Nelson J. |
dc.subject.spa.fl_str_mv |
SARS-Cov-2 COVID-19 Epidemiology Colombia Pandemic Lockdown |
topic |
SARS-Cov-2 COVID-19 Epidemiology Colombia Pandemic Lockdown |
description |
Background: Colombia detected its first coronavirus disease 2019 (COVID-19) case on March 2, 2020. From March 22 to April 25, it implemented a national lockdown that, apparently, allowed the country to keep a low incidence and mortality rate up to mid-May. Forced by the economic losses, the government then 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: A descriptive analysis of PCR-confirmed cases between March and July 25 was performed. Data were described according to the level of measurement. Incidence and mortality rates of COVID-19 were estimated by age, sex, and geographical area. Sampling rates for suspected cases were estimated by geographical area, and the potential for case underestimation was assessed using sampling differences. Results: By July 25, Colombia (population 50 372 424) had reported 240 745 cases and 8269 deaths (case fatality rate of 3.4%). A total of 1 370 271 samples had been analyzed (27405 samples per million people), with a positivity rate of 17%. Sampling rates per million varied by region from 2664 to 158 681 per million, and consequently the incidence and mortality rates also varied. 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 lockdown, but may also be attributed, to some extent, to geographical differences in surveillance capacity. Indigenous populations with little health infrastructure have been hit the hardest. |
publishDate |
2020 |
dc.date.issued.none.fl_str_mv |
2020-08-05 |
dc.date.accessioned.none.fl_str_mv |
2021-03-12T17:22:11Z |
dc.date.available.none.fl_str_mv |
2021-03-12T17:22:11Z |
dc.type.spa.fl_str_mv |
Artículo de revista |
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http://purl.org/coar/resource_type/c_2df8fbb1 |
dc.type.coar.spa.fl_str_mv |
http://purl.org/coar/resource_type/c_6501 |
dc.type.content.spa.fl_str_mv |
Text |
dc.type.driver.spa.fl_str_mv |
info:eu-repo/semantics/article |
dc.type.redcol.spa.fl_str_mv |
http://purl.org/redcol/resource_type/ART |
dc.type.version.spa.fl_str_mv |
info:eu-repo/semantics/acceptedVersion |
format |
http://purl.org/coar/resource_type/c_6501 |
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acceptedVersion |
dc.identifier.issn.spa.fl_str_mv |
12019712 18783511 |
dc.identifier.uri.spa.fl_str_mv |
https://hdl.handle.net/11323/7996 |
dc.identifier.doi.spa.fl_str_mv |
https://doi.org/10.1016/j.ijid.2020.08.017 |
dc.identifier.instname.spa.fl_str_mv |
Corporación Universidad de la Costa |
dc.identifier.reponame.spa.fl_str_mv |
REDICUC - Repositorio CUC |
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https://repositorio.cuc.edu.co/ |
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https://hdl.handle.net/11323/7996 https://doi.org/10.1016/j.ijid.2020.08.017 https://repositorio.cuc.edu.co/ |
dc.language.iso.none.fl_str_mv |
eng |
language |
eng |
dc.relation.references.spa.fl_str_mv |
Amariles et al., 2020 P. Amariles, J. Granados, M. Ceballos, C.J. Montoya COVID-19 in Colombia endpoints. Are we different, like Europe? Res Soc Adm Pharm (2020) Mar Asociación Colombiana de Hospitales y Clínicas, 2019 Asociación Colombiana de Hospitales y Clínicas Siguen aumentando deudas a hospitales y clínicas por prestación de servicios de salud, ya superan los $10 billones de pesos [Internet] [cited 2020 May 21]. Available from: (2019) https://achc.org.co/siguen-aumentando-deudas-a-hospitales-y-clinicas-por-prestacion-de-servicios-de-salud-ya-superan-los-10-billones-de-pesos/ Asociación Colombiana de Infectología and IETS, 2020 Asociación Colombiana de Infectología, IETS Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID-19 en establecimientos de atención de la salud Infectio, 24 (April (3)) (2020), pp. 1-153 Chen et al., 2020 T. Chen, D. Wu, H. Chen, W. Yan, D. Yang, G. Chen, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study BMJ (2020), p. 368 Cagnacci and Xholli, 2020 A. Cagnacci, A. Xholli Age-related difference in the rate of coronavirus disease 2019 mortality in women versus men Am J Obstet Gynecol, 223 (3) (2020), pp. 453-454, 10.1016/j.ajog.2020.05.039 Cotes et al., 2012 K. Cotes, J. Moreno-Montoya, A. Porras-Ramírez, A. Rico-Mendoza, F. de la Hoz-Restrepo Clinical characteristics of patients hospitalized with severe respiratory illness during influenza seasons in the cities of Bogota and Manizales, Colombia 2000-2006 Rev Salud Publica, 14 (1) (2012) Departamento Administrativo Nacional de Estadística, 2018 Departamento Administrativo Nacional de Estadística Censo Nacional de Población y Vivienda [Internet]. 2018 [cited 2020 May 21]. Available from: (2018) Hasell et al., 2020 J. Hasell, E. Mathieu, D. Beltekian, B. Macdonald, C. Giattino, E. Ortiz-Ospina, et al. Coronavirus (COVID-19) Testing - Statistics and Research - Our World in Data. Web page (2020), p. 19 Immovilli et al., 2020 P. Immovilli, N. Morelli, E. Antonucci, G. Radaelli, M. Barbera, D. Guidetti COVID-19 mortality and ICU admission: the Italian experience Crit Care, 24 (1) (2020), p. 228 Institute for Health Metrics and Evaluation (IHME), 2020 Institute for Health Metrics and Evaluation (IHME) COVID-19 Projections [Internet] Available from: (2020) Instituto Nacional de Salud, 2020a Instituto Nacional de Salud Coronavirus Colombia [Internet] [cited 2020 May 21]. Available from: (2020) Instituto Nacional de Salud, 2020b Instituto Nacional de Salud Modelo de transmisión de coronavirus COVID-19. Escenarios para Colombia [Internet] (2020) Available from: https://www.ins.gov.co/Direcciones/ONS/SiteAssets/Modelo COVID-19 Colombia INS_v5.pdf Ji et al., 2020 Y. Ji, Z. Ma, M.P. Peppelenbosch, Q. Pan Potential association between COVID-19 mortality and health-care resource availability Lancet Glob Heal, 8 (4) (2020), p. e480 Kennedy et al., 2020 D.M. Kennedy, G.J. Zambrano, Y. Wang, O.P. Neto Modeling the effects of intervention strategies on COVID-19 transmission dynamics J Clin Virol (2020), p. 104440 Marin et al., 2020 J.E.G. Marin, J. Castellanos, A.J. Rodriguez-Morales, J.A. Cardona-Ospina, J.E.F. Duarte, S. Mattar, et al. Ad-hoc group consensus recommendations on the evaluation and quality control of molecular and serological diagnostics tests for SARS CoV-2 human infection* Infectio, 24 (May (3)) (2020) Ministerio de Salud y Protección Social, 2018 Ministerio de Salud y Protección Social Comportamiento del aseguramiento [Internet] [cited 2020 May 21]. Available from: (2018) https://www.minsalud.gov.co/proteccionsocial/Regimensubsidiado/Paginas/coberturas-del-regimen-subsidiado.aspx Ministerio del Interior, 2020a Ministerio del Interior República de Colombia. Decreto 457 de 2020 [Internet] [cited 2020 May 27]. Available from: (2020) https://id.presidencia.gov.co/Paginas/prensa/2020/Gobierno-Nacional-expide-Decreto-457-mediante-el-cual-imparten-instrucciones-para-cumplimiento-Aislamiento-Preventiv-200323.aspx Ministerio del Interior. República de Colombia, 2020 Ministerio del Interior. República de Colombia Decreto número 689 de 2020 [Internet] Available from: (2020) Pan American Health Organization, 2020 Pan American Health Organization Cumulative suspected and confirmed COVID-19 cases reported by countries and territories in the Americas [Internet] [cited 2020 Aug 2]. Available from: (2020) Perez-Brumer and Silva-Santisteban, 2020 A. Perez-Brumer, A. Silva-Santisteban COVID-19 Policies can Perpetuate Violence Against Transgender Communities: Insights from Peru Aids Behav, 1 (2020), p. 3 Porras Ramírez et al., 2009 A. Porras Ramírez, A. Rico Mendoza, J. Moreno Montoya, K. Cótes, J.D. López, D. Herrera, et al. Mortalidad asociada con las temporadas de mayor circulación de los virus de la influenza en Bogotá, Colombia, 1997-2005 Rev Panam Salud Pública, 26 (2009), pp. 435-439 Pung et al., 2020 R. Pung, C.J. Chiew, B.E. Young, S. Chin, M.I.C. Chen, H.E. Clapham, et al. Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures Lancet, 395 (March (10229)) (2020), pp. 1039-1046 Tiempo, 2020 El Tiempo “Lluvias en Colombia para junio y julio seguirán por debajo de lo normal”: Ideam - Medio Ambiente - Vida - ELTIEMPO.COM. Newspaper (2020) Villalobos et al., 2020 P. Villalobos, J. Browne, I. Madero-Cabib It Is Not Just Mortality: a Call from Chile for Comprehensive COVID-19 Policy Responses among Older People | The Journals of Gerontology: Series B | Oxford Academic J Gerontol (2020), pp. 1-6 World Health Organization, 2020a World Health Organization Rolling updates on coronavirus disease (COVID-19) [Internet] [cited 2020 May 21]. Available from: (2020) World Health Organization, 2020b World Health Organization WHO Coronavirus Disease (COVID-19) Dashboard [Internet] [cited 2020 Jul 25]. Available from: (2020) Wu and McGoogan, 2020 Z. Wu, J.M. McGoogan Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: summary of a report of 72 314 Cases from the Chinese Center for Disease Control and Prevention JAMA (2020) |
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DE LA HOZ RESTREPO, FERNANDODe la Hoz, JuanDe la Hoz Gomez, AlejandroGómez Del Corral, LuzAlvis-Guzmán, NelsonAlvis Zakzuk, Nelson J.virtual::261-12021-03-12T17:22:11Z2021-03-12T17:22:11Z2020-08-051201971218783511https://hdl.handle.net/11323/7996https://doi.org/10.1016/j.ijid.2020.08.017Corporación Universidad de la CostaREDICUC - Repositorio CUChttps://repositorio.cuc.edu.co/Background: Colombia detected its first coronavirus disease 2019 (COVID-19) case on March 2, 2020. From March 22 to April 25, it implemented a national lockdown that, apparently, allowed the country to keep a low incidence and mortality rate up to mid-May. Forced by the economic losses, the government then 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: A descriptive analysis of PCR-confirmed cases between March and July 25 was performed. Data were described according to the level of measurement. Incidence and mortality rates of COVID-19 were estimated by age, sex, and geographical area. Sampling rates for suspected cases were estimated by geographical area, and the potential for case underestimation was assessed using sampling differences. Results: By July 25, Colombia (population 50 372 424) had reported 240 745 cases and 8269 deaths (case fatality rate of 3.4%). A total of 1 370 271 samples had been analyzed (27405 samples per million people), with a positivity rate of 17%. Sampling rates per million varied by region from 2664 to 158 681 per million, and consequently the incidence and mortality rates also varied. 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 lockdown, but may also be attributed, to some extent, to geographical differences in surveillance capacity. Indigenous populations with little health infrastructure have been hit the hardest.DE LA HOZ RESTREPO, FERNANDO-will be generated-orcid-0000-0001-9436-7935-600ALVIS-ZAKZUK, NELSON J.-will be generated-orcid-0000-0001-9382-214X-600De la Hoz, Juan-will be generated-orcid-0000-0002-5584-7511-600De la Hoz, Alejandro-will be generated-orcid-0000-0002-9073-1258-600Gómez Del Corral, LuzAlvis-Guzmán, Nelson-will be generated-orcid-0000-0001-9458-864X-600application/pdfengCorporación Universidad de la CostaCC0 1.0 Universalhttp://creativecommons.org/publicdomain/zero/1.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2International Journal of Infectious Diseaseshttps://www.sciencedirect.com/science/article/pii/S1201971220306469?via%3DihubSARS-Cov-2COVID-19EpidemiologyColombiaPandemicLockdownIs Colombia an example of successful containment of the 2020 COVID-19 pandemic? A critical analysis of the epidemiological data, March to July 2020Artículo de revistahttp://purl.org/coar/resource_type/c_6501http://purl.org/coar/resource_type/c_2df8fbb1Textinfo:eu-repo/semantics/articlehttp://purl.org/redcol/resource_type/ARTinfo:eu-repo/semantics/acceptedVersionAmariles et al., 2020 P. Amariles, J. Granados, M. Ceballos, C.J. Montoya COVID-19 in Colombia endpoints. Are we different, like Europe? Res Soc Adm Pharm (2020) MarAsociación Colombiana de Hospitales y Clínicas, 2019 Asociación Colombiana de Hospitales y Clínicas Siguen aumentando deudas a hospitales y clínicas por prestación de servicios de salud, ya superan los $10 billones de pesos [Internet] [cited 2020 May 21]. Available from: (2019) https://achc.org.co/siguen-aumentando-deudas-a-hospitales-y-clinicas-por-prestacion-de-servicios-de-salud-ya-superan-los-10-billones-de-pesos/Asociación Colombiana de Infectología and IETS, 2020 Asociación Colombiana de Infectología, IETS Consenso colombiano de atención, diagnóstico y manejo de la infección por SARS-COV-2/COVID-19 en establecimientos de atención de la salud Infectio, 24 (April (3)) (2020), pp. 1-153Chen et al., 2020 T. Chen, D. Wu, H. Chen, W. Yan, D. Yang, G. Chen, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: Retrospective study BMJ (2020), p. 368Cagnacci and Xholli, 2020 A. Cagnacci, A. Xholli Age-related difference in the rate of coronavirus disease 2019 mortality in women versus men Am J Obstet Gynecol, 223 (3) (2020), pp. 453-454, 10.1016/j.ajog.2020.05.039Cotes et al., 2012 K. Cotes, J. Moreno-Montoya, A. Porras-Ramírez, A. Rico-Mendoza, F. de la Hoz-Restrepo Clinical characteristics of patients hospitalized with severe respiratory illness during influenza seasons in the cities of Bogota and Manizales, Colombia 2000-2006 Rev Salud Publica, 14 (1) (2012)Departamento Administrativo Nacional de Estadística, 2018 Departamento Administrativo Nacional de Estadística Censo Nacional de Población y Vivienda [Internet]. 2018 [cited 2020 May 21]. Available from: (2018)Hasell et al., 2020 J. Hasell, E. Mathieu, D. Beltekian, B. Macdonald, C. Giattino, E. Ortiz-Ospina, et al. Coronavirus (COVID-19) Testing - Statistics and Research - Our World in Data. Web page (2020), p. 19Immovilli et al., 2020 P. Immovilli, N. Morelli, E. Antonucci, G. Radaelli, M. Barbera, D. Guidetti COVID-19 mortality and ICU admission: the Italian experience Crit Care, 24 (1) (2020), p. 228Institute for Health Metrics and Evaluation (IHME), 2020 Institute for Health Metrics and Evaluation (IHME) COVID-19 Projections [Internet] Available from: (2020)Instituto Nacional de Salud, 2020a Instituto Nacional de Salud Coronavirus Colombia [Internet] [cited 2020 May 21]. Available from: (2020)Instituto Nacional de Salud, 2020b Instituto Nacional de Salud Modelo de transmisión de coronavirus COVID-19. Escenarios para Colombia [Internet] (2020) Available from: https://www.ins.gov.co/Direcciones/ONS/SiteAssets/Modelo COVID-19 Colombia INS_v5.pdfJi et al., 2020 Y. Ji, Z. Ma, M.P. Peppelenbosch, Q. Pan Potential association between COVID-19 mortality and health-care resource availability Lancet Glob Heal, 8 (4) (2020), p. e480Kennedy et al., 2020 D.M. Kennedy, G.J. Zambrano, Y. Wang, O.P. Neto Modeling the effects of intervention strategies on COVID-19 transmission dynamics J Clin Virol (2020), p. 104440Marin et al., 2020 J.E.G. Marin, J. Castellanos, A.J. Rodriguez-Morales, J.A. Cardona-Ospina, J.E.F. Duarte, S. Mattar, et al. Ad-hoc group consensus recommendations on the evaluation and quality control of molecular and serological diagnostics tests for SARS CoV-2 human infection* Infectio, 24 (May (3)) (2020)Ministerio de Salud y Protección Social, 2018 Ministerio de Salud y Protección Social Comportamiento del aseguramiento [Internet] [cited 2020 May 21]. Available from: (2018) https://www.minsalud.gov.co/proteccionsocial/Regimensubsidiado/Paginas/coberturas-del-regimen-subsidiado.aspxMinisterio del Interior, 2020a Ministerio del Interior República de Colombia. Decreto 457 de 2020 [Internet] [cited 2020 May 27]. Available from: (2020) https://id.presidencia.gov.co/Paginas/prensa/2020/Gobierno-Nacional-expide-Decreto-457-mediante-el-cual-imparten-instrucciones-para-cumplimiento-Aislamiento-Preventiv-200323.aspxMinisterio del Interior. República de Colombia, 2020 Ministerio del Interior. República de Colombia Decreto número 689 de 2020 [Internet] Available from: (2020)Pan American Health Organization, 2020 Pan American Health Organization Cumulative suspected and confirmed COVID-19 cases reported by countries and territories in the Americas [Internet] [cited 2020 Aug 2]. Available from: (2020)Perez-Brumer and Silva-Santisteban, 2020 A. Perez-Brumer, A. Silva-Santisteban COVID-19 Policies can Perpetuate Violence Against Transgender Communities: Insights from Peru Aids Behav, 1 (2020), p. 3Porras Ramírez et al., 2009 A. Porras Ramírez, A. Rico Mendoza, J. Moreno Montoya, K. Cótes, J.D. López, D. Herrera, et al. Mortalidad asociada con las temporadas de mayor circulación de los virus de la influenza en Bogotá, Colombia, 1997-2005 Rev Panam Salud Pública, 26 (2009), pp. 435-439Pung et al., 2020 R. Pung, C.J. Chiew, B.E. Young, S. Chin, M.I.C. Chen, H.E. Clapham, et al. Investigation of three clusters of COVID-19 in Singapore: implications for surveillance and response measures Lancet, 395 (March (10229)) (2020), pp. 1039-1046Tiempo, 2020 El Tiempo “Lluvias en Colombia para junio y julio seguirán por debajo de lo normal”: Ideam - Medio Ambiente - Vida - ELTIEMPO.COM. Newspaper (2020)Villalobos et al., 2020 P. Villalobos, J. Browne, I. Madero-Cabib It Is Not Just Mortality: a Call from Chile for Comprehensive COVID-19 Policy Responses among Older People | The Journals of Gerontology: Series B | Oxford Academic J Gerontol (2020), pp. 1-6World Health Organization, 2020a World Health Organization Rolling updates on coronavirus disease (COVID-19) [Internet] [cited 2020 May 21]. Available from: (2020)World Health Organization, 2020b World Health Organization WHO Coronavirus Disease (COVID-19) Dashboard [Internet] [cited 2020 Jul 25]. Available from: (2020)Wu and McGoogan, 2020 Z. Wu, J.M. McGoogan Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: summary of a report of 72 314 Cases from the Chinese Center for Disease Control and Prevention JAMA (2020)Publication969b7cc2-4eeb-48c0-b0b4-eb93f794dd65virtual::261-1969b7cc2-4eeb-48c0-b0b4-eb93f794dd65virtual::261-1https://scholar.google.com.co/citations?user=Paic_C8AAAAJ&hl=esvirtual::261-10000-0001-9382-214Xvirtual::261-1ORIGINALIs Colombia an example of successful containment of the 2020COVID-19 pandemic A critical analysis of the epidemiologicaldata, March to July 2020.pdfIs Colombia an example of successful containment of the 2020COVID-19 pandemic A critical analysis of the epidemiologicaldata, March to July 2020.pdfapplication/pdf1195766https://repositorio.cuc.edu.co/bitstreams/cd34f212-f68d-4db5-b2e9-b0ce3eca9a7a/download8c77895ff85dde7b6eb2a339326c2d5bMD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; 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pandemic A critical analysis of the epidemiologicaldata, March to July 2020.pdf.txttext/plain39007https://repositorio.cuc.edu.co/bitstreams/9c8849ca-0762-49d0-bb1c-275be770e4e7/download4ad5332d374a80720fd69f1f0634909aMD5511323/7996oai:repositorio.cuc.edu.co:11323/79962025-02-20 18:57:10.089http://creativecommons.org/publicdomain/zero/1.0/CC0 1.0 Universalopen.accesshttps://repositorio.cuc.edu.coRepositorio de la Universidad de la Costa 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