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Across the world, the COVID-19 pandemic has disproportionately affected economically disadvantaged groups. This differential impact has numerous possible explanations, each with significantly different policy implications. We examine, for the first time in a low- or middle-income country, which mechanisms best explain the disproportionate impact of the virus on the poor. Combining an epidemiological model with rich data from Bogotá, Colombia, we show that total infections and inequalities in infections are largely driven by inequalities in the ability to work remotely and in within-home secondary attack rates. Inequalities in isolation behavior are less important but non-negligible, while access to testing and contract-tracing plays practically no role because it is too slow to contain the virus. Interventions that mitigate transmission are often more effective when targeted on socioeconomically disadvantaged groups.

Latin America has been severely affected by the COVID-19 pandemic but estimations of rates of infections are very limited and lack the level of detail required to guide policy decisions. We implemented a COVID-19 sentinel surveillance study with 59,770 RT-PCR tests on mostly asymptomatic individuals and combine this data with administrative records on all detected cases to capture the spread and dynamics of the COVID-19 pandemic in Bogota from June 2020 to early March 2021. We describe various features of the pandemic that appear to be specific to a middle income countries. We find that, by March 2021, slightly more than half of the population in Bogota has been infected, despite only a small fraction of this population being detected. The initial buildup of immunity contributed to the containment of the pandemic in the first and second waves. We also show that the share of the population infected by March 2021 varies widely by occupation, socio-economic stratum, and location. This, in turn, has affected the dynamics of the spread with different groups being infected in the two waves.

Public health has developed based on multiple approaches, including the guidelines of the health systems, the community or the individuals. This paper intends to identify the conceptual models of public health that arise after analyzing health or disease categories, as well as the level at which social response occurs: the individual or a family, biophysical and social environment; hygienist or preventive mode. Considering that the concept of model is not only a representation of reality, but an ontological position that allows to understand society and the State, all models are part of a theory and converge with other theories to create a framework of analysis. In consequence, three models of the health-disease process are presented. First, the Canadian model that establishes four determinants -lifestyle, environment, biological factors and health services-. Second, the social determinants model of the World Health Organization (WHO) that establishes three determinants based on risk approach: structural, intermediate and proximal. Finally, the historical-social or social determination model, which looks for the roots of social inequalities that affect health. The development of the Colombia Health System has considered these health models. Today, the Comprehensive Health Care Policy, and its Comprehensive Health Care Model, bases its approach within a model of determinants established by the PAHO.

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