TY - JOUR
T1 - Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil
AU - de Souza, William Marciel
AU - Buss, Lewis Fletcher
AU - Candido, Darlan da Silva
AU - Carrera, Jean Paul
AU - Li, Sabrina
AU - Zarebski, Alexander E.
AU - Pereira, Rafael Henrique Moraes
AU - Prete, Carlos A.
AU - de Souza-Santos, Andreza Aruska
AU - Parag, Kris V.
AU - Belotti, Maria Carolina T.D.
AU - Vincenti-Gonzalez, Maria F.
AU - Messina, Janey
AU - da Silva Sales, Flavia Cristina
AU - Andrade, Pamela dos Santos
AU - Nascimento, Vítor Heloiz
AU - Ghilardi, Fabio
AU - Abade, Leandro
AU - Gutierrez, Bernardo
AU - Kraemer, Moritz U.G.
AU - Braga, Carlos K.V.
AU - Aguiar, Renato Santana
AU - Alexander, Neal
AU - Mayaud, Philippe
AU - Brady, Oliver J.
AU - Marcilio, Izabel
AU - Gouveia, Nelson
AU - Li, Guangdi
AU - Tami, Adriana
AU - de Oliveira, Silvano Barbosa
AU - Porto, Victor Bertollo Gomes
AU - Ganem, Fabiana
AU - de Almeida, Walquiria Aparecida Ferreira
AU - Fantinato, Francieli Fontana Sutile Tardetti
AU - Macário, Eduardo Marques
AU - de Oliveira, Wanderson Kleber
AU - Nogueira, Mauricio L.
AU - Pybus, Oliver G.
AU - Wu, Chieh Hsi
AU - Croda, Julio
AU - Sabino, Ester C.
AU - Faria, Nuno Rodrigues
N1 - Funding Information:
Ethical approval and case definitions. This retrospective national study was supported by the Brazilian Ministry of Health and ethical approval was provided by the national ethical review board (Comissão Nacional de Ética em Pesquisa; protocol number CAAE 30127020.0.0000.0068). A patient presenting with an acute respiratory syndrome (fever and at least one sign/symptom of respiratory illness) and: (1) a history of travel to a location with community transmission of COVID-19; or (2) contact with a confirmed or probable COVID-19 case in the 14d preceding symptom onset; or (3) absence of an alternative diagnosis that completely explained the clinical presentation6 was considered to have suspected COVID-19. Initially, a traveller was suspected to have COVID-19 only when arriving from China, although the definition of suspected cases associated with travel later included Japan, Singapore, South Korea, North Korea, Thailand, Vietnam and Cambodia (21 February 2020), then also Italy, Germany, Australia, the United Arab Emirates, the Philippines, France, Iran and Malaysia (25 February 2020), then also the United States, Canada, Switzerland, the United Kingdom and four additional countries (3 March 2020). From 9 March 2020 onwards, the Ministry of Health decided to start testing all hospitalized patients with severe respiratory symptoms, regardless of their travel history. Contact with a confirmed or probable COVID-19 case was defined as face-to-face or direct contact with someone known to have COVID-19, or direct contact in a healthcare setting. Moreover, patients reporting travel to an affected country in the preceding 14 d were considered imported cases. Cases not meeting this criterion were considered to be due to local transmission. Suspected COVID-19 cases were confirmed by laboratory testing (that is, molecular diagnostics with real-time quantitative PCR), or by clinical epidemiological criteria. In the latter case, the classification was used when laboratory testing was inconclusive or unavailable, as recommended by the Brazilian Ministry of Health guidelines dated 6 April 202048, and by the World Health Organization interim guidance dated 25 March 202049.
Funding Information:
We thank M. Gome, L. Bastos and L. M. Carvalho (MAVE) for useful discussions on SIVEP-Gripe, and we thank L. Matkin (Oxford) for technical support. This work was supported by a FAPESP (2018/14389-0) and Medical Research Council and CADDE partnership award (MR/S0195/1) (http://caddecentre.org/). W.M.S. is supported by the São Paulo Research Foundation, Brazil (2017/13981-0 and 2019/24251-9). N.R.F. is supported by a Wellcome Trust and Royal Society Sir Henry Dale Fellowship (204311/Z/16/Z). O.J.B. was funded by a Sir Henry Wellcome Fellowship funded by the Wellcome Trust (206471/Z/17/Z). V.H.N. and C.A.P. were supported by FAPESP (2018/12579-7). A.E.Z. and B.G. were supported by Oxford Martin School. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Publisher Copyright:
© 2020, The Author(s), under exclusive licence to Springer Nature Limited.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - The first case of COVID-19 was detected in Brazil on 25 February 2020. We report and contextualize epidemiological, demographic and clinical findings for COVID-19 cases during the first 3 months of the epidemic. By 31 May 2020, 514,200 COVID-19 cases, including 29,314 deaths, had been reported in 75.3% (4,196 of 5,570) of municipalities across all five administrative regions of Brazil. The R0 value for Brazil was estimated at 3.1 (95% Bayesian credible interval = 2.4–5.5), with a higher median but overlapping credible intervals compared with some other seriously affected countries. A positive association between higher per-capita income and COVID-19 diagnosis was identified. Furthermore, the severe acute respiratory infection cases with unknown aetiology were associated with lower per-capita income. Co-circulation of six respiratory viruses was detected but at very low levels. These findings provide a comprehensive description of the ongoing COVID-19 epidemic in Brazil and may help to guide subsequent measures to control virus transmission.
AB - The first case of COVID-19 was detected in Brazil on 25 February 2020. We report and contextualize epidemiological, demographic and clinical findings for COVID-19 cases during the first 3 months of the epidemic. By 31 May 2020, 514,200 COVID-19 cases, including 29,314 deaths, had been reported in 75.3% (4,196 of 5,570) of municipalities across all five administrative regions of Brazil. The R0 value for Brazil was estimated at 3.1 (95% Bayesian credible interval = 2.4–5.5), with a higher median but overlapping credible intervals compared with some other seriously affected countries. A positive association between higher per-capita income and COVID-19 diagnosis was identified. Furthermore, the severe acute respiratory infection cases with unknown aetiology were associated with lower per-capita income. Co-circulation of six respiratory viruses was detected but at very low levels. These findings provide a comprehensive description of the ongoing COVID-19 epidemic in Brazil and may help to guide subsequent measures to control virus transmission.
UR - http://www.scopus.com/inward/record.url?scp=85089026992&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85089026992&partnerID=8YFLogxK
U2 - 10.1038/s41562-020-0928-4
DO - 10.1038/s41562-020-0928-4
M3 - Article
C2 - 32737472
AN - SCOPUS:85089026992
SN - 2397-3374
VL - 4
SP - 856
EP - 865
JO - Nature Human Behaviour
JF - Nature Human Behaviour
IS - 8
ER -