News Release

Study of state health data from Brazil reveals outcome of a largely unmitigated epidemic

Peer-Reviewed Publication

American Association for the Advancement of Science (AAAS)

A new study based on daily COVID-19 data from Brazil details the fast spread of both cases and deaths in the country, with distinct patterns by state, and where inequities regarding the implementation of policies and resources exacerbated the spread in lower-income regions. Despite an extensive network of primary care availability, Brazil - which did not pursue a coordinated national pandemic response strategy - has suffered greatly during the COVID-19 pandemic. "[T]he federal response has been a dangerous combination of inaction and wrongdoing," write Marcia Castro and colleagues. Using daily data from State Health Offices, Castro et al. comprehensively analyzed the spatial and temporal patterns of COVID-19 cases and deaths in Brazil from February to October 2020. Reflecting problems in surveillance, data reporting, and low testing capacity, deaths clustered about a month before cases were reported, the data show. Patterns suggest undetected (and thus unmitigated) introduction and propagation of the virus for some time. After the virus's introduction in São Paulo, both cases and deaths progressively moved north until week 20 (starting May 10), when the epidemic started to recede in Amazonas and Ceará but gained force in Rio de Janeiro and São Paulo. In Rio de Janeiro, political chaos, among other factors, compromised a prompt and effective response, and cases and deaths were high. Overall, a higher percentage of COVID-19 cases and deaths were observed outside capital cities. Further analyses by Castro and colleagues revealed how policies adopted at the national and local levels impacted movement of COVID-19 toward the interior states. The authors highlight several complex issues unique to Brazil that drove the virus's fast spread but also show that some states, such as Ceará, were resilient; others such as Rio de Janeiro that comparatively had more resources failed to contain the propagation of COVID-19. They conclude by noting Brazil's current perilous state, as a new virus variant of concern (P.1) is circulating. "Without immediate containment, coordinated epidemiological and genomic surveillance measures, and an effort to vaccinate the largest number of people in the shortest possible time, the propagation of [the new variant]" will likely resemble the patterns here demonstrated, leading to unimaginable loss of lives," they say.


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