Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil

William Marciel de Souza; Lewis Fletcher Buss; Darlan da Silva Candido; Jean Paul Carrera; Sabrina Li; Alexander E. Zarebski; Rafael Henrique Moraes Pereira; Carlos A. Prete; Andreza Aruska de Souza-Santos; Kris V. Parag; Maria Carolina T.D. Belotti; Maria F. Vincenti-Gonzalez; Janey Messina; Flavia Cristina da Silva Sales; Pamela dos Santos Andrade; Vítor Heloiz Nascimento; Fabio Ghilardi; Leandro Abade; Bernardo Gutierrez; Moritz U.G. Kraemer; Carlos K.V. Braga; Renato Santana Aguiar; Neal Alexander; Philippe Mayaud; Oliver J. Brady; Izabel Marcilio; Nelson Gouveia; Guangdi Li; Adriana Tami; Silvano Barbosa de Oliveira; Victor Bertollo Gomes Porto; Fabiana Ganem; Walquiria Aparecida Ferreira de Almeida; Francieli Fontana Sutile Tardetti Fantinato; Eduardo Marques Macário; Wanderson Kleber de Oliveira; Mauricio L. Nogueira; Oliver G. Pybus; Chieh Hsi Wu; Julio Croda; Ester C. Sabino; Nuno Rodrigues Faria

doi:10.1038/s41562-020-0928-4

Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil

William Marciel de Souza, Lewis Fletcher Buss, Darlan da Silva Candido, Jean Paul Carrera, Sabrina Li, Alexander E. Zarebski, Rafael Henrique Moraes Pereira, Carlos A. Prete, Andreza Aruska de Souza-Santos, Kris V. Parag, Maria Carolina T.D. Belotti, Maria F. Vincenti-Gonzalez, Janey Messina, Flavia Cristina da Silva Sales, Pamela dos Santos Andrade, Vítor Heloiz Nascimento, Fabio Ghilardi, Leandro Abade, Bernardo Gutierrez, Moritz U.G. KraemerCarlos K.V. Braga, Renato Santana Aguiar, Neal Alexander, Philippe Mayaud, Oliver J. Brady, Izabel Marcilio, Nelson Gouveia, Guangdi Li, Adriana Tami, Silvano Barbosa de Oliveira, Victor Bertollo Gomes Porto, Fabiana Ganem, Walquiria Aparecida Ferreira de Almeida, Francieli Fontana Sutile Tardetti Fantinato, Eduardo Marques Macário, Wanderson Kleber de Oliveira, Mauricio L. Nogueira, Oliver G. Pybus, Chieh Hsi Wu, Julio Croda, Ester C. Sabino, Nuno Rodrigues Faria

Microbiology, Immunology, and Molecular Genetics

Research output: Contribution to journal › Article › peer-review

259 Scopus citations

Abstract

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.

Original language	English
Pages (from-to)	856-865
Number of pages	10
Journal	Nature Human Behaviour
Volume	4
Issue number	8
DOIs	https://doi.org/10.1038/s41562-020-0928-4
State	Published - Aug 1 2020

Bibliographical note

Publisher Copyright:
© 2020, The Author(s), under exclusive licence to Springer Nature Limited.

Funding

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. 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.

Funders	Funder number
CADDE-Genomic-Network
Sir Henry Wellcome Postdoctoral Fellowship
Wellcome Trust Centre for Mitochondrial Research	204311/Z/16/Z, 206471/Z/17/Z
Royal Society Sir Henry Dale Fellowship	2018/12579-7
Wellcome Trust	204311, 206471
Fundação de Amparo à Pesquisa do Estado de São Paulo	2018/14389-0, 2017/13981-0, 2019/24251-9
Ministério da Saúde	CAAE 30127020.0.0000.0068
UK Medical Research Council, Engineering and Physical Sciences Research Council	MR/S0195/1

ASJC Scopus subject areas

Social Psychology
Experimental and Cognitive Psychology
Behavioral Neuroscience

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de Souza, W. M., Buss, L. F., Candido, D. D. S., Carrera, J. P., Li, S., Zarebski, A. E., Pereira, R. H. M., Prete, C. A., de Souza-Santos, A. A., Parag, K. V., Belotti, M. C. T. D., Vincenti-Gonzalez, M. F., Messina, J., da Silva Sales, F. C., Andrade, P. D. S., Nascimento, V. H., Ghilardi, F., Abade, L., Gutierrez, B., ... Faria, N. R. (2020). Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil. Nature Human Behaviour, 4(8), 856-865. https://doi.org/10.1038/s41562-020-0928-4

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title = "Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil",

abstract = "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.",

author = "\{de Souza\}, \{William Marciel\} and Buss, \{Lewis Fletcher\} and Candido, \{Darlan da Silva\} and Carrera, \{Jean Paul\} and Sabrina Li and Zarebski, \{Alexander E.\} and Pereira, \{Rafael Henrique Moraes\} and Prete, \{Carlos A.\} and \{de Souza-Santos\}, \{Andreza Aruska\} and Parag, \{Kris V.\} and Belotti, \{Maria Carolina T.D.\} and Vincenti-Gonzalez, \{Maria F.\} and Janey Messina and \{da Silva Sales\}, \{Flavia Cristina\} and Andrade, \{Pamela dos Santos\} and Nascimento, \{V{\'i}tor Heloiz\} and Fabio Ghilardi and Leandro Abade and Bernardo Gutierrez and Kraemer, \{Moritz U.G.\} and Braga, \{Carlos K.V.\} and Aguiar, \{Renato Santana\} and Neal Alexander and Philippe Mayaud and Brady, \{Oliver J.\} and Izabel Marcilio and Nelson Gouveia and Guangdi Li and Adriana Tami and \{de Oliveira\}, \{Silvano Barbosa\} and Porto, \{Victor Bertollo Gomes\} and Fabiana Ganem and \{de Almeida\}, \{Walquiria Aparecida Ferreira\} and Fantinato, \{Francieli Fontana Sutile Tardetti\} and Mac{\'a}rio, \{Eduardo Marques\} and \{de Oliveira\}, \{Wanderson Kleber\} and Nogueira, \{Mauricio L.\} and Pybus, \{Oliver G.\} and Wu, \{Chieh Hsi\} and Julio Croda and Sabino, \{Ester C.\} and Faria, \{Nuno Rodrigues\}",

note = "Publisher Copyright: {\textcopyright} 2020, The Author(s), under exclusive licence to Springer Nature Limited.",

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doi = "10.1038/s41562-020-0928-4",

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de Souza, WM, Buss, LF, Candido, DDS, Carrera, JP, Li, S, Zarebski, AE, Pereira, RHM, Prete, CA, de Souza-Santos, AA, Parag, KV, Belotti, MCTD, Vincenti-Gonzalez, MF, Messina, J, da Silva Sales, FC, Andrade, PDS, Nascimento, VH, Ghilardi, F, Abade, L, Gutierrez, B, Kraemer, MUG, Braga, CKV, Aguiar, RS, Alexander, N, Mayaud, P, Brady, OJ, Marcilio, I, Gouveia, N, Li, G, Tami, A, de Oliveira, SB, Porto, VBG, Ganem, F, de Almeida, WAF, Fantinato, FFST, Macário, EM, de Oliveira, WK, Nogueira, ML, Pybus, OG, Wu, CH, Croda, J, Sabino, EC & Faria, NR 2020, 'Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil', Nature Human Behaviour, vol. 4, no. 8, pp. 856-865. https://doi.org/10.1038/s41562-020-0928-4

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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

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AU - Li, Guangdi

AU - Tami, Adriana

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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

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Epidemiological and clinical characteristics of the COVID-19 epidemic in Brazil

Abstract

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