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

  1. William Marciel de Souza
  2. Lewis Fletcher Buss
  3. Darlan da Silva Candido
  4. Jean-Paul Carrera
  5. Sabrina Li
  6. Alexander E. Zarebski
  7. Maria F. Vincenti-Gonzalez
  8. Janey Messina
  9. Flavia Cristina da Silva Sales
  10. Pamela dos Santos Andrade
  11. Carlos A. Prete
  12. Vítor Heloiz Nascimento
  13. Fabio Ghilardi
  14. Rafael Henrique Moraes Pereira
  15. Andreza Aruska de Souza Santos
  16. Leandro Abade
  17. Bernardo Gutierrez
  18. Moritz U. G. Kraemer
  19. Renato Santana Aguiar
  20. Neal Alexander
  21. Philippe Mayaud
  22. Oliver J. Brady
  23. Izabel Oliva Marcilio de Souza
  24. Nelson Gouveia
  25. Guangdi Li
  26. Adriana Tami
  27. Silvano Barbosa de Oliveira
  28. Victor Bertollo Gomes Porto
  29. Fabiana Ganem
  30. Walquiria Aparecida Ferreira de Almeida
  31. Francieli Fontana Sutile Tardetti Fantinato
  32. Eduardo Marques Macário
  33. Wanderson Kleber de Oliveira
  34. Oliver G. Pybus
  35. Chieh-Hsi Wu
  36. Julio Croda
  37. Ester C. Sabino
  38. Nuno Rodrigues Faria
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Abstract

Background

The first case of COVID-19 was detected in Brazil on February 25, 2020. We report the epidemiological, demographic, and clinical findings for confirmed COVID-19 cases during the first month of the epidemic in Brazil.

Methods

Individual-level and aggregated COVID-19 data were analysed to investigate demographic profiles, socioeconomic drivers and age-sex structure of COVID-19 tested cases. Basic reproduction numbers (R0) were investigated for São Paulo and Rio de Janeiro. Multivariate logistic regression analyses were used to identify symptoms associated with confirmed cases and risk factors associated with hospitalization. Laboratory diagnosis for eight respiratory viruses were obtained for 2,429 cases.

Findings

By March 25, 1,468 confirmed cases were notified in Brazil, of whom 10% (147 of 1,468) were hospitalised. Of the cases acquired locally (77·8%), two thirds (66·9% of 5,746) were confirmed in private laboratories. Overall, positive association between higher per capita income and COVID-19 diagnosis was identified. The median age of detected cases was 39 years (IQR 30-53). The median R0 was 2·9 for São Paulo and Rio de Janeiro. Cardiovascular disease/hypertension were associated with hospitalization. Co-circulation of six respiratory viruses, including influenza A and B and human rhinovirus was detected in low levels.

Interpretation

Socioeconomic disparity determines access to SARS-CoV-2 testing in Brazil. The lower median age of infection and hospitalization compared to other countries is expected due to a younger population structure. Enhanced surveillance of respiratory pathogens across socioeconomic statuses is essential to better understand and halt SARS-CoV-2 transmission.

Funding

São Paulo Research Foundation, Medical Research Council, Wellcome Trust and Royal Society.

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