Subnational analysis of the COVID-19 epidemic in Brazil

  1. Thomas A Mellan
  2. Henrique H Hoeltgebaum
  3. Swapnil Mishra
  4. Charlie Whittaker
  5. Ricardo P Schnekenberg
  6. Axel Gandy
  7. H Juliette T Unwin
  8. Michaela A C Vollmer
  9. Helen Coupland
  10. Iwona Hawryluk
  11. Nuno Rodrigues Faria
  12. Juan Vesga
  13. Harrison Zhu
  14. Michael Hutchinson
  15. Oliver Ratmann
  16. Mélodie Monod
  17. Kylie E C Ainslie
  18. Marc Baguelin
  19. Sangeeta Bhatia
  20. Adhiratha Boonyasiri
  21. Nicholas Brazeau
  22. Giovanni Charles
  23. Zulma Cucunuba
  24. Gina Cuomo-Dannenburg
  25. Amy Dighe
  26. Jeff Eaton
  27. Sabine L van Elsland
  28. Katy A M Gaythorpe
  29. Will Green
  30. Edward Knock
  31. Daniel Laydon
  32. John A Lees
  33. Andria Mousa
  34. Gemma Nedjati-Gilani
  35. Pierre Nouvellet
  36. Kris V Parag
  37. Hayley A Thompson
  38. Robert Verity
  39. Caroline E Walters
  40. Haowei Wang
  41. Yuanrong Wang
  42. Oliver J Watson
  43. Lilith Whittles
  44. Xiaoyue Xi
  45. Ilaria Dorigatti
  46. Patrick Walker
  47. Azra C Ghani
  48. Steven Riley
  49. Neil M Ferguson
  50. Christl A Donnelly
  51. Seth Flaxman
  52. Samir Bhatt
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Abstract

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Abstract

Brazil is currently reporting the second highest number of COVID-19 deaths in the world. Here we characterise the initial dynamics of COVID-19 across the country and assess the impact of non-pharmaceutical interventions (NPIs) that were implemented using a semi-mechanistic Bayesian hierarchical modelling approach. Our results highlight the significant impact these NPIs had across states, reducing an average Rt > 3 to an average of 1.5 by 9-May-2020, but that these interventions failed to reduce Rt < 1, congruent with the worsening epidemic Brazil has experienced since. We identify extensive heterogeneity in the epidemic trajectory across Brazil, with the estimated number of days to reach 0.1% of the state population infected since the first nationally recorded case ranging from 20 days in São Paulo compared to 60 days in Goiás, underscoring the importance of sub-national analyses in understanding asynchronous state-level epidemics underlying the national spread and burden of COVID-19.

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