RESUMEN
BackgroundThe 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. MethodsIndividual-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 Sao 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. FindingsBy 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{middle dot}8%), two thirds (66{middle dot}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{middle dot}9 for Sao 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. InterpretationSocioeconomic 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. FundingSao Paulo Research Foundation, Medical Research Council, Wellcome Trust and Royal Society.
RESUMEN
COVID-19 is now a pandemic and many of the affected countries face severe shortages of hospital resources. In Brazil, the first case was reported on February 26. As the number of cases grows in the country, there is a concern that the health system may become overwhelmed, resulting in shortages of hospital beds, intensive care unit beds, and mechanical ventilators. The timing of shortage is likely to vary geographically depending on the observed onset and pace of transmission observed, on the availability of resources, and on the actions implemented. Here we consider the daily number of cases reported in municipalities in Brazil to simulate twelve alternative scenarios of the likely timing of shortage, based on parameters consistently reported for China and Italy, on rates of hospital occupancy for other health conditions observed in Brazil in 2019, and on assumptions of allocation of patients in public and private facilities. Results show that hospital services could start to experience shortages of hospital beds, ICU beds, and ventilators in early April, the most critical situation observed for ICU beds. Increasing the allocation of beds for COVID-19 (in lieu of other conditions) or temporarily placing all resources under the administration of the state delays the anticipated start of shortages by a week. This suggests that solutions adopted by the Brazilian government must aim at expanding the available capacity (e.g., makeshift hospitals), and not simply prioritizing the allocation of available resources to COVID-19.
