Aspectos demográficos, clínico-epidemiológicos y geoespaciales de la COVID-19 en Santiago de Cuba / Demographic, clinical-epidemiological and geospatial aspects of COVID-19 in Santiago de Cuba

RESUMEN Fundamento: Santiago de Cuba al igual que el resto de las provincias cubanas, fue afectada por la COVID-19, aunque es de los territorios con menor incidencia de la enfermedad. Objetivo: describir los aspectos demográficos, clínico-epidemiológicos y geoespaciales de la COVID-19 en Santiago de Cuba. Métodos: se realizó un estudio observacional analítico en los niveles individual y poblacional. En el nivel individual, la población de estudio se integró por los 49 casos de COVID-19 de la provincia. Se estimó la frecuencia y distribución de casos, así como las pruebas de hipótesis para descubrir las diferencias entre estas. Para analizar el aspecto geoespacial se empleó como dato de área, el número de casos por territorio y como unidades de agregación de la información, los datos georreferenciados de la totalidad de consejos populares en que se encuentra dividida la provincia. Se realizó el análisis exploratorio de los datos espaciales, se estimó la autocorrelación espacial por consejos populares, por medio del índice global I de Moran y se visualizó la formación de conglomerados mediante el estadístico local G* de Getis-Ord. Resultados: se obtuvieron la frecuencia y distribución de las características demográficas, clínicas-epidemiológicas y la formación de agrupaciones espaciales por consejos populares según el número de casos de COVID-19 y su significación. Conclusiones: el municipio Santiago de Cuba marcó las diferencias a nivel poblacional en la epidemia de esta provincia. En cambio, a nivel individual se apreciaron diferencias entre los casos confirmados en algunos aspectos demográficos, no así en los clínicos ni epidemiológicos.

ABSTRACT Background: Santiago de Cuba, like the rest of the Cuban provinces, was affected by COVID-19, although it is one of the territories with the lowest incidence of the disease. Objective: to describe the demographic, clinical-epidemiological and geospatial aspects of COVID-19 in Santiago de Cuba. Methods: an analytical observational study was carried out at the individual and population levels. At the individual level, the 49 confirmed cases of COVID-19 in the province are used as the study population. The frequency and distribution of cases were estimated, as well as hypothesis tests, with a 5% significance, to discover the differences between them. To analyze the geospatial aspect, the geo-referenced data from all the popular councils into which the province is divided were used as area data, the number of cases by territory and as aggregation units of the information. The exploratory analysis of the spatial data was performed, the spatial autocorrelation was estimated by popular councils, using the Moran global index I, and the formation of clusters was visualized using the local G* statistic from Getis-Ord. Results: the frequency and distribution of the demographic, clinical and epidemiological characteristics were obtained, as well as the formation of spatial groupings by popular councils according to the number of COVID-19 cases and their significance. Conclusions: the municipality of Santiago de Cuba marked the differences at the population level in the epidemic of this province. On the other hand, at an individual level, differences were observed between the confirmed cases in some demographic aspects, but not in the clinical or epidemiological ones.

Descriptive study of the initial cases of Covid-19 in a city in the interior of Ceará, Brazil / Estudio descriptivo de los casos iniciales de Covid-19 en una ciudad del interior de Ceará, Brasil

Objective: to describe the sociodemographic, epidemiological and clinical characteristics of the initial cases of Covid-19 in the municipality of Sobral, Ceará, Brazil. Materials and methods: descriptive, temporal and quantitative epidemiological study, developed in the municipality of Sobral - Ceará, Brazil, with 110 confirmed cases of Covid-19. Descriptive and analytical analysis was performed, using the Chi-square test and Logistic Regression to verify the association between variables. The level of significance was set at 95% (p≤0.05). Results: it was observed that 60% of cases occurred in women, 74.5% were adults between 20 and 59 years old, 15.5% health workers and the lethality rate was 1.8%. In 58.2% of cases the main reporting unit was the hospital, 10% required hospitalization, and 64.5% were diagnosed with rapid tes. The main symptoms manifested were: cough (58.2%), fever (57.3%), sore throat (36.4%) and difficulty breathing (31.9%). There was an association between age and the presence of fever, cough and sore throat (p=0.05). Conclusion: the results suggest that older people are more susceptible to some symptoms when compared to younger people. Associated with global estimates, this work can provide subsidies for Covid-19 prevention and control actions in small and medium-sized Brazilian municipalities..(Au)

Objectivo: describir las características sociodemográficas, epidemiológicas y clínicas de los casos iniciales de Covid-19 en el municipio de Sobral, Ceará, Brasil. Materiales y métodos: estudio epidemiológico descriptivo, temporal y cuantitativo, desarrollado en el municipio de Sobral - Ceará, Brasil, con 110 casos confirmados de Covid -19. Se realizó análisis descriptivo y analítico, utilizando la prueba de chi-cuadrado y regresión logística para verificar la asociación entre variables. El nivel de significancia se estableció en 95% (p≤0.05). Resultados: se observó que el 60,0% de los casos ocurrieron en mujeres, el 74,5% eran adultos entre 20 y 59 años, el 15,5% trabajadores de la salud y la tasa de letalidad fue del 1,8%. En el 58,2% de los casos la principal unidad de notificación fue el hospital, el 10% requirió hospitalización y el 64,5% fueron diagnosticados con pruebas rápidas. Los principales síntomas manifestados fueron: tos (58,2%), fiebre (57,3%), dolor de garganta (36,4%) y dificultad para respirar (31,9%). Hubo asociación entre la edad y la presencia de fiebre, tos y dolor de garganta (p=0,05). Conclusión: los resultados sugieren que las personas mayores son más susceptibles a algunos síntomas en comparación con las personas más jóvenes. Asociado a estimaciones globales, este trabajo puede proporcionar subsidios para acciones de prevención y control de Covid-19 en municipios brasileños pequeños y medianos..(Au)

Chronic non-communicable diseases and Covid-19: Epicovid-19 Brazil results / Doenças crônicas não transmissíveis e covid-19: resultados do estudo Epicovid-19 Brasil

ABSTRACT OBJECTIVE Describing the prevalence of chronic diseases and associated socioeconomic and demographic factors, evaluating the patterns of social distancing and the antibodies prevalence against SARS-CoV-2 and COVID-19 symptoms in carriers and non-carriers of chronic diseases. METHODS Data from 77,075 individuals aged 20 to 59 from three steps of the EPICOVID-19 Brazil (a nationwide serological survey conducted between May and June, 2021) were assessed. The presence of antibodies against SARS-CoV-2 was examined by rapid tests. Self-reported prevalence of hypertension, diabetes, asthma, cancer, chronic kidney disease and heart disease were investigated. The prevalence of mask use, adherence to isolation measures and antibodies were evaluated separately amid carriers and non-carriers of chronic diseases. The prevalence of symptoms was analyzed among carriers and non-carriers of chronic diseases with antibodies. RESULTS The prevalence of at least one chronic disease was 43%, higher in the Southeast region, among white and indigenous individuals, women, less schooled and in lower socioeconomic position. The use of masks when leaving home was similar among carriers and non-carriers of chronic diseases (98%). The proportion of participants who reported adherence to isolation measures was higher amid carriers (15.9%) than non-carriers (24.9%) of chronic diseases. The prevalence of antibodies to SARS-CoV-2 was similar amongst carriers and non-carriers (2.4% and 2.3%). The prevalence of cough, dyspnea, palpitations and myalgia was significantly higher among carriers, but the proportion of symptomatic patients was similar between groups. CONCLUSION The prevalence of chronic diseases in Brazil is high and the COVID-19 pandemic affects carriers and non-carriers of chronic diseases similarly. Carriers present more severe forms of COVID-19 and higher prevalence of symptoms. Greater adherence to social distancing measures among chronic patients is disassociated from a lower incidence of COVID-19 in this group.

RESUMO OBJETIVO Descrever a prevalência de doenças crônicas e fatores socioeconômicos e demográficos associados, avaliar os padrões de distanciamento social e a prevalência de anticorpos contra SARS-CoV-2 e sintomas de covid-19 em portadores e não portadores de doenças crônicas. MÉTODOS Foram avaliados dados de 77.075 mil indivíduos de 20 a 59 anos de três etapas do inquérito sorológico de abrangência nacional Epicovid-19 Brasil, realizadas entre maio e junho de 2021. A presença de anticorpos contra SARS-CoV-2 foi avaliada por teste rápido. Foram investigadas as prevalências autorreferidas de hipertensão, diabetes, asma, câncer, doença renal crônica e doença cardíaca. A prevalência de uso de máscara, de adesão a medidas de isolamento e de anticorpos foi avaliada separadamente entre portadores e não portadores de doenças crônicas. A prevalência de sintomas foi avaliada entre doentes crônicos e não doentes portadores de anticorpos. RESULTADOS A prevalência do pelo menos uma doença crônica foi de 43%, maior na região Sudeste, entre indivíduos brancos e indígenas, mulheres, menos escolarizados e em menor posição socioeconômica. O uso de máscara ao sair do domicílio não diferiu entre doentes crônicos e não doentes (98%). A proporção de participantes que referiram adesão ao isolamento foi maior entre doentes crônicos (15,9%) que entre não doentes (24,9%). A prevalência de anticorpos contra SARS-CoV-2 foi semelhante entre doentes crônicos e não doentes (2,4% e 2,3%). A prevalência de tosse, dispneia, palpitações e mialgia foi significativamente maior entre doentes crônicos, mas a proporção de sintomáticos não diferiu entre os grupos. CONCLUSÃO A prevalência de doenças crônicas no país é alta e a pandemia de covid-19 atinge de forma semelhante doentes e não doentes. Doentes crônicos apresentam formas mais graves de covid-19 e maior prevalência de sintomas. A maior adesão às medidas de distanciamento social entre doentes crônicos não se reflete em menor incidência de covid-19 nesse grupo.

Covid-19 in northeast Brazil: first year of the pandemic and uncertainties to come / Covid-19 no nordeste do Brasil: primeiro ano de pandemia e incertezas que estão por vir

ABSTRACT OBJECTIVE To analyze the epidemic of COVID-19 in northeastern Brazil, one of the regions most affected by the virus. METHODS The official data for COVID-19, from March 2020 to March 2021 in the states of the Northeast Region (NE), were used. The analysis of capital cities and states for accumulated weekly cases and confirmed deaths was made using the JoinPoint Trend Analysis application. RESULTS In one year, the Northeast region reported 22.9% of the cases and 21.5% of the deaths in the country due to COVID-19. At the beginning of the pandemic, all states showed a growing number of cases, first in the capitals and then in the interior. Following this wave, decreases are observed in all states and their capitals, but with many still reporting a large number of cases. In the middle of the 2nd semester of 2020 the number of cases begins to increase again simultaneously in states and their capitals—some at explosive speed—especially in late 2020 and early 2021. A similar pattern is observed in deaths, which exceed or approach the peak seen in the first wave. In the first wave, all capitals and northeastern states adopted intense isolation measures. Fortaleza, Recife and Teresina reached the highest isolation index of all capitals, close to 0.60. This index decreases, with a slight growth trend until the end of December. With the exception of Fortaleza and Salvador, the other capitals fell to less than 0.40. CONCLUSION The Brazilian NE and the country are in increasingly complicated health, social and economic situations. It is necessary to speed up vaccinations and maintain non-pharmacological measures: face masks, social distancing measures and hygiene care, in addition to policies to protect workers who have lost their incomes and to subsidize small business owners.

RESUMO OBJETIVO Analisar a epidemia da covid-19 na região Nordeste do Brasil, uma das mais atingidas por essa virose. MÉTODOS Os dados oficiais para covid-19 dos estados do Nordeste são referentes ao período de março de 2020 a março de 2021. A análise para capitais e estados da série do acumulado semanal de casos e de óbitos confirmados foi feita com emprego do aplicativo JoinPoint Trend Analysis. RESULTADOS Em um ano, o Nordeste acumulou 22,9% dos casos e 21,5% dos óbitos do país pela covid-19. No início da pandemia, todos os estados apresentaram um crescimento sustentável de casos, primeiro nas capitais e depois interior. Em seguida, observam-se decréscimos em todos os estados e suas capitais, porém muitos permanecem com números elevados. Em meados do segundo semestre de 2020, o número de casos começa a crescer nos estados e suas capitais, alguns em velocidade explosiva, em especial no final de 2020 e início de 2021. Padrão similar é observado para os óbitos, os quais ultrapassaram ou aproximam-se do teto observado na primeira onda, na qual todas as capitais e estados do Nordeste adotaram intensas medidas de isolamento. Fortaleza, Recife e Teresina atingiram os maiores índices de isolamento de todas as capitais, perto de 0,60. Esse índice decresce, com tendência leve de crescimento até final de dezembro, voltando a decrescer. Com exceção de Fortaleza e Salvador, as demais capitais caíram para menos de 0,40. CONCLUSÃO O Nordeste brasileiro e o país estão em uma situação sanitária, social e econômica cada vez mais complexa. É necessário acelerar o processo de vacinação e manter as medidas não farmacológicas - constante uso de máscaras faciais, medidas de distanciamento e cuidados de higiene -, além de políticas de proteção aos trabalhadores que perderam as suas rendas e subsídios aos pequenos empresários.

La cavidad bucal como fuente de transmisión del SARSCoV-2 / Oral cavity as a transmission source for SARSCoV-2

RESUMEN Fundamento: debido a las características de la infección con SARSCoV-2, la cavidad bucal es un entorno que representa un alto riesgo para producir infección cruzada entre los pacientes y los odontólogos. Objetivo: recopilar la evidencia científica sobre si la cavidad bucal es una fuente de transmisión del SARSCoV-2. Métodos: se realizó una revisión en PubMed/Medline y Cochrane mediante términos de indización, para obtener información si la cavidad bucal es una fuente de transmisión del SARSCoV-2. Resultados: debido al contacto cercano con la boca y la nariz del paciente, las gotas y los aerosoles producidos en el tratamiento bucal exponen al odontólogo a infectarse con SARSCoV-2. Al analizar la información bibliográfica se encuentra evidencia de que el SARSCoV-2 se une de forma inicial a la enzima convertidora de angiotensina II que se encuentra en la mucosa oral, la lengua y las glándulas salivales, para después recién colonizar los tractos respiratorios; por lo que, se puede considerar a la cavidad bucal como una fuente de contagio y además la saliva puede usarse para realizar el análisis molecular del SARSCoV-2. Conclusiones: la evidencia científica recopilada, sugiere que la cavidad bucal puede actuar como una fuente de contagio del SARSCoV-2, gracias a la presencia en la boca de la enzima convertidora de angiotensina II que actúa como receptor del SARSCoV-2 y convierte a esta cavidad en una fuente de transmisión.

ABSTRACT Background: due to the characteristics of SARSCoV-2 infection, the oral cavity is a high risk environment for cross-infection between patients and dentists. Objective: to gather scientific evidence on whether the oral cavity is a source of SARSCoV-2 transmission. Methods: a review was performed in PubMed / Medline and Cochrane using indexing terms, to obtain information if the oral cavity is a source of SARSCoV-2 transmission. Results: due to close contact with the patient's mouth and nose, the drops and aerosols produced in the oral treatment expose the dentist to becoming infected with SARSCoV-2. Analyzing the bibliographic information, we find evidence that SARSCoV-2 binds initially to the angiotensin II converting enzyme found in the oral mucosa, tongue and salivary glands, and then only recently colonized the respiratory tracts; therefore, the oral cavity can be considered as a source of contagion and saliva can also be used to perform the molecular analysis of SARSCoV-2. Conclusions: the collected scientific evidence suggests that the oral cavity may act as a source of SARSCoV-2 transmission, thanks to the presence in the mouth of the angiotensin II converting enzyme that acts as a receptor for SARSCoV-2 and converts this cavity into a source of transmission.

Efectividad de las medidas ante la COVID-19 basada en el análisis del curso pandémico / Effectiveness of measures against COVID-19 based on pandemic case analysis

RESUMEN Fundamento: la falta de referencias a crisis semejantes a la pandemia COVID-19 en el pasado hace difícil poder predecir qué pueda suceder en el futuro inmediato. Lógicamente, los efectos presentes son fáciles y documentables, pero aquellos que dejarán huella en los distintos actores a medio y a largo plazo resultan más sujetos a debate. Objetivo: analizar el comportamiento de esta pandemia en la región cubana centrado en el mes de abril, al mostrar la mejor dirección a seguir a la hora de la toma de decisiones. Métodos: se diseñó un modelo matemático en función del impacto de la efectividad de las medidas ante esta pandemia basada en las funciones polinómicas de casos confirmados y los casos recuperados en el territorio durante el mes de abril. Resultados: se tiene el comportamiento actual y futuro de la efectividad del tratamiento ante esta pandemia al permitir tomar decisiones a corto y largo plazo atendiendo a estas variables. Conclusiones: se obtuvo la función de efectividad basado en las funciones de casos confirmados y casos recuperados diarios, al evidenciar que se pronostica mejoras en el enfrentamiento de la pandemia con extrema disciplina. Lo que permite al territorio establecer una estrategia de mejora basadas en un plan de acción.

ABSTRACT Background: the lack of references to crises similar to COVID-19 pandemic in the past makes difficult to predict what may happen in the immediate future. Logically, the present effects are easily documented, but those that will leave their mark on the different actors in the medium and long term are subject to more debate. Objective: to analyze the behavior of this pandemic in the Cuban region centered on the month of April, showing the best direction to follow when making decisions. Methods: a mathematical model was designed based on the impact of the effectiveness of the measures in the face of this pandemic based on the polynomial functions of confirmed cases and the cases recovered in the territory during the month of April. Results: the current and future behavior of the effectiveness of the treatment in the face of this pandemic is showed, allowing decisions to be made in the short and long term, taking into account these variables. Conclusions: the effectiveness function was obtained based on the functions of confirmed cases and daily recovered cases, showing that improvements are expected in the confrontation of the pandemic with extreme discipline, which allows the territory to establish an improvement strategy based on an action plan.

Detección de conglomerados «activos¼ emergentes de altas tasas de incidencia, para la vigilancia rápida de la COVID-19 / Detection of emerging "active" clusters with high incidence rates, for rapid surveillance of COVID-19

RESUMEN La geografía médica se ha aplicado en el marco de la fusión de la gestión gubernamental con el potencial científico disponible, con el objetivo de encontrar las mejores respuestas a la COVID-19. La investigación geográfica, en función del seguimiento y control de la actual pandemia, deviene tendencia mundial. Entre los procedimientos empleados, la técnica de Kulldorff es una metodología de análisis espacial implementada para la vigilancia rápida de la enfermedad. En Cuba existe experiencia de su uso, pero no con esta finalidad. Esta investigación muestra la aplicación de la opción de análisis espacio-temporal prospectivo, con datos de casos confirmados diariamente con la COVID-19 en la provincia de Villa Clara, que resulta en la detección de conglomerados «activos¼ emergentes de altas tasas de incidencia de la enfermedad. En caso de futuros rebrotes en el país, este recurso puede proveer información orientadora para las acciones encaminadas a la contención de la enfermedad.

ABSTRACT Medical geography has been applied within the framework of the government management and the available scientific potential, with the aim of finding the best answers to COVID-19. Geographical research, based on the monitoring and control of the current pandemic, becomes a global trend. Kulldorff's method, is among the procedures used, the spatial analysis methodology implemented for rapid surveillance of the disease. In Cuba, there is experience of its use, but not for this purpose. This research shows the implementation of a prospective spatio-temporal analysis, with data from cases confirmed daily with COVID-19 in Villa Clara province, which results in the detection of emerging "active" conglomerates with high incidence rates of the illness. This resource can provide guiding information for actions aimed at containing future outbreaks of the disease in our country.

Translating transmissibility measures into recommendations for coronavirus prevention

ABSTRACT The rapid increase in clinical cases of the new coronavirus disease, COVID-19, suggests high transmissibility. However, the estimates of the basic reproductive number reported in the literature vary widely. Considering this, we drew the function of contact-rate reduction required to control the transmission from both detectable and undetectable sources. Based on this, we offer a set of recommendations for symptomatic and asymptomatic populations during the current pandemic. Understanding the dynamics of transmission is essential to support government decisions and improve the community's adherence to preventive measures.

Outbreak investigation in cargo ship in times of COVID-19 crisis, Port of Santos, Brazil / Investigação de surto em navio de carga em tempo de COVID-19, Porto de Santos, Brasil

ABSTRACT In February 2020, a Chinese cargo ship docked at the Port of Santos with reports of crew members with a feverish and respiratory condition. A team was gathered to verify the existence of suspected cases of COVID-19 inside the vessel and define its clearance. All 25 crew members were interviewed, and no suspected cases were found. The vessel was then cleared for port activities. The investigation resulted from the implementation of the contingency plan to face a public health emergency of international importance and several surveillance entities cooperated.

RESUMO Em fevereiro de 2020, um navio de carga vindo da China atracou no Porto de Santos com relato de tripulantes com quadro febril e respiratório. Uma equipe foi mobilizada para verificar a existência de casos suspeitos de COVID-19 dentro da embarcação e definir a liberação da embarcação no porto. Todos os 25 tripulantes foram entrevistados e não foram encontrados casos suspeitos. Então a embarcação foi liberada para atividades no porto. A investigação resultou da aplicação do plano de contingência diante de uma emergência de saúde pública de importância internacional e houve a colaboração de diversas entidades de vigilância.

Mortalidade de profissionais de enfermagem pelo Covid-19 no Brasil no primeiro semestre de 2020 / Mortality of nursing professionals by Covid-19 in Brazil in the first half of 2020 / Mortalidad de profesionales de enfermería por Covid-19 en Brasil en el primer semestre de 2020

Objetivo: Analisar a mortalidade de profissionais de enfermagem (PE) pelo COVID-19 no Brasil no primeiro semestre do ano de 2020. Método: Trata-se de um estudo exploratório, descritivo e de abordagem quantitativa. Os dados foram extraídos junto ao Observatório da Enfermagem organizado do Conselho Federal de Enfermagem. Resultados: Foram identificados 18.857 casos reportados de PE infectados pelo Covid-19 e o universo de 194 registros de óbitos destes com taxa de letalidade de 2,44%. As maiores preponderâncias dos registros de óbito identificados foram de 40,7% (n=79) na região Sudeste (SE), 20,6% (n=40) no estado de São Paulo (SP), 66% (n=128) do sexo feminino e 25,8% (n=50) pessoas que pertenciam a faixa etária entre 51 a 60 anos. Considerações Finais: Por meio da presente pesquisa foi identificado aumento na frequência de registros de óbito de PE no recorte geográfico e histórico analisados.

Objective: To analyze the mortality of nursing professionals (PE) by COVID-19 in Brazil in the first half of 2020. Method: This is an exploratory, descriptive study with a quantitative approach. The data were extracted from the Nursing Observatory organized by the Federal Nursing Council. Results: 18.857 reported cases of PE infected with Covid-19 were identified and the universe of 194 death records of these with a lethality rate of 2.44%. The largest preponderances of the death records identified were 40.7% (n=79) in the Southeast (SE), 20.6% (n=40) in the state of São Paulo (SP), 66% (n=128 ) females and 25.8% (n=50) people who belonged to the age group between 51 and 60 years. Final Considerations: Through this research, an increase in the frequency of PE death records was identified in the analyzed geographical and historical context

Objetivo: analizar la mortalidad de los profesionales de enfermería (EP) por COVID-19 en Brasil en el primer semestre de 2020. Método: Este es un estudio exploratorio, descriptivo con un enfoque cuantitativo. Los datos fueron extraídos del Observatorio de Enfermería organizado por el Consejo Federal de Enfermería. Resultados: se identificaron 18.857 casos reportados de PE infectados con Covid-19 y el universo de 194 registros de defunción de estos con una tasa de mortalidad del 2,44%. La mayor preponderancia de los registros de defunción identificados fue 40.7% (n=79) en el sudeste (SE), 20.6% (n=40) en el estado de São Paulo (SP), 66% (n=128) mujeres y 25.8% (n=50) personas que pertenecían al grupo de edad entre 51 y 60 años. Consideraciones finales: A través de esta investigación, se identificó un aumento en la frecuencia de los registros de defunciones de PE en el perfil geográfico e histórico analizado.

Adults at high-risk of severe coronavirus disease-2019 (Covid-19) in Brazil

ABSTRACT OBJECTIVE To estimate the proportion and total number of the general adult population who may be at higher risk of severe Covid-19 in Brazil. METHODS We included 51,770 participants from a nationally representative, household-based health survey (PNS) conducted in Brazil. We estimated the proportion and number of adults (≥ 18 years) at risk of severe Covid-19 by sex, educational level, race/ethnicity, and state based on the presence of one or more of the following risk factors: age ≥ 65 years or medical diagnosis of cardiovascular disease, diabetes, hypertension, chronic respiratory disease, cancer, stroke, chronic kidney disease and moderate to severe asthma, smoking status, and obesity. RESULTS Adults at risk of severe Covid-19 in Brazil varied from 34.0% (53 million) to 54.5% (86 million) nationwide. Less-educated adults present a 2-fold higher prevalence of risk factors compared to university graduated. We found no differences by sex and race/ethnicity. São Paulo, Rio de Janeiro, Minas Gerais, and Rio Grande do Sul were the most vulnerable states in absolute and relative terms of adults at risk. CONCLUSIONS Proportion and total number of adults at risk of severe Covid-19 are high in Brazil, with wide variation across states and adult subgroups. These findings should be considered while designing and implementing prevention measures in Brazil. We argue that these results support broad social isolation measures, particularly when testing capacity for SARS-CoV-2 is limited.

A brief-review of the risk factors for covid-19 severity

ABSTRACT The World Health Organization has emphasized that one of the most important questions to address regarding the covid-19 pandemic is to understand risk factors for disease severity. We conducted a brief review that synthesizes the available evidence and provides a judgment on the consistency of the association between risk factors and a composite end-point of severe-fatal covid-19. Additionally, we also conducted a comparability analysis of risk factors across 17 studies. We found evidence supporting a total of 60 predictors for disease severity, of which seven were deemed of high consistency, 40 of medium and 13 of low. Among the factors with high consistency of association, we found age, C-reactive protein, D-dimer, albumin, body temperature, SOFA score and diabetes. The results suggest that diabetes might be the most consistent comorbidity predicting disease severity and that future research should carefully consider the comparability of reporting cases, factors, and outcomes along the different stages of the natural history of covid-19.