The use of health geography modeling to understand early dispersion of COVID-19 in São Paulo, Brazil.

Public health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy.

Two hundred days of COVID-19 in São Paulo State, Brazil.

Two hundred days after the first confirmed case of COVID-19 in Brazil, the epidemic has rapidly spread in metropolitan areas and advanced throughout the countryside. We followed the temporal epidemic pattern at São Paulo State, the most populous of the country, the first to have a confirmed case of COVID-19, and the one with the most significant number of cases until now. We analysed the number of new cases per day in each regional health department and calculated the effective reproduction number (Rt) over time. Social distance measures, along with improvement in testing and isolating positive cases, general population mask-wearing and standard health security protocols for essential and non-essential activities, were adopted and impacted on slowing down epidemic velocity but were insufficient to stop transmission.

Is it time to talk about the end of social distancing? A joinpoint analysis of COVID-19 time series in Brazilian capitals

INTRODUCTION: Monitoring coronavirus disease (COVID-19)-related infections and deaths in Brazil is controversial, with increasing pressure to ease social distance measures. However, no evidence of a sustained, widespread fall in cases exists. METHODS We used segmented (joinpoint) regression analysis to describe the behavior of COVID-19 infections in Brazilian capital cities. RESULTS All capitals showed an exponential or a near-exponential increase in cases through May. A decline in reported cases was subsequently noted in 20 cities but was only significant for 8 (29.6%) and was followed in two by a renewed increase. CONCLUSIONS Caution is warranted when considering the relaxation of restrictions.

Is it time to talk about the end of social distancing? A joinpoint analysis of COVID-19 time series in Brazilian capitals.

INTRODUCTION: Monitoring coronavirus disease (COVID-19)-related infections and deaths in Brazil is controversial, with increasing pressure to ease social distance measures. However, no evidence of a sustained, widespread fall in cases exists. METHODS: We used segmented (joinpoint) regression analysis to describe the behavior of COVID-19 infections in Brazilian capital cities. RESULTS: All capitals showed an exponential or a near-exponential increase in cases through May. A decline in reported cases was subsequently noted in 20 cities but was only significant for 8 (29.6%) and was followed in two by a renewed increase. CONCLUSIONS: Caution is warranted when considering the relaxation of restrictions.

Increasing molecular diagnostic capacity and COVID-19 incidence in Brazil.

Different countries have adopted strategies for the early detection of SARS-CoV-2 since the declaration of community transmission by the World Health Organization (WHO) and timely diagnosis has been considered one of the major obstacles for surveillance and healthcare. Here, we report the increase of the number of laboratories to COVID-19 diagnosis in Brazil. Our results demonstrate an increase and decentralisation of certified laboratories, which does not match the much higher increase in the number of COVID-19 cases. Also, it becomes clear that laboratories are irregularly distributed over the country, with a concentration in the most developed state, São Paulo.

O raciocínio geográfico e as chaves de leitura da Covid-19 no território brasileiro

ABSTRACT To understand how covid-19 is distributed in Brazil, geographers use geographical reasoning supported by mapping techniques and spatial representation. We thus propose here a series of procedures to understand the disease in the geographic space, first with an exploration and descriptive analysis of the data, a spatial analysis and a synthesis through graphical modeling, followed by a cartographic communication. As a result, we hope that this theoretical and methodological path may guide the creation of a world image capable of responding to the most urgent demands posed by the pandemic, and concomitantly create reflections on how the production of geographical space creates vulnerabilities in this perverse globalization.