Evaluating the impacts of release in Sao Paulo State (Brazil) on the epidemic of covid-19 based on mathematical model

ABSTRACT

To flatten the curve of the natural epidemic of covid-19, many countries adopted lockdown or isolation resulting in the containment of the SARS-CoV-2 transmission. However, an important question arises about the strategies of release of isolated persons to avoid overloaded hospitals and increased deaths. Sao Paulo State (Brazil) implemented the isolation of the population in non-essential activities on March 24, and the progressive flexibilization considering the characteristics of each location (release of the isolated population) initiated on June 15. A mathematical model based on the natural history of covid-19 was applied to describe the epidemiological scenario with isolation in Sao Paulo State, and assess the impact of release on the covid-19 epidemic. Using data collected from Sao Paulo State, we estimated the model parameters to obtain the curves of the epidemic, the number of deaths, and the clinical evolution of covid-19. The epidemic under isolation was the framework to evaluate the strategies of the release, that is, how these curves are changed with the release of isolated persons. We evaluated three strategies of release. First two strategies considered four releases in the isolated population in four equal proportions, but successive releases elapsed by 14 and 21 days. In each strategy the beginning of the release was on June 29 and July 13, when the effective reproduction number Ref was evaluated. The third strategy aimed at the protection of the elder subpopulation. We observed that the delay to begin the release and the increased elapse between successive releases resulted in a better scenario by decreasing severe covid-19 cases and, consequently, to avoid overloaded hospitals. We also observed that the release delayed to achieve lower values for Ref and infectious persons retarded in several months the quick increasing phase of the forthcoming epidemic. However, this epidemic can be flattened or even suppressed by isolation of infectious persons by mass testing and/or by rigid adoption of protective measures and social distancing.