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The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil

Although international airports served as main entry points for SARS-CoV-2, the factors driving the uneven geographic spread of COVID-19 cases and deaths in Brazil remain mostly unknown. Here we show that three major factors influenced the early macro-geographical dynamics of COVID-19 in Brazil. Mat...

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Autores principales: Nicolelis, Miguel A. L., Raimundo, Rafael L. G., Peixoto, Pedro S., Andreazzi, Cecilia S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217556/
https://www.ncbi.nlm.nih.gov/pubmed/34155241
http://dx.doi.org/10.1038/s41598-021-92263-3
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author Nicolelis, Miguel A. L.
Raimundo, Rafael L. G.
Peixoto, Pedro S.
Andreazzi, Cecilia S.
author_facet Nicolelis, Miguel A. L.
Raimundo, Rafael L. G.
Peixoto, Pedro S.
Andreazzi, Cecilia S.
author_sort Nicolelis, Miguel A. L.
collection PubMed
description Although international airports served as main entry points for SARS-CoV-2, the factors driving the uneven geographic spread of COVID-19 cases and deaths in Brazil remain mostly unknown. Here we show that three major factors influenced the early macro-geographical dynamics of COVID-19 in Brazil. Mathematical modeling revealed that the “super-spreading city” of São Paulo initially accounted for more than 85% of the case spread in the entire country. By adding only 16 other spreading cities, we accounted for 98–99% of the cases reported during the first 3 months of the pandemic in Brazil. Moreover, 26 federal highways accounted for about 30% of SARS-CoV-2’s case spread. As cases increased in the Brazilian interior, the distribution of COVID-19 deaths began to correlate with the allocation of the country’s intensive care units (ICUs), which is heavily weighted towards state capitals. Thus, severely ill patients living in the countryside had to be transported to state capitals to access ICU beds, creating a “boomerang effect” that contributed to skew the distribution of COVID-19 deaths. Therefore, if (i) a lockdown had been imposed earlier on in spreader-capitals, (ii) mandatory road traffic restrictions had been enforced, and (iii) a more equitable geographic distribution of ICU beds existed, the impact of COVID-19 in Brazil would be significantly lower.
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spelling pubmed-82175562021-06-22 The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil Nicolelis, Miguel A. L. Raimundo, Rafael L. G. Peixoto, Pedro S. Andreazzi, Cecilia S. Sci Rep Article Although international airports served as main entry points for SARS-CoV-2, the factors driving the uneven geographic spread of COVID-19 cases and deaths in Brazil remain mostly unknown. Here we show that three major factors influenced the early macro-geographical dynamics of COVID-19 in Brazil. Mathematical modeling revealed that the “super-spreading city” of São Paulo initially accounted for more than 85% of the case spread in the entire country. By adding only 16 other spreading cities, we accounted for 98–99% of the cases reported during the first 3 months of the pandemic in Brazil. Moreover, 26 federal highways accounted for about 30% of SARS-CoV-2’s case spread. As cases increased in the Brazilian interior, the distribution of COVID-19 deaths began to correlate with the allocation of the country’s intensive care units (ICUs), which is heavily weighted towards state capitals. Thus, severely ill patients living in the countryside had to be transported to state capitals to access ICU beds, creating a “boomerang effect” that contributed to skew the distribution of COVID-19 deaths. Therefore, if (i) a lockdown had been imposed earlier on in spreader-capitals, (ii) mandatory road traffic restrictions had been enforced, and (iii) a more equitable geographic distribution of ICU beds existed, the impact of COVID-19 in Brazil would be significantly lower. Nature Publishing Group UK 2021-06-21 /pmc/articles/PMC8217556/ /pubmed/34155241 http://dx.doi.org/10.1038/s41598-021-92263-3 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Article
Nicolelis, Miguel A. L.
Raimundo, Rafael L. G.
Peixoto, Pedro S.
Andreazzi, Cecilia S.
The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil
title The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil
title_full The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil
title_fullStr The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil
title_full_unstemmed The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil
title_short The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil
title_sort impact of super-spreader cities, highways, and intensive care availability in the early stages of the covid-19 epidemic in brazil
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8217556/
https://www.ncbi.nlm.nih.gov/pubmed/34155241
http://dx.doi.org/10.1038/s41598-021-92263-3
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