Expected impact of COVID-19 outbreak in a major metropolitan area in Brazil

Tarcisio M Rocha Filho; Fabiana S. Ganem dos Santos; Victor B Gomes; Thiago A.H. Rocha; Julio H.R. Croda; Walter M Ramalho; Wildo N Araujo

Brazil has one of the largest public health care systems in the world [20] , and understanding 38 how an eventual COVID-19 epidemic in the country could affect this system is central for the 39 preparation of a proper response. In the past, epidemiological models have been used to predict 40 the occurrence of measles cases in order to support decision making in public health 41 emergencies. This paper aims to present tools capable of making projections of the impact of a 42 COVID-19 epidemic in the major metropolitan region of the country. This of particular 43 importance not only for the size of its population, but also for being the main hub of arrival and 44 departure from the country. 45 We analyze the expected time evolution during the onset of the epidemic in the metropolitan 46 area of São Paulo, with a total estimated population of 21.5 million individuals, the fourth largest 47 in the world. We use a generalized age-stratified SEIR model with the addition of hospitalized income countries, with reduced availability of health infrastructure and preparedness to respond 52 to an emergency.