Epidemiological and clinical characteristics of the early phase of the COVID-19 epidemic in Brazil

Souza, William Marciel de; Buss, Lewis Fletcher; da Silva Candido, Darlan; Carrera, Jean Paul; Li, Sabrina; Zarebski, Alexander; Vincenti-Gonzalez, Maria; Messina, Janey; Sales, Flavia Cristina da Silva; Andrade, Pamela dos Santos; Prete, Carlos A; Nascimento, Vitor Heloiz; Ghilardi, Fabio; Pereira, Rafael Henrique Moraes; Santos, Andreza Aruska de Souza; Abade, Leandro; Gutierrez, Bernardo; Kraemer, Moritz U. G.; Aguiar, Renato Santana; Alexander, Neal; Mayaud, Philippe; Brady, Oliver J; Souza, Izabel Oliva Marcilio de; Gouveia, Nelson; Li, Guangdi; Tami, Adriana; Oliveira, Silvano Barbosa; Porto, Victor Bertollo Gomes; Ganem, Fabiana; Almeida, Walquiria Ferreira; Fantinato, Francieli Fontana Sutile Tardetti; Macario, Eduardo Marques; Oliveira, Wanderson Kleber; Pybus, Oliver; Wu, Chieh-Hsi; Croda, Julio; Sabino, Ester Cerdeira; Faria, Nuno R.

Background: The first case of COVID-19 was detected in Brazil on February 25, 2020. We report the epidemiological, demographic, and clinical findings for confirmed COVID-19 cases during the first month of the epidemic in Brazil. Methods: Individual-level and aggregated COVID-19 data were analysed to investigate demographic profiles, socioeconomic drivers and age-sex structure of COVID-19 tested cases. Basic reproduction numbers (R0) were investigated for Sao Paulo and Rio de Janeiro. Multivariate logistic regression analyses were used to identify symptoms associated with confirmed cases and risk factors associated with hospitalization. Laboratory diagnosis for eight respiratory viruses were obtained for 2,429 cases. Findings: By March 25, 1,468 confirmed cases were notified in Brazil, of whom 10% (147 of 1,468) were hospitalised. Of the cases acquired locally (77.8%), two thirds (66.9% of 5,746) were confirmed in private laboratories. Overall, positive association between higher per capita income and COVID-19 diagnosis was identified. The median age of detected cases was 39 years (IQR 30-53). The median R0 was 2.9 for Sao Paulo and Rio de Janeiro. Cardiovascular disease/hypertension were associated with hospitalization. Co-circulation of six respiratory viruses, including influenza A and B and human rhinovirus was detected in low levels. Interpretation: Socioeconomic disparity determines access to SARS-CoV-2 testing in Brazil. The lower median age of infection and hospitalization compared to other countries is expected due to a younger population structure. Enhanced surveillance of respiratory pathogens across socioeconomic statuses is essential to better understand and halt SARS-CoV-2 transmission.