The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil
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Abstract
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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SciScore for 10.1101/2020.09.19.20197749: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Despite this limitation, the European Medicines Agency and the US Federal Drug Administration (FDA) approved Dengvaxia for use in December 2018 and in May 2019 respectively, provided it is preceded by immunological profiling and given only to seropositive subjects. A second vaccine, TAK-003 (TAKEDA) has already reported partial results on its Phase III clinical trials [42]. Out of 13,380 subjects that received at least one dose of …
SciScore for 10.1101/2020.09.19.20197749: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Despite this limitation, the European Medicines Agency and the US Federal Drug Administration (FDA) approved Dengvaxia for use in December 2018 and in May 2019 respectively, provided it is preceded by immunological profiling and given only to seropositive subjects. A second vaccine, TAK-003 (TAKEDA) has already reported partial results on its Phase III clinical trials [42]. Out of 13,380 subjects that received at least one dose of TAK-003, the vaccine’s overall efficiency reached 80.9%, and 75% in seronegatives [42]. When dengue hospitalizations were considered, TAK-003’s efficiency reached 95.4% of the tested population [42]. TAK-003 was more effective (97.7%) for the DENV-2 serotype, but also moderately effective for the other three (73.7% for DENV-1, 63.2% for DENV-3, and inconclusive results of 63% for DENV-4). Finally, different from DengvaxiaTAK-003, Phase III data revealed an incidence of severe adverse effects similar to the control group [42]. Given this context, we propose that the next step would be to carry out clinical studies to measure how effective infection by DENV has been in protecting patients against SARS-CoV-2 infection in a population in which DENV was very prevalent during 2019-2020. Such a clinical study could quickly yield some fundamental information and test our hypothesis in a relative short-time. Assuming that our hypothesis is confirmed, i.e. that DENV infection produces a clinically relevant level of COVID-19 immunity, consideration could be gi...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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SciScore for 10.1101/2020.09.19.20197749: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
Despite this limitation, the European Medicines Agency and the US Federal Drug Administration (FDA) approved Dengvaxia for use in December 2018 and in May 2019 respectively, provided it is preceded by immunological profiling and given only to seropositive subjects. A second vaccine, TAK-003 (TAKEDA) has already reported partial results on its Phase III clinical trials [42]. Out of 13,380 subjects that received at least one dose of …
SciScore for 10.1101/2020.09.19.20197749: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
No key resources detected.
Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
Despite this limitation, the European Medicines Agency and the US Federal Drug Administration (FDA) approved Dengvaxia for use in December 2018 and in May 2019 respectively, provided it is preceded by immunological profiling and given only to seropositive subjects. A second vaccine, TAK-003 (TAKEDA) has already reported partial results on its Phase III clinical trials [42]. Out of 13,380 subjects that received at least one dose of TAK003, the vaccine’s overall efficiency reached 80.9%, and 75% in seronegatives [42]. When dengue hospitalizations were considered, TAK-003’s efficiency reached 95.4% of the tested population [42]. TAK-003 was more effective (97.7%) for the DENV-2 serotype, but also moderately effective for the other three (73.7% for DENV-1, 63.2% for DENV-3, and inconclusive results of 63% for DENV-4). Finally, different from DengvaxiaTAK-003, Phase III data revealed an incidence of severe adverse effects similar to the control group [42]. Given this context, we propose that the next step would be to carry out clinical studies to measure how effective infection by DENV has been in protecting patients against SARS-CoV-2 infection in a population in which DENV was very prevalent during 2019-2020. Such a clinical study could quickly yield some fundamental information and test our hypothesis in a relative short-time. Assuming that our hypothesis is confirmed, i.e. that DENV infection produces a clinically relevant level of COVID-19 immunity, consideration could be giv...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
About SciScore
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