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

Journal Article (Journal 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.

Full Text

Duke Authors

Cited Authors

  • Nicolelis, MAL; Raimundo, RLG; Peixoto, PS; Andreazzi, CS

Published Date

  • June 21, 2021

Published In

Volume / Issue

  • 11 / 1

Start / End Page

  • 13001 -

PubMed ID

  • 34155241

Pubmed Central ID

  • PMC8217556

Electronic International Standard Serial Number (EISSN)

  • 2045-2322

Digital Object Identifier (DOI)

  • 10.1038/s41598-021-92263-3


  • eng

Conference Location

  • England