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Pereira FAC, Filho FMHS, de Azevedo AR, de Oliveira GL, Flores-Ortiz R, Valencia LIO, Rodrigues MS, Ramos PIP, da Silva NB, de Oliveira JF. Profile of COVID-19 in Brazil-risk factors and socioeconomic vulnerability associated with disease outcome: retrospective analysis of population-based registers. BMJ Glob Health 2022; 7:bmjgh-2022-009489. [PMID: 36517111 PMCID: PMC9755904 DOI: 10.1136/bmjgh-2022-009489] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 10/23/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To classify the most up-to-date factors associated with COVID-19 disease outcomes in Brazil. DESIGN Retrospective study. SETTING Nationwide Brazilian COVID-19 healthcare registers. PARTICIPANTS We used healthcare data of individuals diagnosed with mild/moderate (n=70 056 602) or severe (n=2801 380) COVID-19 disease in Brazil between 26 February 2020 and 15 November 2021. MAIN OUTCOME MEASURES Risk of hospitalisation and mortality affected by demographic, clinical and socioeconomic variables were estimated. The impacts of socioeconomic inequalities on vaccination rates, cases and deaths were also evaluated. RESULTS 15.6 million SARS-CoV-2 infection cases and 584 761 COVID-19-related deaths occurred in Brazil between 26 February 2020 and 15 November 2021. Overall, men presented a higher odds of death than women (OR=1.14, 95% CI 1.13 to 1.15), but postpartum patients admitted to hospital wards were at increased odds of dying (OR=1.23, 95% CI 1.13 to 1.34) compared with individuals without reported comorbidities. Death in younger age groups was notably higher in most deprived municipalities and also among individuals <40 years belonging to indigenous backgrounds compared with white patients, as shown by descriptive analysis. Ethnic/racial backgrounds exhibited a continuum of decreasing survival chances of mixed-race (OR=1.11, 95% CI 1.10 to 1.12), black (OR=1.34, 95% CI 1.32 to 1.36) and indigenous (OR=1.42, 95% CI 1.31 to 1.54) individuals, while those in most deprived municipalities also presented an increased odds of death (OR=1.38, 95% CI 1.36 to 1.40). Deprivation levels also affect the prompt referral of patients to adequate care. Our results show that the odds of death of individuals hospitalised for less than 4 days is more than double that of patients with close-to-average hospital stays (OR=2.07, 95% CI 2.05 to 2.10). Finally, negative vaccination status also increased the odds of dying from the disease (OR=1.29, 95% CI 1.28 to 1.31). CONCLUSIONS The data provide evidence that the patterns of COVID-19 mortality in Brazil are influenced by both individual-level health and social risk factors, as well as municipality-level deprivation. In addition, these data suggest that there may be inequalities in the timely provision of appropriate healthcare that are related to municipality-level deprivation.
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Affiliation(s)
- Felipe A C Pereira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Fábio M H S Filho
- Rondônia Oswaldo Cruz Foundatio, Oswaldo Cruz Foundation, Porto Velho, Rondônia, Brazil
| | - Arthur R de Azevedo
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Guilherme L de Oliveira
- Federal Center for Technological Education of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Renzo Flores-Ortiz
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Luis Iván O Valencia
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Moreno S Rodrigues
- Rondônia Oswaldo Cruz Foundatio, Oswaldo Cruz Foundation, Porto Velho, Rondônia, Brazil
| | - Pablo Ivan P Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil
| | - Nívea B da Silva
- Department of Statistics, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Juliane Fonseca de Oliveira
- Center for Data and Knowledge Integration for Health (CIDACS), Oswaldo Cruz Foundation, Salvador, Bahia, Brazil,Center of Mathematics of University of Porto (CMUP), University of Porto, Porto, Portugal
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Jorge DCP, Rodrigues MS, Silva MS, Cardim LL, da Silva NB, Silveira IH, Silva VAF, Pereira FAC, de Azevedo AR, Amad AAS, Pinho STR, Andrade RFS, Ramos PIP, Oliveira JF. Assessing the nationwide impact of COVID-19 mitigation policies on the transmission rate of SARS-CoV-2 in Brazil. Epidemics 2021; 35:100465. [PMID: 33984687 DOI: 10.1101/2020.06.26.20140780] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/13/2021] [Accepted: 04/30/2021] [Indexed: 05/25/2023] Open
Abstract
COVID-19 is now identified in almost all countries in the world, with poorer regions being particularly more disadvantaged to efficiently mitigate the impacts of the pandemic. In the absence of efficient therapeutics or large-scale vaccination, control strategies are currently based on non-pharmaceutical interventions, comprising changes in population behavior and governmental interventions, among which the prohibition of mass gatherings, closure of non-essential establishments, quarantine and movement restrictions. In this work we analyzed the effects of 707 governmental interventions published up to May 22, 2020, and population adherence thereof, on the dynamics of COVID-19 cases across all 27 Brazilian states, with emphasis on state capitals and remaining inland cities. A generalized SEIR (Susceptible, Exposed, Infected and Removed) model with a time-varying transmission rate (TR), that considers transmission by asymptomatic individuals, is presented. We analyze the effect of both the extent of enforced measures across Brazilian states and population movement on the changes in the TR and effective reproduction number. The social mobility reduction index, a measure of population movement, together with the stringency index, adapted to incorporate the degree of restrictions imposed by governmental regulations, were used in conjunction to quantify and compare the effects of varying degrees of policy strictness across Brazilian states. Our results show that population adherence to social distance recommendations plays an important role for the effectiveness of interventions and represents a major challenge to the control of COVID-19 in low- and middle-income countries.
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Affiliation(s)
- Daniel C P Jorge
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Mateus S Silva
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luciana L Cardim
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | - Nívea B da Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil; Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ismael H Silveira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Vivian A F Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | | | - Arthur R de Azevedo
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alan A S Amad
- College of Engineering, Swansea University, Swansea, Wales, United Kingdom
| | - Suani T R Pinho
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Roberto F S Andrade
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | - Pablo I P Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | - Juliane F Oliveira
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil; Centre of Mathematics of the University of Porto (CMUP), Department of Mathematics, Porto, Portugal.
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3
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Jorge DCP, Rodrigues MS, Silva MS, Cardim LL, da Silva NB, Silveira IH, Silva VAF, Pereira FAC, de Azevedo AR, Amad AAS, Pinho STR, Andrade RFS, Ramos PIP, Oliveira JF. Assessing the nationwide impact of COVID-19 mitigation policies on the transmission rate of SARS-CoV-2 in Brazil. Epidemics 2021; 35:100465. [PMID: 33984687 PMCID: PMC8106524 DOI: 10.1016/j.epidem.2021.100465] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 03/13/2021] [Accepted: 04/30/2021] [Indexed: 12/14/2022] Open
Abstract
COVID-19 is now identified in almost all countries in the world, with poorer regions being particularly more disadvantaged to efficiently mitigate the impacts of the pandemic. In the absence of efficient therapeutics or large-scale vaccination, control strategies are currently based on non-pharmaceutical interventions, comprising changes in population behavior and governmental interventions, among which the prohibition of mass gatherings, closure of non-essential establishments, quarantine and movement restrictions. In this work we analyzed the effects of 707 governmental interventions published up to May 22, 2020, and population adherence thereof, on the dynamics of COVID-19 cases across all 27 Brazilian states, with emphasis on state capitals and remaining inland cities. A generalized SEIR (Susceptible, Exposed, Infected and Removed) model with a time-varying transmission rate (TR), that considers transmission by asymptomatic individuals, is presented. We analyze the effect of both the extent of enforced measures across Brazilian states and population movement on the changes in the TR and effective reproduction number. The social mobility reduction index, a measure of population movement, together with the stringency index, adapted to incorporate the degree of restrictions imposed by governmental regulations, were used in conjunction to quantify and compare the effects of varying degrees of policy strictness across Brazilian states. Our results show that population adherence to social distance recommendations plays an important role for the effectiveness of interventions and represents a major challenge to the control of COVID-19 in low- and middle-income countries.
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Affiliation(s)
- Daniel C P Jorge
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | | | - Mateus S Silva
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luciana L Cardim
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | - Nívea B da Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil; Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Ismael H Silveira
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Vivian A F Silva
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | | | - Arthur R de Azevedo
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Alan A S Amad
- College of Engineering, Swansea University, Swansea, Wales, United Kingdom
| | - Suani T R Pinho
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Roberto F S Andrade
- Instituto de Fısica, Universidade Federal da Bahia, Salvador, Bahia, Brazil; Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | - Pablo I P Ramos
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil
| | - Juliane F Oliveira
- Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Bahia, Brazil; Centre of Mathematics of the University of Porto (CMUP), Department of Mathematics, Porto, Portugal.
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4
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Oliveira JF, Jorge DCP, Veiga RV, Rodrigues MS, Torquato MF, da Silva NB, Fiaccone RL, Cardim LL, Pereira FAC, de Castro CP, Paiva ASS, Amad AAS, Lima EABF, Souza DS, Pinho STR, Ramos PIP, Andrade RFS. Mathematical modeling of COVID-19 in 14.8 million individuals in Bahia, Brazil. Nat Commun 2021; 12:333. [PMID: 33436608 PMCID: PMC7803757 DOI: 10.1038/s41467-020-19798-3] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/26/2020] [Indexed: 12/30/2022] Open
Abstract
COVID-19 is affecting healthcare resources worldwide, with lower and middle-income countries being particularly disadvantaged to mitigate the challenges imposed by the disease, including the availability of a sufficient number of infirmary/ICU hospital beds, ventilators, and medical supplies. Here, we use mathematical modelling to study the dynamics of COVID-19 in Bahia, a state in northeastern Brazil, considering the influences of asymptomatic/non-detected cases, hospitalizations, and mortality. The impacts of policies on the transmission rate were also examined. Our results underscore the difficulties in maintaining a fully operational health infrastructure amidst the pandemic. Lowering the transmission rate is paramount to this objective, but current local efforts, leading to a 36% decrease, remain insufficient to prevent systemic collapse at peak demand, which could be accomplished using periodic interventions. Non-detected cases contribute to a ∽55% increase in R0. Finally, we discuss our results in light of epidemiological data that became available after the initial analyses.
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Affiliation(s)
- Juliane F Oliveira
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil.
- Centre of Mathematics of the University of Porto (CMUP), Department of Mathematics, Porto, Portugal.
| | - Daniel C P Jorge
- Instituto de Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Rafael V Veiga
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | | | - Nivea B da Silva
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Rosemeire L Fiaccone
- Instituto de Matemática e Estatística, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Luciana L Cardim
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | | | - Caio P de Castro
- Instituto de Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Aureliano S S Paiva
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Alan A S Amad
- College of Engineering, Swansea University, Swansea, Wales, UK
| | - Ernesto A B F Lima
- Oden Institute for Computational Engineering and Sciences, The University of Texas at Austin, Austin, TX, USA
| | - Diego S Souza
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Suani T R Pinho
- Instituto de Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Pablo Ivan P Ramos
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
| | - Roberto F S Andrade
- Center of Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Bahia, Brazil
- Instituto de Física, Universidade Federal da Bahia, Salvador, Bahia, Brazil
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5
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Nogueira TN, Pereira FAC, Procopio J, Sartorelli JC. Dripping faucet dynamics in a nonuniform electric field. Chaos 2018; 28:113101. [PMID: 30501219 DOI: 10.1063/1.5040757] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 10/10/2018] [Indexed: 06/09/2023]
Abstract
Two experimental bifurcation diagrams were obtained with two different control parameters. One parameter was the faucet opening and the other one, keeping fixed the faucet opening, was an electrical voltage (V) applied to a metallic cylinder that surrounds the pendant water column. In this way, the drops are formed in an electrical field gradient that polarizes the water column altering the effective surface tension that is consistent with the observed decreasing of the drop mass as the potential is increased, while the water flow rate remains constant. We observed that the two bifurcations are similar for S ≲ 65 and V ≲ 2.05 kV ; otherwise, the bifurcation evolutions are quite different.
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Affiliation(s)
- T N Nogueira
- Instituto de Física, Universidade de São Paulo, Caixa Postal 66318, 05315-970 São Paulo, Brazil
| | - F A C Pereira
- Instituto de Física, Universidade de São Paulo, Caixa Postal 66318, 05315-970 São Paulo, Brazil
| | - J Procopio
- Instituto de Física, Universidade de São Paulo, Caixa Postal 66318, 05315-970 São Paulo, Brazil
| | - J C Sartorelli
- Instituto de Física, Universidade de São Paulo, Caixa Postal 66318, 05315-970 São Paulo, Brazil
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Depetri GI, Pereira FAC, Marin B, Baptista MS, Sartorelli JC. Dynamics of a parametrically excited simple pendulum. Chaos 2018; 28:033103. [PMID: 29604657 DOI: 10.1063/1.5016819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The dynamics of a parametric simple pendulum submitted to an arbitrary angle of excitation ϕ was investigated experimentally by simulations and analytically. Analytical calculations for the loci of saddle-node bifurcations corresponding to the creation of resonant orbits were performed by applying Melnikov's method. However, this powerful perturbative method cannot be used to predict the existence of odd resonances for a vertical excitation within first order corrections. Yet, we showed that period-3 resonances indeed exist in such a configuration. Two degenerate attractors of different phases, associated with the same loci of saddle-node bifurcations in parameter space, are reported. For tilted excitation, the degeneracy is broken due to an extra torque, which was confirmed by the calculation of two distinct loci of saddle-node bifurcations for each attractor. This behavior persists up to ϕ≈7π/180, and for inclinations larger than this, only one attractor is observed. Bifurcation diagrams were constructed experimentally for ϕ=π/8 to demonstrate the existence of self-excited resonances (periods smaller than three) and hidden oscillations (for periods greater than three).
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Affiliation(s)
- Gabriela I Depetri
- Instituto de Física, Universidade de São Paulo, Caixa Postal 66318, 05315-970 São Paulo, Brazil
| | - Felipe A C Pereira
- Instituto de Física, Universidade de São Paulo, Caixa Postal 66318, 05315-970 São Paulo, Brazil
| | - Boris Marin
- Departamento de Física, Faculdade de Filosofia, Ciências e Letras, Universidade de São Paulo, Avenida Bandeirantes, 3900, 14040-901 Ribeirão Preto, Brazil
| | | | - J C Sartorelli
- Instituto de Física, Universidade de São Paulo, Caixa Postal 66318, 05315-970 São Paulo, Brazil
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