ArticleScientific reports2021
The impact of super-spreader cities, highways, and intensive care availability in the early stages of the COVID-19 epidemic in Brazil.
Article in Scientific reports, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 33 papers.
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Who cites it
33 citing papers in PubMed.
- First Phylodynamic Analysis of HRSV-A and HRSV-B in Rio de Janeiro, Brazil, Reveals Recurrent Dispersals From the Megalopolis Center to Suburban Cities.Journal of medical virology · 2026Article
- Mechanistic Understanding of Pandemic Dynamics: A Multiscale Algorithmic Framework.Life (Basel, Switzerland) · 2026Article
- A comprehensive analysis of the SARS-CoV-2 omicron variant in Tocantins State, Brazil, and tracing the spread of the XBB.1.18.1 lineage.Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] · 2026Article
- Dataset on Brazilian Municipal Health Policies During the COVID-19 Pandemic.Scientific data · 2025Article
- Contributing Factors to Safety: What Hospitalized Patients Can Tell Us? A Cross-Sectional Study.The International journal of health planning and management · 2025Article
- Decoding the cross-immune pressure: Dengue's role in SARS-CoV-2 evolution.Computational and structural biotechnology journal · 2025Article
- SARS-CoV-2 Pandemic in a Small-Sized Municipality in Ceará State, Brazil: Temporal and Spatial Evolution.Tropical medicine and infectious disease · 2024Article
- COVID-19 death risk predictors in Brazil using survival tree analysis: a retrospective cohort from 2020 to 2022.International journal for equity in health · 2024Article
- Article
- The Omicron Lineages BA.1 and BA.2 (Viruses · 2023Article
- The impact of Brazil's transport network on the spread of COVID-19.Scientific reports · 2023Article
- Retrospective Insights of the COVID-19 Epidemic in the Major Latin American City, São Paulo, Southeastern Brazil.Viruses · 2023Article
- Influence of socioeconomic inequality on the distribution of COVID-19 hospitalizations and deaths in Brazilian municipalities, 2020: an ecological study.Epidemiologia e servicos de saude : revista do Sistema Unico de Saude do Brasil · 2023Article
- COVID-19 contagion across remote communities in tropical forests.Scientific reports · 2022Article
- Urban Determinants of COVID-19 Spread: a Comparative Study across Three Cities in New York State.Journal of urban health : bulletin of the New York Academy of Medicine · 2022Article
- Recursive state and parameter estimation of COVID-19 circulating variants dynamics.Scientific reports · 2022Article
- Spatial and temporal fluctuations in COVID-19 fatality rates in Brazilian hospitals.Nature medicine · 2022Article
- Socioecological vulnerability and the risk of zoonotic disease emergence in Brazil.Science advances · 2022Article
- Epidemiology of COVID-19 in Individuals under 18 Years Old in Cartagena, Colombia: An Ecological Study of the First 14 Months of the Pandemic.Tropical medicine and infectious disease · 2022Article
- Impacts of a delayed and slow-paced vaccination on cases and deaths during the COVID-19 pandemic: a modelling study.Journal of the Royal Society, Interface · 2022Article
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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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