SARS-CoV-2 Pandemic in a Small-Sized Municipality in Ceará State, Brazil: Temporal and Spatial Evolution.

Data on the temporal and spatial evolution of SARS-CoV-2 and local control measures and their effects on morbidity and mortality patterns in rural Brazil are scarce. We analyzed the data from case notification systems, epidemiological investigation reports, and municipal decrees in Itapajé, a small municipality in Ceará State in northeast Brazil. For spatial and spatio-temporal analyses, cases and deaths were mapped. There were a total of 3020 cases of COVID-19, recorded between April 2020 and December 2021; 135 (4.5%) died. The cumulative incidence and mortality rates were 5650.3 cases and 252.6 deaths per 100,000 people, respectively. The index case of SARS-CoV-2 in Itapajé was diagnosed in March 2020. The first peak of cases and deaths occurred in May 2020. The second wave peaked in May 2021, with the highest number of deaths in March 2021. According to the spatial analysis, the highest density of cases and deaths occurred in the central urban areas. In these areas, there were also the clusters of highest risk according to the spatio-temporal analyses. The municipal government issued 69 decrees on restriction measures, surveillance, and the maintenance of social isolation as a response to the pandemic. The spread of the SARS-CoV-2 pandemic in Itapajé mirrored the dynamics in large metropolitan regions, going from central neighborhoods of low socio-economic status to the wealthier peripheries.