Expected impact of COVID-19 outbreak in a major metropolitan area in Brazil

AbstractIn January 2020 China reported to the World Health Organization an outbreak of pneumonia of undetermined origin in the city of Wuhan, Hubei. In January 30, 2020, the World Health Organization declared the outbreak of COVID-19 as a Public Health Emergency of International Interest (PHEI).ObjectivesThe aim of this study is to assess the impact of a COVID-19 epidemic in the metropolitan region of São Paulo, Brazil.MethodsWe used a generalized SEIR (Susceptibles, Exposed, Infectious, Recovered) model, with additional Hospitalized variables (SEIHR model) and age-stratified structure to analyze the expected time evolution during the onset of the epidemic in the metropolitan area of São Paulo. The model allows to determine the evolution of the number of cases, the number of patients admitted to hospitals and deaths caused by COVID-19. In order to investigate the sensibility of our results with respect to parameter estimation errors we performed Monte Carlo analysis with 100 000 simulations by sampling parameter values from an uniform distribution in the confidence interval.ResultsWe estimate 1 368 (IQR: 880, 2 407) cases, 301 (22%) in older people (≥60 years), 81 (50, 143) hospitalizations, and 14 (9, 26) deaths in the first 30 days, and 38 583 (IQR: 16 698, 113, 163) cases, 8 427 (21.8%) in older people (≥60 years), 2181 (914, 6392) hospitalizations, and 397(166, 1205) deaths in the first 60 days.LimitationsWe supposed a constant transmission probability Pc among different age-groups, and that every severe and critic case will be hospitalized, as well as that the detection capacity in all the primary healthcare services does not change during the outbreak.ConclusionSupposing the reported parameters in the literature apply in the city of São Paulo, our study shows that it is expected that the impact of a COVID-19 outbreak will be important, requiring special planning from the authorities. This is the first study for a major metropolitan center in the south hemisphere, and we believe it can provide policy makers with a prognosis of the burden of the pandemic not only in Brazil, but also in other tropical zones, allowing to estimate total cases, hospitalization and deaths, in support to the management of the public health emergence caused by COVID-19.

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A qualitative study of old patients’ experiences of the quality of the health services in hospital and 30 days after hospitalization

10.21203/rs.2.11434/v2 ◽

2019 ◽

Author(s):

Ingvild Lilleheie ◽

Jonas Debesay ◽

Asta Bye ◽

Astrid Bergland

Keyword(s):

Older People ◽

World Health Organization ◽

Everyday Life ◽

Financial Burden ◽

Healthcare Quality ◽

World Health ◽

Old Patients ◽

The World ◽

Health Organization ◽

The Impact

Abstract Background: The number of people aged 80 years and above is projected to triple over the next 30 years. People in this age group normally have at least two chronic conditions. The impact of multimorbidity is often significantly greater than expected from the sum of the effects of each condition. The World Health Organization has indicated that healthcare systems must prepare for a change in the focus of clinical care for older people. The World Health Organization (WHO) defines healthcare quality as care that is effective, efficient, integrated, patient centered, equitable and safe. The degree to which healthcare quality can be defined as acceptable is determined by services’ ability to meet the needs of users and adapt to patients’ expectations and perceptions.Method: We took a phenomenological perspective to explore older patients’ subjective experiences and conducted semistructured individual interviews. Eighteen patients (aged from 82 to 100 years) were interviewed twice after discharge from hospital. The interview transcriptions were analyzed thematically.Results: The patients found their meetings with the health service to be complex and demanding. They reported attempting to restore a sense of security and meaning in everyday life, balancing their own needs against external requirements. Five overarching themes emerged from the interviews: hospital stay and the person behind the diagnosis, poor communication and coordination, life after discharge, relationship with their next of kin, and organizational and systemic determinants.Conclusion: According to the WHO, to deliver quality healthcare, services must include all six of the dimensions listed above. Our findings show that they do not. Healthcare focused on measurable values and biomedical inquiries. Few opportunities for participation, scant information and suboptimal care coordination left the patients with a feeling of being in limbo, where they struggled to find balance in their everyday life. Further work must be done to ensure that integrated services are provided without a financial burden, centered on the needs and rights of older people.

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Evaluating the effects of re-opening plans on dynamics of COVID-19 in São Paulo, Brazil1

10.1101/2021.01.14.21249809 ◽

2021 ◽

Author(s):

F.A. Rubio ◽

T.N. Vilches

Keyword(s):

Virus Transmission ◽

Sao Paulo ◽

World Health ◽

Local Health ◽

São Paulo ◽

The Government ◽

Health Organization ◽

Five Phases ◽

Local Health System ◽

The City

AbstractCoronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization in early March 2020. In Brazil, São Paulo is the most affected state, comprising about 20% of the country’s cases. With no vaccine available to date, distancing measures have been taken to reduce virus transmission. To reduce the pandemic’s effect on the economy, the government of São Paulo has proposed a plan consisting of five phases of the gradual re-opening of activities. In this context, we have developed a mathematical model to simulate the gradual re-opening plan on the transmission dynamics of COVID-19, in the city of São Paulo. The model shows that a precipitous reopening can cause a higher peak of the disease, which may compromise the local health system. Waiting for the reduction in the incidence of infected individuals for at least 15 days to phase transition is the most efficient strategy compared to the fixed-period scenario at each phase of the re-opening plan.

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Trachoma Prevalence After Discontinuation of Mass Azithromycin Distribution

The Journal of Infectious Diseases ◽

10.1093/infdis/jiz691 ◽

2020 ◽

Vol 221 (Supplement_5) ◽

pp. S519-S524

Author(s):

William Godwin ◽

Joaquin M Prada ◽

Paul Emerson ◽

P J Hooper ◽

Ana Bakhtiari ◽

...

Keyword(s):

Public Health ◽

Diagnostic Tests ◽

Public Health Problem ◽

World Health ◽

Simulation Based ◽

The World ◽

Health Organization ◽

Program Cycle ◽

The Impact ◽

Oral Azithromycin

Abstract Background As the World Health Organization seeks to eliminate trachoma by 2020, countries are beginning to control the transmission of trachomatous inflammation–follicular (TF) and discontinue mass drug administration (MDA) with oral azithromycin. We evaluated the effect of MDA discontinuation on TF1–9 prevalence at the district level. Methods We extracted from the available data districts with an impact survey at the end of their program cycle that initiated discontinuation of MDA (TF1–9 prevalence <5%), followed by a surveillance survey conducted to determine whether TF1–9 prevalence remained below the 5% threshold, warranting discontinuation of MDA. Two independent analyses were performed, 1 regression based and 1 simulation based, that assessed the change in TF1–9 from the impact survey to the surveillance survey. Results Of the 220 districts included, TF1–9 prevalence increased to >5% from impact to surveillance survey in 9% of districts. Regression analysis indicated that impact survey TF1–9 prevalence was a significant predictor of surveillance survey TF1–9 prevalence. The proportion of simulations with >5% TF1–9 prevalence in the surveillance survey was 2%, assuming the survey was conducted 4 years after MDA. Conclusion An increase in TF1–9 prevalence may represent disease resurgence but could also be due to measurement error. Improved diagnostic tests are crucial to elimination of TF1–9 as a public health problem.

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Mathematical modeling of the transmission of SARS-CoV-2—Evaluating the impact of isolation in São Paulo State (Brazil) and lockdown in Spain associated with protective measures on the epidemic of CoViD-19

PLoS ONE ◽

10.1371/journal.pone.0252271 ◽

2021 ◽

Vol 16 (6) ◽

pp. e0252271

Author(s):

Hyun Mo Yang ◽

Luis Pedro Lombardi Junior ◽

Fábio Fernandes Morato Castro ◽

Ariana Campos Yang

Keyword(s):

Face Mask ◽

Sao Paulo ◽

World Health ◽

Model Parameters ◽

São Paulo ◽

Protective Measures ◽

Paulo State ◽

São Paulo State ◽

Health Organization ◽

The Impact

Coronavirus disease 2019 (CoViD-19), with the fatality rate in elder (60 years old or more) being much higher than young (60 years old or less) patients, was declared a pandemic by the World Health Organization on March 11, 2020. A mathematical model considering young and elder subpopulations under different fatality rates was formulated based on the natural history of CoViD-19 to study the transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The model considered susceptible, exposed, asymptomatic, pre-symptomatic, mild CoViD-19, severe CoViD-19, and recovered compartments, besides compartments of isolated individuals and those who were caught by test. This model was applied to study the epidemiological scenario resulting from the adoption of quarantine (isolation or lockdown) in many countries to control the rapid propagation of CoViD-19. We chose as examples the isolation adopted in São Paulo State (Brazil) in the early phase but not at the beginning of the epidemic, and the lockdown implemented in Spain when the number of severe CoViD-19 cases was increasing rapidly. Based on the data collected from São Paulo State and Spain, the model parameters were evaluated, and we obtained a higher estimation for the basic reproduction number R0 (9.24 for São Paulo State, and 8 for Spain) compared to the currently accepted estimation of R0 around 2 using the SEIR (susceptible, exposed, infectious, and recovered compartments) model. In comparison with the lockdown in Spain, the relatively early adoption of the isolation in São Paulo State resulted in enlarging the period of the first wave of the epidemic and delaying its peak. The model allowed to explain the flattening of the epidemic curves by quarantine when associated with the protective measures (face mask, washing hands with alcohol and gel, and social distancing) adopted by the population. The description of the epidemic under quarantine and protections can be a background to foreseen the epidemiological scenarios from the release strategies, which can help guide public health policies by decision-makers.

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Reduction in prostate cancer hospitalizations in the COVID-19 pandemic epicenter of Latin America.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e18814 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e18814-e18814

Author(s):

Isabella Batista Martins Portugal ◽

Fernando Adami ◽

Jean Henri Schoueri ◽

Leandro Fórnias Machado Rezende ◽

Fernando Luiz Affonso Fonseca ◽

...

Keyword(s):

Public Health ◽

Hospital Admissions ◽

Sao Paulo ◽

Malignant Neoplasms ◽

São Paulo ◽

Outbreak Period ◽

Icd 10 ◽

The Impact ◽

The City ◽

Male Genital

e18814 Background: The novel SARS-CoV-2 coronavirus disease 2019 (COVID-19) has disrupted health care systems worldwide since December 2019 causing atypical pneumonia and affecting multiple body organs. In Latin America, COVID-19 had its first case in the megacity of São Paulo, Brazil, thus being the starting point and epicenter of this disease. In this context, prostate cancer (PC) is the most common non-skin cancer among men and its preventive healthcare is substantial to public health surveillance. Additionally, PC raises particular interest during COVID-19 outbreak as PC androgen-deprivation therapies have shown to mitigate SARS-CoV-2 infection, which suggests an association between SARS-CoV-2 and PC cells. Thus, the consequences of the COVID-19 outbreak on male genital cancers care remain inconclusive and will probably be felt for decades. This study aimed to determine the impact of pandemic on the incidence of hospital admissions (HA) due to malignant neoplasms of male genital organs in the city of São Paulo, Brazil. Methods: This is a cross-sectional study of the HAs due to malignant neoplasms of male genital organs in the city of São Paulo comparing the outbreak period (January-June 2020) and a pre-pandemic corresponding period of the years 2017-2019. Data were obtained from the Brazilian Unified Health System - Hospital Information System database according to the chapter II of the International Classification of Diseases - 10th revision (ICD-10). Linear regression was used to analyze the relationship between the incidence of HAs and time (months). Results: A significant reduction in HAs due to malignant neoplasms of male genital organs was observed in PC, but not other malignant neoplasms of male genital organs during the outbreak period (January-June 2020). PC (-19, CI -36 to -1) showed to be remarkably affected while other male genital cancers (-1, CI -5 to 3) did not (Table). Conclusions: Our findings seem to be associated to delayed oncological care delivery to PC during the lockdown and health system disruption. Further studies are required to evaluate the impact of the ongoing pandemic in malignant neoplasm of male genital organs, particularly PC, in order to strategically corroborate public health actions for implications of COVID-19 pandemic. Linear regression of hospital admissions for the years 2017-2020 (January until June) due to malignant neoplasms of male genital organs (chapter II of the ICD-10). Municipality of São Paulo, São Paulo, Brazil.[Table: see text]

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Preventable Mortality in Regions of Slovakia—Quantification of Regional Disparities and Investigation of the Impact of Environmental Factors

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph16081382 ◽

2019 ◽

Vol 16 (8) ◽

pp. 1382

Author(s):

Beata Gavurova ◽

Peter Toth

Keyword(s):

Public Health ◽

Environmental Factors ◽

Regional Disparities ◽

Point Of View ◽

World Health ◽

Cross Sectional ◽

The World ◽

Health Organization ◽

The Impact ◽

Preventable Mortality

Environmental health is among the priority areas of public health, and the current professional communities are intensively engaged with it. The main objective of the study is to quantify regional disparities of preventable mortality in Slovakia and to study the extent of the influence of selected environmental factors on changes in the development of its values. A cross-sectional linear regression model is used to quantify effects of environmental factors on the preventable mortality. Also, cluster analysis is used to identify regions with similar levels of air pollution. Environmental factors were selected based on the study of the World Health Organization. From the point of view of the influence of environmental factors on preventable mortality in the case of men, statistically significant connection to sewerage, SO2 production, and production of particulate matter was demonstrated. In the case of women, equally important factors showed connection to sewerage and SO2. The results of this study point to significant regional disparities in preventable mortality and a different degree of impact of environmental factors. Preventable mortality is above the Slovak average in most of the least-developed districts. Even in this group, there are significant differences.

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Regulatory Framework Implementation for the Prescription of Zolpidem in France, What Impact in the Older People?

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph182212099 ◽

2021 ◽

Vol 18 (22) ◽

pp. 12099

Author(s):

Alexandra Jobert ◽

Marion Istvan ◽

Edouard-Jules Laforgue ◽

Benoit Schreck ◽

Caroline Victorri-Vigneau

Keyword(s):

Observational Study ◽

Older People ◽

Regulatory Framework ◽

World Health ◽

Healthcare Data ◽

The World ◽

Before And After ◽

Hypnotic Drugs ◽

Health Organization ◽

The Impact

Background: Zolpidem is one of the most prescribed hypnotic drugs. In 2001, the World Health Organization alerted a risk of pharmacodependence associated with zolpidem. The French health authority decided in 2017 to enforce security on the prescription of zolpidem to reduce those risks. The aim of our study was to evaluate the impact of regulatory framework implementation, secure prescription pad, on the prevalence and incidence of prescriptions of zolpidem according to the age. Methods: This study was based on an observational study using the French healthcare data system. Two age categories were defined: “younger” and “older” (<65 years, ≥65 years); in order to study the evolution of prevalence and incidence of zolpidem use in our two groups, two periods were defined, before and after the implementation of the measure. Results: The prevalence decreased in the younger population by 51% (4012 vs. 7948 consumers), while that of the older population decreased by 42% (4151 vs. 7282). This difference in our two groups, with a greater decrease in the younger people, is statistically significant compared to the older people. Conclusion: Our study showed that regulatory framework implementation and mandatory secure prescription pad is more effective for decreasing prevalence of zolpidem prescription for younger people compared to older people.

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Study of underreporting of cases of meningitis during a Covid-19 pandemic in the state of São Paulo

10.5327/1516-3180.034 ◽

2021 ◽

Author(s):

Paloma Fernandes de Oliveira ◽

Matheus Gomes Diniz e Silva ◽

Daniel Rocha Diniz Teles ◽

Sabrina de Freitas Barros Soares ◽

Antônio Fernando Soares Menezes Segundo

Keyword(s):

Health Services ◽

Health System ◽

Sao Paulo ◽

The State ◽

World Health ◽

São Paulo ◽

Significant Drop ◽

Knowing That ◽

The World ◽

Health Organization

Introduction: In 2020, the World Health Organization declared the COVID-19 pandemic, which brought an overload on the health system. This also impacted the care of other diseases such as meningitis. Meningitis is classified into infectious and non-infectious meningitis, and its prognosis changes with the etiology. Objective: To assess notifications of meningitis in São Paulo compared to the country before and during the COVID-19 pandemic. Methods: An analytical epidemiological study was carried out, from the DATASUS platform, of meningitis notifications, from 2016 to September 2020 in the state of São Paulo in comparison to the country. Results: In 2020 there was a drop in meningitis notifications in São Paulo regarding the average of cases between 2016-2019, where 1,837 cases were reported in 2020, while the average of 2016-2019 was 6,800 notifications, a decrease of approximately 27%. What was also observed in the country, where in 2020, 4,718 cases were reported compared to the 2016- 2019 average of 16,603 cases, a drop of 28.4%. There was a slight increase in the mortality from meningitis in the state from 6% to 7%. Conclusions: Knowing that there was a significant drop in notifications of cases of meningitis in the state of São Paulo and in the country, we can suspect a correlation with the coronavirus pandemic. Therefore, there are some possibilities for this phenomenon: the population with meningitis, for fear of becoming infected, did not seek health services or the overload of health services to monitor patients with COVID-19 led to underreporting of meningitis cases.

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Elementary spatial structures and dispersion of COVID-19: health geography directing responses to public health emergency in São Paulo State, Brazil

10.1101/2020.04.26.20080895 ◽

2020 ◽

Author(s):

Carlos Magno Castelo Branco Fortaleza ◽

Raul Borges Guimarães ◽

Rafael de Castro Catão ◽

Cláudia Pio Ferreira ◽

Gabriel Berg de Almeida ◽

...

Keyword(s):

Public Health ◽

Metropolitan Area ◽

Sao Paulo ◽

São Paulo ◽

Population Mobility ◽

Long Distance ◽

Public Health Policies ◽

Social Distancing ◽

Public Health Strategies ◽

The Impact

AbstractPublic health policies to contain the spread of COVID-19 rely mainly on non-pharmacological measures. Those measures, especially social distancing, are a challenge for developing countries, such as Brazil. In São Paulo, the most populous state in Brazil (45 million inhabitants), most COVID-19 cases up to April 18th were reported in the Capital and metropolitan area. However, the inner municipalities, where 20 million people live, are also at risk. As governmental authorities discuss the loosening of measures for restricting population mobility, it is urgent to analyze the routes of dispersion of COVID-19 in those municipalities. In this ecological study, we use geographical models of population mobility as patterns for spread of SARS-Cov-2 infection. Based on surveillance data, we identify two patterns: one by contiguous diffusion from the capital metropolitan area and other that is hierarchical, with long-distance spread through major highways to cities of regional relevance. We also modelled the impact of social distancing strategies in the most relevant cities, and estimated a beneficial effect in each and every setting studied. This acknowledgement can provide real-time responses to support public health strategies.

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Epidemia do novo coronavírus (COVID-19): análise dos indicadores nos três primeiros meses, Estado de São Paulo, Brasil

ARCHIVES OF HEALTH INVESTIGATION ◽

10.21270/archi.v9i4.5102 ◽

2020 ◽

Vol 9 (4) ◽

Author(s):

Roudom Ferreira Moura ◽

Ana Paula Miranda Mundim-Pombo ◽

Rosângela Elaine Minéo Biagolini ◽

Janessa de Fátima Morgado de Oliveira

Keyword(s):

Public Health ◽

Case Fatality ◽

Sao Paulo ◽

World Health ◽

Health Concern ◽

Current Status ◽

São Paulo ◽

America Latina ◽

Novel Coronavirus ◽

Health Organization

Introdução: O Estado de São Paulo foi a Unidade da Federação onde ocorreu a notificação do primeiro caso de COVID-19 no Brasil e América Latina,apresentando indicadores de saúde alarmantes e boa parte dos municípios afetados. Objetivo: Analisar os indicadores de saúde do Novo Coronavírus (COVID-19) no Estado de São Paulo (ESP) nos três primeiros meses da epidemia a partir da confirmação do primeiro caso. Material e método: Estudo ecológico, descritivo, considerando os casos confirmados de COVID-19 captados pelo Centro de Vigilância Epidemiológica do ESP para o período de 26 de fevereiro a 26 de maio de 2020. Resultados: Houve crescimento do número de municípios (35, 284 e 510), casos confirmados (1.015, 20.652 e 85.459), óbitos (57, 1.700 e 6.423), coeficientes de incidência (2,21; 44,97 e 186,11 para cada 100.000 habitantes) e mortalidade (0,12; 3,70 e 13,99 para cada 100.000 habitantes) - respectivamente, março, abril e maio. Observou-se declínio do coeficiente de letalidade no terceiro mês comparado ao segundo (respectivamente, 8,23 e 7,52 para cada 100 casos). Conclusão: A magnitude do COVID-19 extrapola os indicadores mundiais em algumas localidades do Estado de São Paulo.Descritores: Infecções por Coronavírus; Pandemias; Epidemiologia Descritiva; Estudos Ecológicos.ReferênciasTan W, Zhao X, Ma X, Wang W, Niu P, Xu W et al. A Novel Coronavirus Genome Identified in a Cluster of Pneumonia Cases — Wuhan, China 2019−2020. China CDC Weekly, 2020;2(4):61-2.Rafael RDMR, Neto M, Carvalho MMB de, David HMSL, Acioli S, Faria MG de A. Epidemiologia, políticas públicas e pandemia de Covid-19: o que esperar no Brasil? Rev enferm UERJ. 2020;28:e49570.Wang C, Horby PW, Hayden FG, Gao GF. A novel coronavirus outbreak of global health concern [published correction appears in Lancet. 2020. Lancet. 2020;395(10223):470-73.Di Gennaro F, Pizzol D, Marotta C, Antunes M, Racalbuto V, Veronese N et al. Coronavirus Diseases (COVID-19) Current Status and Future Perspectives: A Narrative Review. Int J Environ Res Public Health. 2020;17(8):2690.World Health Organization. Coronavirus disease (COVID-19). Coronavirus disease (COVID-2019) Situation Report - 117. World Heal Organ [Internet]. 2020;8(1):3–8. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200516-covid-19-sitrep-117.pdf?sfvrsn=8f562cc_World Health Organization. Coronavirus disease (COVID-19). Coronavirus disease (COVID-19) Situation Report 138. 2020;(June). Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200606-covid-19-sitrep-138.pdf?sfvrsn=c8abfb17_4BRASIL. Ministério da Saúde S de V em S. Boletim Epidemiológico Especial COE COVID-19. Bol Epidemiológico Espec COE-COVID19 [Internet]. 2020; Available at: https://www.saude.gov.br/images/pdf/2020/May/29/2020-05-25---BEE17---Boletim-do-COE.pdf.The Lancet. COVID-19 in Brazil: "So what?". Lancet. 2020;395(10235):1461.Rodriguez-Morales AJ, Gallego V, Escalera-Antezana JP, Mendez CA, Zambrano LI, Franco-Paredes et. al. COVID-19 in Latin America: The implications of the first confirmed case in Brazil. Travel Med Infect Dis. 2020;35:101613.Governo do Estado de São Paulo10 - Secretaria de Estado da Saúde - Coordenadoria de Controle de Doenças - Centro de Vigilância Epidemiológica “Prof. Alexandre Vranjac” – Novo Coronavírus (COVID-19) - Situação Epidemiológica 26 de fevereiro a 26 de maio de 2020, disponíveis em: http://www.saude.sp.gov.br/cve-centro-de-vigilancia-epidemiologica-prof.-alexandre-vranjac/areas-de-vigilancia/doencas-de-transmissao-respiratoria/coronavirus-covid-19/situacao-epidemiologicaIBGE. Instituto Brasileiro de Geografia e Estatística. Brasil. São Paulo. Arandu. Disponível em: https://cidades.ibge.gov.br/brasil/sp/arandu/pesquisa/37/30255Castro Delgado R, Arcos González P. Analyzing the health system's capacity to respond to epidemics: a key element in planning for emergencies. El análisis de la capacidad de respuesta sanitaria como elemento clave en la planificación ante emergencias epidémicas. Emergencias. 2020;32(3):157-59.World-o-Meter. Disponível em: https://www.worldometers.info/coronavirus/. Acesso em: 14 de maio de 2020.Ren H, Zhao L, Zhang A, Song L, Liao Y, Lu W et al. Early forecasting of the potential risk zones of COVID-19 in China's megacities. Sci Total Environ. 2020;729:138995.Morgenstern H. Ecologic studies in epidemiology: concepts, principles, and methods. Annu Rev Public Health. 1995;16:61-81. Organização Pan-americana de Saúde. REDE Interagencial de Informação para a Saúde – RIPSA. Indicadores Básicos para a Saúde no Brasil: conceitos e aplicações. 2. ed. – Brasília: Organização Pan-Americana da Saúde, 2008. p. 144. Disponível em: http://tabnet.datasus.gov.br/tabdata/livroidb/2ed/CapituloC.pdfMedeiros de Figueiredo A, Daponte A, Moreira Marculino de Figueiredo DC, Gil-García E, Kalache A. Letalidad del COVID-19: ausencia de patrón epidemiológico [Case fatality rate of COVID-19: absence of epidemiological pattern] Gac Sanit. 2020;S0213-9111(20)30084-4.SEADE – Fundação Sistema Estadual de Análise de Dados. Perfil dos Municípios Paulistas. Disponível em: https://perfil.seade.gov.br/. Acessado em: 10/06/2020.Governo de São Paulo. SP Contra o Novo Coronavírus. Adesão ao Isolamento Social em São Paulo. Disponível em: https://www.saopaulo.sp.gov.br/coronavirus/isolamento/. Acessado em 10/06/2020.

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