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

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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The use of health geography modeling to understand early dispersion of COVID-19 in São Paulo, Brazil

PLoS ONE ◽

10.1371/journal.pone.0245051 ◽

2021 ◽

Vol 16 (1) ◽

pp. e0245051

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 ◽

Urban Hierarchy ◽

Use Of Resources ◽

Disease Impact ◽

Public Health Strategies

Public 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 São Paulo territory. We hypothesize that urban hierarchy is the main responsible for the disease spreading, and we identify the hotspots and the main routes of virus movement from the metropolis to the inner state. In this ecological study, we use geographic models of population mobility to check for patterns for the spread of SARS-CoV-2 infection. We identify two patterns based on surveillance data: one by contiguous diffusion from the capital metropolitan area, and the other hierarchical with long-distance spread through major highways that connects São Paulo city with cities of regional relevance. This knowledge can provide real-time responses to support public health strategies, optimizing the use of resources in order to minimize disease impact on population and economy.

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The impact of early social distancing at COVID-19 Outbreak in the largest Metropolitan Area of Brazil

10.1101/2020.04.06.20055103 ◽

2020 ◽

Cited By ~ 6

Author(s):

Fabiana Ganem ◽

Fabio Macedo Mendes ◽

Silvano Barbosa de Oliveira ◽

Victor Bertollo Gomes Porto ◽

Wildo Navegantes de Araújo ◽

...

Keyword(s):

Metropolitan Area ◽

Sao Paulo ◽

São Paulo ◽

Seir Model ◽

Social Distancing ◽

The Impact

AbstractWe calculated the impact of early social distancing on the COVID-19 transmission in the São Paulo metropolitan area and forecasted the ICU beds needed to cope the epidemic demand by using an age-stratified SEIR model. Within 60 days, these measures would avoid 89,133 deaths.

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

10.1101/2020.03.14.20035873 ◽

2020 ◽

Cited By ~ 8

Author(s):

Tarcísio M. Rocha Filho ◽

Fabiana Sherine Ganem dos Santos ◽

Victor Bertollo Gomes ◽

Thiago Augusto Hernandes Rocha ◽

Julio Henrique Rosa Croda ◽

...

Keyword(s):

Public Health ◽

Older People ◽

Metropolitan Area ◽

Sao Paulo ◽

World Health ◽

São Paulo ◽

The World ◽

Health Organization ◽

The Impact ◽

The City

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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Impact of vehicular emissions on the formation of fine particles in the Sao Paulo Metropolitan Area: a numerical study with the WRF-Chem model

Atmospheric Chemistry and Physics ◽

10.5194/acp-16-777-2016 ◽

2016 ◽

Vol 16 (2) ◽

pp. 777-797 ◽

Cited By ~ 29

Author(s):

A Vara-Vela ◽

M. F. Andrade ◽

P. Kumar ◽

R. Y. Ynoue ◽

A. G. Muñoz

Keyword(s):

Size Distribution ◽

Metropolitan Area ◽

Atmospheric Aerosols ◽

Fine Particles ◽

Sao Paulo ◽

Vehicular Emissions ◽

São Paulo ◽

Mass Size Distribution ◽

Mass Size ◽

The Impact

Abstract. The objective of this work is to evaluate the impact of vehicular emissions on the formation of fine particles (PM2.5; ≤  2.5 µm in diameter) in the Sao Paulo Metropolitan Area (SPMA) in Brazil, where ethanol is used intensively as a fuel in road vehicles. The Weather Research and Forecasting with Chemistry (WRF-Chem) model, which simulates feedbacks between meteorological variables and chemical species, is used as a photochemical modelling tool to describe the physico-chemical processes leading to the evolution of number and mass size distribution of particles through gas-to-particle conversion. A vehicular emission model based on statistical information of vehicular activity is applied to simulate vehicular emissions over the studied area. The simulation has been performed for a 1-month period (7 August–6 September 2012) to cover the availability of experimental data from the NUANCE-SPS (Narrowing the Uncertainties on Aerosol and Climate Changes in Sao Paulo State) project that aims to characterize emissions of atmospheric aerosols in the SPMA. The availability of experimental measurements of atmospheric aerosols and the application of the WRF-Chem model made it possible to represent some of the most important properties of fine particles in the SPMA such as the mass size distribution and chemical composition, besides allowing us to evaluate its formation potential through the gas-to-particle conversion processes. Results show that the emission of primary gases, mostly from vehicles, led to a production of secondary particles between 20 and 30 % in relation to the total mass concentration of PM2.5 in the downtown SPMA. Each of PM2.5 and primary natural aerosol (dust and sea salt) contributed with 40–50 % of the total PM10 (i.e. those ≤  10 µm in diameter) concentration. Over 40 % of the formation of fine particles, by mass, was due to the emission of hydrocarbons, mainly aromatics. Furthermore, an increase in the number of small particles impaired the ultraviolet radiation and induced a decrease in ozone formation. The ground-level O3 concentration decreased by about 2 % when the aerosol-radiation feedback is taken into account.

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The Impact of Antipsychotic Polytherapy Costs in the Public Health Care in Sao Paulo, Brazil

PLoS ONE ◽

10.1371/journal.pone.0124791 ◽

2015 ◽

Vol 10 (4) ◽

pp. e0124791 ◽

Cited By ~ 13

Author(s):

Denise Razzouk ◽

Monica Kayo ◽

Aglaé Sousa ◽

Guilherme Gregorio ◽

Hugo Cogo-Moreira ◽

...

Keyword(s):

Public Health ◽

Health Care ◽

Sao Paulo ◽

Public Health Care ◽

São Paulo ◽

The Public ◽

The Impact

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Impact of nonpharmaceutical strategies on trends of COVID-19 in São Paulo State

Revista de Saúde Pública ◽

10.11606/s1518-8787.2021055003599 ◽

2021 ◽

Vol 55 ◽

pp. 48

Author(s):

Cristiane Ravagnani Fortaleza ◽

Thomas Nogueira Vilches ◽

Gabriel Berg de Almeida ◽

Claudia Pio Ferreira ◽

Lenice do Rosário de Souza ◽

...

Keyword(s):

Interrupted Time Series ◽

Sao Paulo ◽

Reproductive Number ◽

São Paulo ◽

Social Distancing ◽

Paulo State ◽

São Paulo State ◽

Time Series Analyses ◽

The Impact ◽

Mandatory Use

Interrupted time series analyses were conducted to measure the impact of social distancing policies (instituted on March 22, 2020) and of subsequent mandatory masking in the community (instituted on May 4, 2020) on the incidence and effective reproductive number of COVID-19 in São Paulo State, Brazil. Overall, the impact of social distancing both on incidence and Rt was greater than the incremental effect of mandatory masking. Those findings may reflect either a small impact of face masking or the loosening of social distancing after mandatory use of masks.

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Teaching geriatrics during the COVID-19 pandemic: experience of a brazilian medical school

Geriatrics Gerontology and Aging ◽

10.5327/z2447-212320202000061 ◽

2020 ◽

Vol 14 (3) ◽

pp. 203-206

Author(s):

Marcos Daniel Saraiva ◽

Milton Luiz Gorzoni

Keyword(s):

Geriatric Medicine ◽

Practical Experience ◽

Sao Paulo ◽

São Paulo ◽

Learning Tool ◽

Web Based ◽

Social Distancing ◽

Course Content ◽

Web Based Learning ◽

The Impact

INTRODUCTION: During the COVID-19 pandemic, the discipline of geriatrics at the Santa Casa de Sao Paulo School of Medical Sciences of São Paulo was adapted to a web-based learning environment due to social distancing measures. OBJECTIVE: To describe the full adaptation of the discipline of geriatrics to a web-based learning tool, of two activities that were developed including the current COVID-19 to illustrate some of the main concepts of geriatric medicine. METHODS: The course was fully adapted to the open-source course management system called MOODLE. The first activity was a COVID-19 clinical case discussion, whose main objective was to include COVID-19 in the content of our course, illustrating some of the main concepts of geriatrics. The second activity was a Comprehensive Geriatric Assessment (CGA) experience, done via videoconference, which also assessed the impact of social distancing measures on the health of older adults. RESULTS: A total of 43 medical students performed both activities, and 95% of the students considered the inclusion of the COVID-19 into the discipline of geriatrics useful, 88% approved the practical experience of CGA, and 84% felt that they contributed to the health of the interviewees after contact. CONCLUSION: Adapting our discipline to a web-based learning tool, while including the current COVID-19 in our course content and a practical experience of CGA via videoconference was possible and approved by students. The adoption of this initiative may not only be an academic strategy, but also a possible way to improve the quality of life of older people during the COVID-19 pandemic.

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Evaluating Atmospheric Pollutants from Urban Buses under Real-World Conditions: Implications of the Main Public Transport Mode in São Paulo, Brazil

Atmosphere ◽

10.3390/atmos10030108 ◽

2019 ◽

Vol 10 (3) ◽

pp. 108 ◽

Cited By ~ 2

Author(s):

Thiago Nogueira ◽

Pamela Dominutti ◽

Marcelo Vieira-Filho ◽

Adalgiza Fornaro ◽

Maria Andrade

Keyword(s):

Public Health ◽

Air Quality ◽

Public Transport ◽

Sao Paulo ◽

Atmospheric Pollutants ◽

Transport Sector ◽

São Paulo ◽

Transport Mode ◽

The Public ◽

The Impact

The broad expanse of the urban metropolitan area of São Paulo (MASP) has made buses, the predominant public transport mode for commuters in the city. In 2016, the bus fleet in the MASP reached 56,354 buses and it was responsible for more than 12 million daily trips. Here, we evaluate for the first time, the emission profile of gaseous and particulate pollutants from buses running on 7% biodiesel + 93% petroleum diesel and their spatial distribution in the MASP. This novel study, based on four bus terminal experiments, provides an extensive analysis of atmospheric pollutants of interest to public health and climate changes, such as CO2, CO, NOx, VOCs, PM10, PM2.5 and their constituents (black carbon (BC) and elements). Our results suggest that the renovation of the bus fleet from Euro II to Euro V and the incorporation of electric buses had a noticeable impact (by a factor of up to three) on the CO2 emissions and caused a decrease in NO emissions, by a factor of four to five. In addition, a comparison with previous Brazilian studies, shows that the newer bus fleet in the MASP emits fewer particles. Emissions from the public transport sector have implications for public health and air quality, not only by introducing reactive pollutants into the atmosphere but also by exposing the commuters to harmful concentrations. Our findings make a relevant contribution to the understanding of emissions from diesel-powered buses and about the impact of these new vehicular technologies on the air quality in the MASP.

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Uma experiência de formação para a participação social

Trilhas Filosóficas ◽

10.25244/tf.v10i1.3063 ◽

2018 ◽

Vol 10 (1) ◽

pp. 67-84

Author(s):

Francisca Fabiana da Silva ◽

José Carlos Martins da Silva

Keyword(s):

Public Health ◽

Rio Grande ◽

Sao Paulo ◽

Health Policies ◽

The Political ◽

São Paulo ◽

Educational Materials ◽

Public Health Policies ◽

The Social

Resumo: O presente trabalho configura-se como um estudo acerca da atuação da Pastoral da Criança no controle social das políticas públicas de saúde, especificamente no desenvolvimento de processos de formação que favorecem a participação social e o exercício da cidadania, que constituem práticas fundamentais para a construção da sociedade do Bem Viver. As atividades realizadas pelos voluntários, capacitados pela Pastoral da Criança, nos espaços políticos e sociais, semeiam esperança junto a um povo sofrido, esquecido pela sua condição social, ao mesmo tempo que fortalecem a comunidade. Trata-se de uma pesquisa de natureza qualitativa, em que analisamos a ação da entidade à luz dos materiais educativos produzidos para formação e acompanhamento dos agentes voluntários. Como pressupostos teóricos utilizamos, entre outros, os estudos de Gonh (2011), Pastoral da Criança (2000, 2008) e Nascimento (2006). Os resultados revelam que as ações desenvolvidas pela Pastoral da Criança aliadas à participação política dos voluntários, nos conselhos municipais de saúde e na comunidade, contribuem para a melhoria das políticas públicas de saúde e se constituem como práticas sociais efetivas de construção da cidadania. Palavras-chave: Formação; Participação Social; Saúde; Cidadania. Abstract: The present work is a study about the performance of Pastoral da Criança in the social control of public health policies, which are fundamental practices for the construction of the society of well live. The activities carried out by volunteers, trained by Pastoral da Criança, in the political and social spaces, hey sow hope together with the suffering people, forgotten by their social condition, at the same time that they strengthen the community. This is a qualitative research, in which we analyze the action of the entity in the light of the educational materials produced for training and follow-up of volunteer agents. As theoretical presuppositions, we use, among others, the studies of Gonh (2011), Pastoral da Criança (2000, 2008) and Nascimento (2006). The results show that the actions developed by Pastoral da Criança, together with the political participation of the volunteers, in the municipal health councils and in the community, contribute to the improvement of public health policies and constitute effective social practices for the construction of citizenship. Keywords: Formation; Social Participation; health; Citizenship. REFERÊNCIAS BRASIL. Constituição (1988). Constituição Federal. República Federativa do Brasil. Brasília: Senado Federal, 1988. _____. Ministério da Saúde. Secretaria da Atenção à Saúde. Lei 8.080 de 19 de setembro de 1990. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Diário Oficial da União. Brasília, DF, 1990. CONFERENCIA NACIONAL DOS BISPOS DO BRASIL. Fraternidade e Política: justiça e paz se abraçaram: Manual/CNBB. São Paulo: Salesiana Dom Bosco, 1996. ______. Compêndio da doutrina Social da Igreja / Pontifício Conselho “justiça e paz”. 4 ed. São Paulo: Paulinas, 2008. GOHN, Maria da Glória. Conselhos gestores e participação sociopolítica. São Paulo: Cortez, 2011. GIL, Antonio Carlos. Métodos e técnicas da pesquisa social. 6. ed. São Paulo: Atlas, 2011. INSTITUTO BRASILEIRO DE GEOGRAFIA E ESTATÍSTICA. Censo demográfico 2010: população residente, resultados do universo segundo mesorregiões, microregiões, municípios, distritos, subdistritos e bairros: Rio Grande do Norte. [online]: IBGE, 2010. Disponível em: <http://www.ibge.com.br>. Acesso em: 03 jan. 2014. ISTITUTO GOVERNAR. Revista Governar Cidades. Ano 1. n.O1, p. 8-16, fev. 2010. NASCIMENTO, José Mateus. Um Evangelho segundo a Pastoral da Criança: por uma pedagogia de sobrevivência. 2006. 265f. Tese (Doutorado em Educação) – Universidade Federal do Rio Grande do Norte, Centro de Ciências Sociais Aplicadas, 2006. PASTORAL DA CRIANÇA. Guia do líder da Pastoral da Criança: Para países de língua portuguesa. 22. ed. Curitiba. 2000. _____. O Articulador junto ao conselho de saúde. Curitiba: [s.n.], 2008. (Série Participação e Controle Social). REIMBERG, Cristiane Oliveira. Dois olhares sobre a relação entre jornalismo e a Pastoral da Criança: a comunicação popular do jornal da entidade e a cobertura jornalística da Folha de S.Paulo. São Paulo. 164f. Monografia (Especialização em Jornalismo Social) - Coordenadoria Geral de Especialização, Aperfeiçoamento e Extensão. Pontifícia Universidade Católica de São Paulo. São Paulo, 2006.

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Aiming for Intrasectorality: Public Safety and Health

International Archives of Medicine ◽

10.3823/2595 ◽

2019 ◽

Vol 12 ◽

Author(s):

Luiz Fernando de Lima Paulo ◽

Marco Akerman

Keyword(s):

Public Health ◽

Health And Safety ◽

Sao Paulo ◽

Western Region ◽

São Paulo ◽

Significance Level ◽

Intelligence System ◽

Qualitative Variables ◽

The Impact ◽

Public Health And Safety

Question: Are Public policies that contemplate intrasectorality capable of producing better results for society, public health and safety? Design: Descriptive study with data analysis from September 2014 to December 2015. Participants: Civil and Military Police of São Paulo State (western region of São Paulo City). Intervention: Analysis of criminal indicators of public health interest in the western region of São Paulo City during the period of applicability of intrasectorality as public health and safety policy. Outcome measures: analysis of the management model and record of reports interesting to public health. The first analysis was carried out in 3 police districts, later spreading to the entire western region of São Paulo City. Qualitative variables were based on the International Code of Diseases (ICD). The quantitative results obtained were extracted from the Criminal Intelligence System. Data were analyzed using descriptive statistics with a significance level of 95%. The software used was the bioestat 5.0 for windows. Results: There was a reduction of 4% to 44% in criminal indicators of public health interest. Conclusion: Intrasectorality was able to improve public health outcomes when used as public policy in police institutions, reducing the impact of violence on public health.

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