The prevalence of comorbidities and associated risk factors among Covid-19 deceased in Mizoram, India

2021 ◽  
Vol 12 (3) ◽  
pp. 1822-1832
Author(s):  
Andrew Lalchhuanawma ◽  
Divya Sanghi ◽  
Lalhlimpuii Chawngthu
Keyword(s):  
Diabetes Mellitus ◽  
Case Fatality ◽  
Cardiovascular Complications ◽  
Health Concern ◽  
Laboratory Findings ◽  
Presenting Symptoms ◽  
Increased Risk ◽  
Group B ◽  
Novel Coronavirus ◽  
Associated Risk Factors

The WHO declaration of the novel coronavirus (Covid-19) caused by SARS-CoV-2 as a pandemic has raised serious questions and has since been a global health concern. Data on the clinical characteristics, laboratory findings of deceased covid-19 individuals are sparse. The study analyzed the clinical and laboratory profiles of Covid-19 deceased in Zoram Medical College Mizoram, India. We gathered information from the Mizoram Government Covid-19 portal and hospital medical record section. The study examined eight confirmed Covid-19 deaths out of the total nine Covid-19 fatalities reported in Mizoram as of February 14, 2021. The decedents' mean age was 62.88 (±18.659) years; among them, 87.5% were males, and blood group B was associated with half of the deceased. In Mizoram, the case fatality rate, crude death rate, and recovery rate were 0.2%, 7.27 per million, and 99.40%, respectively, with 3547 cases per million. The median length of hospital and ICU stay (between admission and death) was 15.5 and 11 days. The common presenting symptoms were fever (75%), shortness of breath (62.5%), cough/ sore throat (50%). Hypertension (62.5%) and diabetes mellitus (62.5%) were the two most prevalent comorbidities, followed by cardiovascular diseases (25%). The concurrence of hypertension and diabetes mellitus constituted 87.5%, 75% of the decedents reported the presence of at least one of the comorbidities. The two most common complications were an acute respiratory failure (87.5%) and cardiovascular complications (87.5%). Increased risk of severe Covid-19 disease increases with advanced age (>60 years), gender (male), and underlying comorbidities.

scholarly journals The Epidemiology and Predictors of Outcomes Among Confirmed COVID-19 Cases in a Large Community Healthcare System in South Florida

2021 ◽  
Author(s):  
Shenae Samuels ◽  
Jianli Niu ◽  
Candice Sareli ◽  
Paula Eckardt
Keyword(s):  
Healthcare System ◽  
South Florida ◽  
Health Concern ◽  
Community Healthcare ◽  
Logistic Regression Models ◽  
Icu Admission ◽  
Large Community ◽  
Increased Risk ◽  
Predictors Of Outcomes ◽  
Novel Coronavirus

AbstractThe novel coronavirus disease 2019 (COVID-19) continues to be a major public health concern. The aim of this study was to describe the presenting characteristics, epidemiology and predictors of outcomes among confirmed COVID-19 cases seen at a large community healthcare system which serves the epicenter and diverse region of Florida. We conducted a retrospective analysis of individuals with lab-confirmed SARS-CoV-2 infection who were seen, from March 2, 2020 to May 31, 2020, at Memorial Healthcare System in South Florida. Data was extracted from a COVID-19 registry of patients with lab-confirmed SARS-CoV-2 infection. Univariate and backward stepwise multivariate logistic regression models were used to determine predictors of key study outcomes. There were a total of 1692 confirmed COVID-19 patients included in this study. Increasing age was found to be a significant predictor of hospitalization, 30-day readmission and death. Having a temperature of 38 °C or more and increasing comorbidity score were also associated with an increased risk of hospitalization. Significant predictors of ICU admission included having a saturated oxygen level less than 90%, hypertension, dementia, rheumatologic disease, having a respiratory rate greater than 24 breaths per minute. Being of Hispanic ethnicity and immunosuppressant utilization greatly increased the risk of 30-day readmission. Having an oxygen saturation less than 90% and an underlying neurological disorder were associated with an increased likelihood of death. Results show that a patient’s demographic, underlying condition and vitals at triage may increase or reduce their risk of hospitalization, ICU admission, 30-day readmission or death.

scholarly journals COVID-19 and Congenital Heart Disease: Results from a Nationwide Survey

2020 ◽  
Vol 9 (6) ◽  
pp. 1774 ◽  
Author(s):  
Jolanda Sabatino ◽  
Paolo Ferrero ◽  
Massimo Chessa ◽  
Francesco Bianco ◽  
Paolo Ciliberti ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Congenital Heart ◽  
Case Fatality ◽  
Nationwide Survey ◽  
High Volume ◽  
Cardiovascular Complications ◽  
High Risk Population ◽  
Cardiovascular Comorbidities ◽  
Novel Coronavirus

Background. The pandemic of Novel Coronavirus Disease 2019 (COVID-19) is challenging, given the large number of hospitalized patients. Cardiovascular co-morbidities are linked to a higher mortality risk. Thus, patients with Congenital Heart Disease (CHD) might represent a high-risk population. Nevertheless, no data about them are available, yet. Hence, we conducted a nationwide survey to assess clinical characteristics and outcomes in patients with congenital heart disease affected by COVID-19. Methods and Results. This is a multi-centre, observational, nationwide survey, involving high-volume Italian CHD centres. COVID-19 diagnosis was defined as either “clinically suspected” or “confirmed”, where a severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) test had been performed and was positive. Cardiovascular comorbidities were observed among adult patients—atrial fibrillation (seven; 9%), hypertension (five; 7%), obesity (seven; 9%) and diabetes (one; 1%)—but were absent among children. Cardiovascular complications were mainly observed in the “confirmed” COVID-19+ group, consisting of heart failure (9%), palpitations/arrhythmias (3%), stroke/TIA (3%) and pulmonary hypertension (3%). Cardiovascular symptoms such as chest pain (1%), myocardial injury (1%) and pericardial effusion (1%) were also recorded. On the contrary, CHD patients from the clinically suspected COVID-19 group presented no severe symptoms or complications. Conclusions. Despite previous reports pointing to a higher case-fatality rate among patients with cardiovascular co-morbidities, we observed a mild COVID-19 clinical course in our cohort of CHD patients. Although these results should be confirmed in larger cohorts to investigate the underlying mechanisms, the findings of low cardiovascular complications rates and no deaths are reassuring for CHD patients.

scholarly journals Elevated D-Dimer Levels are Associated with Increased Risk of Mortality in COVID-19: A Systematic Review and Meta-Analysis

2020 ◽  
Author(s):  
Siddharth Shah ◽  
Kuldeep Shah ◽  
Siddharth B Patel ◽  
Forum S Patel ◽  
Mohammed Osman ◽  
...  
Keyword(s):  
Systematic Review ◽  
Meta Analysis ◽  
Severe Disease ◽  
Case Fatality ◽  
Inclusion Criteria ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Novel Coronavirus ◽  
D Dimer

AbstractIntroductionThe 2019 novel Coronavirus (2019-nCoV), now declared a pandemic has an overall case fatality of 2–3% but it is as high as 50% in critically ill patients. D-dimer is an important prognostic tool, often elevated in patients with severe COVID-19 infection and in those who suffered death. In this systematic review, we aimed to investigate the prognostic role of D-dimer in COVID-19 infected patients.MethodsWe searched PubMed, Medline, Embase, Ovid, and Cochrane for studies reporting admission D-dimer levels in COVID-19 patients and its effect on mortality.Results18 studies (16 retrospective and 2 prospective) with a total of 3,682 patients met the inclusion criteria. The pooled mean difference (MD) suggested significantly elevated D-dimer levels in patients who died versus those survived (MD 6.13 mg/L, 95% CI 4.16 − 8.11, p <0.001). Similarly, the pooled mean D-dimer levels were significantly elevated in patients with severe COVID-19 infection (MD 0.54 mg/L, 95% CI 0.28 − 0.8, p< 0.001). In addition, the risk of mortality was four-fold higher in patients with positive D-dimer vs negative D-dimer (RR 4.11, 95% CI 2.48 − 6.84, p< 0.001) and the risk of developing the severe disease was two-fold higher in patients with positive D-dimer levels vs negative D-dimer (RR 2.04, 95% CI 1.34 − 3.11, p < 0.001).ConclusionOur meta-analysis demonstrates that patients with COVID-19 presenting with elevated D-dimer levels have an increased risk of severe disease and mortality.

scholarly journals Application of artificial intelligence in prediction of cardiovascular complications in patients with diabetes mellitus type 2: A protocol of systematic review

2021 ◽  
Author(s):  
Hengameh Ferdosian ◽  
◽  
Hadi Zamanian ◽  
Sayed Ali Emami ◽  
Elahe Sedighi ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Systematic Review ◽  
Microvascular Complications ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Patients With Diabetes ◽  
Review Question

Review question / Objective: The aim of this systematic review is to evaluate AI-based models in identifying predictors of cardiovascular events and risk predtion in patients with diabetes mellitus type2. Condition being studied: T2DM patients have an increased risk of macrovascular and microvascular complications, lead to decreased quality of life and mortality. Considering the significance of cardiovascular complications in these patients, prediction of such events would be important. Different traditional statistical methods(such as regression) and new AI-besed algorithms are used to predict these complications in diabetic patients.

scholarly journals Clinical Characteristics of Coronavirus Disease 2019 (COVID-19): An Updated Systematic Review

2020 ◽  
Author(s):  
Zhangfu Fang ◽  
Fang Yi ◽  
Kang Wu ◽  
Kefang Lai ◽  
Xizhuo Sun ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Characteristics ◽  
Case Fatality ◽  
Admission Rate ◽  
Final Analysis ◽  
Common Symptom ◽  
Laboratory Findings ◽  
Large Patient ◽  
Unbiased Manner ◽  
Novel Coronavirus

AbstractOBJECTIVEClinical characteristics of novel coronavirus disease (COVID-19) have been described in numerous studies but yielded varying results. We aimed to conduct a systematic review on scientific literatures and to synthesize critical data on clinical traits of COVID-19 from its initial outbreak to pandemic.METHODSSystematic searches were conducted to identify retrospective observational study that contained clinical characteristics on COVID-19 through multiple databases. Two reviewers independently evaluated eligible publications. Data on clinical characteristics of COVID-19 were extracted and analyzed.RESULTSSeventy-two retrospective studies demonstrating the clinical characteristics of COVID-19 were included. A total of 3470 COVID-19 patients were synthesized to the final analysis in an unbiased manner. The most common symptom was fever (2878 [83.0%]), and 63.4% of the patients presented fever as onset symptom. There were 2528 [88.2%] of 2866 cases had abnormal lung findings on chest CT scan. Laboratory findings showed that 1498 [62.8%] of 2387 cases had lymphopenia, and 1354 [64.8%] of 2091 cases had an increased level of C-reactive protein (CRP). A total of 185 [11.5%] patients were admitted to intensive care unit (ICU) while the overall case fatality rate (CFR) was 3.7%. Compared to patients admitted outside of Hubei, China, those from Hubei had a significant higher ICU admission rate (21.9% vs. 2.5%, p<0.001). Also, CFR attributed to COVID-19 was significantly higher in Hubei than that of non-Hubei admissions (10.4% vs. 0.6%, p<0.001).INTERPRETATIONThis large patient-based systematic review presents a more precise profiling of the COVID-19 from its outbreak to current pandemic. Dynamic evolvements of COVID-19 are needed to be characterized in future studies.

scholarly journals Clinical Profile of Kawasaki Disease (KD) in Children admitted at Dhaka Shishu Hospital

2017 ◽  
Vol 8 (2) ◽  
pp. 216-219
Author(s):  
Mamun Miah ◽  
Kazi Zahidul Hoque ◽  
Md Ashraful Islam ◽  
Akhand Tanzi Sultana ◽  
Shubhra Prakash Paul ◽  
...  
Keyword(s):  
Kawasaki Disease ◽  
Clinical Features ◽  
Gastrointestinal Symptoms ◽  
Cervical Lymphadenopathy ◽  
Heart Association ◽  
Cardiovascular Complications ◽  
Unknown Etiology ◽  
Conjunctival Hyperemia ◽  
Laboratory Findings ◽  
Presenting Symptoms

Background : Kawasaki disease (KD) is an acute, febrile, self-limiting vasculitis of the medium-and small-sized arteries of unknown etiology. Recently its incidence is increasing worldwide.Objective : The aim of this study was to evaluate its presenting symptoms, clinical features and laboratory tests for the diagnosis of complete and incomplete KD in children.Materials & Methods : Medical records of 20 children with KD admitted in Dhaka Shishu Hospital from January, 2011 to December 2014, were reviewed. Demographic features, diagnostic clinical features of KD, and additional clinical findings including arthritis and/or arthralgia, gastrointestinal symptoms, respiratory symptoms and central nervous system symptoms were recorded for each patient. Besides, available laboratory findings collected on admission before Intravenous Immunoglobulin (IVIG) administration were reviewed. The diagnosis of complete and incomplete KD was made using the American Heart Association (AHA) recommendations.Results : About two-thirds of the children (65%) were 30 – 60 months, 20% were < 30 months and 15% were 60 or above 60 months old with mean age being 42 months. Over half (55%) of the children were female and 50% affected in summer season. Of the five principal signs, polymorphous skin rash was predominant (90%), followed by changes in oral mucosa or lip (85%), conjunctival hyperemia (75%), cervical lymphadenopathy (70%) and changes in distal extremities and gastrointestinal symptoms (each 65%). Majority of the children had raised WBC (75%), raised ESR (95%), increased platelet count (70%) and elevated CRP (75%). Uveitis was a predominant complication (45%), followed by facial paralysis (30%) and neurosensory hypoacusia (20%). Cardiovascular complications were less commonly found (30%). Neither age nor sex was found to be associated with type of Kawasaki disease (p = 0.450 and p = 0.535 respectively). Sixty percent of the patient fulfilled the criteria of complete KD and the rest incomplete KD. However, cervical lymphadenopathy and changes in distal extremity were significantly common in complete KD than those in incomplete KD (p = 0.019 and p = 0.05 respectively).Conclusion : In this study 60% of the patient fulfilled the criteria of complete KD and the rest incomplete KD.Northern International Medical College Journal Vol.8(2) January 2017: 216-219

scholarly journals THE EFFECT OF PRO197LEU POLYMORPHISM OF THE GPX1 GENE ON THE DEVELOPMENT OF COMPLICATIONS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND PATIENTS WITH TYPE 2 DIABETES MELLITUS AND COMORBID OBESITY

2019 ◽  
Vol 19 (2) ◽  
pp. 48-52
Author(s):  
A. Popruha
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Complications ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Wide Range ◽  
Antioxidant Defence System ◽  
Diabetes And Obesity

Type 2 diabetes and obesity are among the most common diseases worldwide. Due to the extremely high prevalence of these diseases that has been reached in recent years, at present they are recognized as non-infectious epidemics. Obesity is the leading modifying pathogenetic factor of type 2 diabetes. Almost 90% of diabetic patients are overweight or obese. Today, adipose tissue is positioned as an endocrine organ that produces numerous proteins with autocrine, paracrine, and endocrine functions. As a result, chronic activation of the body's immune system occurs with overproduction of a wide range of pro-inflammatory cytokines with subsequent development and progression of chronic non-specific systemic inflammation and oxidative stress, which make a significant contribution to the development of many chronic diseases. Based on the relationship of the pathogenetic moments between type 2 diabetes and obesity, attention should be paid to study the role of genetic factors of the antioxidant defence system, and, in particular, the glutathione peroxidase-1 (GPx1) gene polymorphism, on the development and course of these pathologies. Therefore, we investigated the specific effects of the Pro197Leu polymorphism of the GPx1 gene on the development of diabetic and cardiovascular complications in patients with type 2 diabetes and patients with type 2 diabetes and comorbid obesity in the Poltava region. Significant relationship was found out between the presence of the Leu allele and the increased risk of both type 2 diabetes and type 2 diabetes in combination with obesity. It has been established that in the patients with type 2 diabetes and patients with type 2 diabetes and comorbid obesity, the carriage of the Pro allele can be a protective factor with a protective effect towards preventing the development of complications in the clinical and pathogenetic course of both diseases, while the presence of the mutant Leu allele in the homo- and heterozygous state of the GPx1 gene is associated with an increased risk of the development of the diseases studied as well as concomitant diabetic and cardiovascular complications with more adverse clinical course of both diseases.

scholarly journals Effect of frequent hand washing for COVID-19 prevention

2020 ◽  
Vol 8 (11) ◽  
pp. 3969
Author(s):  
Raj Kumar ◽  
Sweta S. Kumar ◽  
Adesh Kumar ◽  
Prateek Jain
Keyword(s):  
Side Effects ◽  
Hand Hygiene ◽  
Preventive Measure ◽  
Hand Washing ◽  
Health Concern ◽  
Common Symptom ◽  
Global Public Health ◽  
Increased Risk ◽  
Hygiene Measures ◽  
Group B

Background: Coronavirus disease 2019 (COVID-19) has become a global public health concern. While dealing with COVID-19 pandemic, hand washing and the use of hand-hygiene products has been advocated, as a preventive measure. However, frequent hand washing leads to an increased risk of skin changes ranging from dryness and peeling of skin to itching, redness and blister formation. This study aims to understand the hand-hygiene practices and compare side effects between group using hand sanitizers with the group using soap with water.Methods: A 12-item self-administered close ended questionnaire assessing the hand washing habits and effect of the same on skin was used. A total of 60 cases were enrolled. The correlation between use of hand hygiene measures and the clinical changes was studied.Results: In our study, 32 out of the 60 reported a frequency of hand washing between 5-10 times a day. The awareness about using hand moisturizer was noted in 75% individuals. Side effects were more commonly observed in group B using alcohol-based sanitizers as compared to group A using soap with water. Dryness was the most common symptom, observed in 23.3% individuals using alcohol-based sanitizers and 10% individuals using soap with water.Conclusions: Hand-hygiene measures remain the cornerstone of prevention of COVID-19 transmission. However, the use of hand-hygiene products is associated with side effects especially dryness. Regular use of hand moisturizer is essential in preventing the unnecessary effects of frequent hand washing.

scholarly journals Analysis of Covid - 19 Situations in Davanagere District, Karnataka

2021 ◽  
Vol 2 (4) ◽  
pp. 01-08
Author(s):  
Gouri Sakre ◽  
Gulappa Devagappanavar
Keyword(s):  
Attack Rate ◽  
Case Fatality Rate ◽  
Case Fatality ◽  
Secondary Data ◽  
World Health ◽  
Severe Illness ◽  
Fatality Rate ◽  
First Case ◽  
Increased Risk ◽  
Novel Coronavirus

Background: According to CDC, Coronavirus disease 2019 (COVID-19) is caused by a new coronavirus which was first identified in Wuhan, China, in December 2019. Although most people who have COVID-19 have mild symptoms, it can also cause severe illness and even death. Some groups, including older adults and people who have certain underlying medical conditions, are at increased risk of severe illness. On February 11, 2020, the World Health Organization announced an official name for the disease that is causing the 2019 novel coronavirus outbreak. The new name of this disease is coronavirus disease 2019, abbreviated as COVID-19. Objectives: Analysis of COVID 19 data in the Davanagere district from April 2020 to August 2020. Methods: In this current study the secondary data is obtained from the Official Website of Government of Karnataka, Covid-19 Informational Portal – Media Bulletin. By using different indicators Davanagere district covid data is further used to calculate Attack rate, Case fatality rate and complete case fatality rate. Results: In this study it is found that, in the month of April there were no covid positive cases reported till fourth week of month, by fourth week, total two positive cases were reported the first case being encountered on 28th April 2020, with discharge of those patient in the end of the month. The attack rate has steeped up from 8.018 to 355.74 per one lakh population i.e. about 44 times more than initial months of pandemic. The strict preventive measures were followed by public and government too. So the prevalence rate is less in May, June and went on increasing once the unlocking is done. In summer the total positive cases steeping up from 2 cases to 154 total positive cases for the month April to May, and there is steady in rise of total positive cases for the month June with total positive cases of 153. In the beginning of summer there were fewer cases as pandemic was just begun and chances of transmission were very less. As monsoon appeared in June last week there is surge in total positive cases. With added burden of Unlock 1.0 phase, as public started moving out from home without any freak of infection. Conclusion: In this study it is found that due to strict nationwide lockdown and social distancing, hygiene practices among the Davanagere people has made it possible to restrict the spread of covid among the people, although the international immigration of Davanagere residents lead to transmission of infection. Further removal of lockdown after three months has lead to three fold spread of disease. Also there is rise in death rate, attack rate and case fatality in Davanagere district.

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

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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