Brazil has been severely hit by COVID-19, with rapid spatial spread of both cases and deaths. We use daily data on reported cases and deaths to understand, measure, and compare the spatiotemporal pattern of the spread across municipalities. Indicators of clustering, trajectories, speed, and intensity of the movement of COVID-19 to interior areas, combined with indices of policy measures show that while no single narrative explains the diversity in the spread, an overall failure of implementing prompt, coordinated, and equitable responses in a context of stark local inequalities fueled disease spread. This resulted in high and unequal infection and mortality burdens. With a current surge in cases and deaths and several variants of concern in circulation, failure to mitigate the spread could further aggravate the burden.

The aim of this study was to assess how coronavirus disease 2019 (COVID-19) clustered across districts in South Korea and to assess whether the pattern and duration of clusters changed following the country's containment strategy. Methods: A spatiotemporal analysis of COVID-19 daily confirmed cases by 250 districts in South Korea from January 20 to May 31, 2020, obtained from the Korea Centers for Disease Control and Prevention and each provincial website, was conducted. The global Moran's I statistic was used for spatial autocorrelation analysis, and the retrospective space-time scan statistic was used to analyze spatiotemporal clusters of COVID-19. Results: The geographical distribution showed strong spatial autocorrelation, with a global Moran's I coefficient of 0.784 (p = 0.0001). Twelve statistically significant spatiotemporal clusters were identified by space-time scan statistic using a discrete Poisson model. The spatial pattern of clusters changed and the duration of clusters became shorter over time. Conclusions: The results indicate that South Korea's containment strategy for COVID-19 was highly effective in both early detection and mitigation, with recent clusters being small in size and duration. Lessons from South Korea should spark a discussion on epidemic response.

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BackgroundThis study was conducted to determine the prevalence of a low appendicular skeletal muscle index (ASMI) using three cut-off points (mean ASMI-2SD of a gender-specific young reference group (aged 18–39 years), mean ASMI-1SD of a gender-specific young reference group, and the lower 20 percentile value of a gender-specific older group (aged ≥ 65 years)) in Korean older people and the relationship between ASMI and subjective health-related quality of life.MethodsThis study utilized data acquired during the Korean National Health and Nutrition Examination Survey (KNHANES) from 2008–2011. Dual-energy X-ray absorptiometry body compositional data was obtained from a subsample of 6538 subjects (men 2804, women 3734) aged 18–39 and 4413 subjects (men 1872, women 2541) aged 65 years and older. The three definitions of low appendicular skeletal muscle and the EQ-5D-3 L-Korean descriptive system were applied to Korean older people.ResultsFor the ASMI cutoff points used, in men, the three cutoff points were ASMI 2SD (6.09 kg/m2), ASMI 20 (6.48 kg/m2), and ASMI 1SD (6.95 kg/m2). In women, ASMI 2SD (4.38 kg/m2) was the lowest, followed by ASMI 1SD (4.96 kg/m2) and ASMI 20 (5.33 kg/m2). Proportions of older subjects with a low ASMI using the three cutoff points were 9.7% (ASMI 2SD) and 40.9% (ASMI 1SD) in men, and 0.7% (ASMI 2SD) and 7.4% (ASMI 1SD) in women. By multivariate ordinal logistic regression analysis, men with a low ASMI had significantly high odd ratios for the three domains of mobility (p < 0.001), self-care (p = 0.005), and usual activities (p = 0.004) among the five domains of the EQ-5D and EQ-5D index (p = 0.010).ConclusionsThe ASMI 2SD cut-off points for older Koreans, 6.09 kg/m2 for men and 4.38 kg/m2 for women, resulted in low prevalences of a low ASM, that is, 9.7% for men and 0.7% for women, and showed low clinical usefulness due to very low determined prevalence in women. Hence, we suggest that the cut-off point of the lowest 20% of Korean older people (men: 6.48 kg/m2, women; 5.33 kg/m2) be used for older Koreans.