Analysis of COVID-19 mortality and case-fatality in a low- income region: an ecological time-series study in Tocantins, Brazilian Amazon

Abstract

Introduction: Inserted in the vulnerable context of the Brazilian Amazon, the state of Tocantins has suffered damages with the dissemination of COVID-19 in its territory; however, little evidence is published from this state. 
 Objective: This study aims to analyze the case-fatality, mortality, and incidence of COVID-19 in Tocantins. 
 Methods: This is an ecological study, population-based, time-series analysis of COVID-19 cases and deaths in the state of Tocantins from March 2020 to August 2021. 
 Results: During the examined period, 219,031 COVID-19 cases, and 3,594 deaths were registered due to disease. Two possible occurrence peaks were characterized in this time-series analysis. Remarkably, the Second Wave had the highest lethality rates (3.02% - April 2021), mortality (39.81 deaths per 100,000 inhabitants – March 2021), and incidence (1,938.88 cases per 100,000 inhabitants – March 2021). At the end of the period, mortality, incidence, and lethality showed flat trends, suggesting a positive outcome of the vaccination program. 
 Conclusion: The prevention, surveillance, and control actions of COVID-19 cases in Tocantins State have been directed to mitigate the deleterious effects of the pandemic. Nevertheless, efforts are still needed to decrease lethality, mortality, and incidence trends, and ultimately to achieve control of the COVID-19 pandemic in the region.

Space-temporal analysis of the incidence, mortality and case fatality of COVID-19 in the State of Rio Grande do Norte, in the period from 2020 to 2022, in the Northeast of Brazil

“…Thus, a vigilant and proactive approach is needed to address potential relapses and ensure public health protection at all times. The observed results of seasonal patterns reinforce the need for a continuous and flexible response to effectively face the evolution of the pandemic 18,29 .…”

“…The occurrence of variations in incidence, mortality and case fatality over time frequently occurs in different countries and regions, as was also observed in this study. These patterns are widely observed and have been studied in different contexts 29,32 .…”

“…However, the increase in COVID-19 cases in the state of Rio Grande do Norte was lower compared to other Brazilian states located in the North and Northeast regions, which experienced growth in case rates per million inhabitants higher than the national average, during the period from 2020 to 2021. In two of them the increase was almost 50 times in May: Tocantins (49.8) and Sergipe (47.8) 29 .…”

“…It is important to emphasize the distinct characteristics of each region, and that the variations in the time series of cases and deaths from COVID-19 differ between locations, not showing a uniform pattern of behavior. In this way, each region and/or country has its own epidemiological characteristics and based on these, specific response measures are developed and adopted 4,29,32,34 .…”

Analyzing the COVID-19 Transmission Dynamics in Acre, Brazil: An Ecological Study

“…The northern Brazilian region is characterized by widespread poverty, with all states exhibiting poverty indicators surpassing the national average [ 6 , 7 , 8 ] and Acre ranking among the poorest states in the country [ 8 ]. These disparities have exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas facing limited healthcare resources [ 8 , 9 ] and discernible discrepancies in healthcare infrastructure and investment relative to other regions of Brazil [ 10 ].…”