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.
Highlights
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; little evidence is published from this state
The prevention, surveillance, and control actions of COVID-19 cases in Tocantins State have been directed to mitigate the deleterious effects of the pandemic
From March 2020 to August 2021, Tocantins was affected by 219,031 cases of COVID-19, in which 3,594 of them evolved to death
Summary
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; little evidence is published from this state. The COVID-19 pandemic has beaten Brazil hardly, ranking second in deaths, behind the United States of America. Since its first confirmed COVID-19 case reported on February 26, 20202, Brazil has exhibited critical epidemiological circumstances in its enormous territorial dimension, ranging in severity from region to region[3]. These geographical differences in population density, access to health services, age, and socioeconomic factors have accentuated inequities, mainly impacting the country’s most impoverished regions, such as the Northern region[4]. 93% of its population depends on the National Health System[7]
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