Transmission Rate Of Virus Research Articles

A multimethod approach for county-scale geospatial analysis of emerging infectious diseases: a cross-sectional case study of COVID-19 incidence in Germany

BackgroundAs of 13 July 2020, 12.9 million COVID-19 cases have been reported worldwide. Prior studies have demonstrated that local socioeconomic and built environment characteristics may significantly contribute to viral transmission and incidence rates, thereby accounting for some of the spatial variation observed. Due to uncertainties, non-linearities, and multiple interaction effects observed in the associations between COVID-19 incidence and socioeconomic, infrastructural, and built environment characteristics, we present a structured multimethod approach for analysing cross-sectional incidence data within in an Exploratory Spatial Data Analysis (ESDA) framework at the NUTS3 (county) scale.MethodsBy sequentially conducting a geospatial analysis, an heuristic geographical interpretation, a Bayesian machine learning analysis, and parameterising a Generalised Additive Model (GAM), we assessed associations between incidence rates and 368 independent variables describing geographical patterns, socioeconomic risk factors, infrastructure, and features of the build environment. A spatial trend analysis and Local Indicators of Spatial Autocorrelation were used to characterise the geography of age-adjusted COVID-19 incidence rates across Germany, followed by iterative modelling using Bayesian Additive Regression Trees (BART) to identify and measure candidate explanatory variables. Partial dependence plots were derived to quantify and contextualise BART model results, followed by the parameterisation of a GAM to assess correlations.ResultsA strong south-to-north gradient of COVID-19 incidence was identified, facilitating an empirical classification of the study area into two epidemic subregions. All preliminary and final models indicated that location, densities of the built environment, and socioeconomic variables were important predictors of incidence rates in Germany. The top ten predictor variables’ partial dependence exhibited multiple non-linearities in the relationships between key predictor variables and COVID-19 incidence rates. The BART, partial dependence, and GAM results indicate that the strongest predictors of COVID-19 incidence at the county scale were related to community interconnectedness, geographical location, transportation infrastructure, and labour market structure.ConclusionsThe multimethod ESDA approach provided unique insights into spatial and aspatial non-stationarities of COVID-19 incidence in Germany. BART and GAM modelling indicated that geographical configuration, built environment densities, socioeconomic characteristics, and infrastructure all exhibit associations with COVID-19 incidence in Germany when assessed at the county scale. The results suggest that measures to implement social distancing and reduce unnecessary travel may be important methods for reducing contagion, and the authors call for further research to investigate the observed associations to inform prevention and control policy.

Potential link between compromised air quality and transmission of the novel corona virus (SARS-CoV-2) in affected areas

The emergence of a novel human corona virus disease (COVID-19) has been declared as a pandemic by the World Health Organization. One of the mechanisms of airborne transmission of the severe acute respiratory syndrome - corona virus (SARS-CoV-2) amid humans is through direct ejection of droplets via sneezing, coughing and vocalizing. Nevertheless, there are ample evidences of the persistence of infectious viruses on inanimate surfaces for several hours to a few days. Through a critical review of the current literature and a preliminary analysis of the link between SARS-CoV-2 transmission and air pollution in the affected regions, we offer a perspective that polluted environment could enhance the transmission rate of such deadly viruses under moderate-to-high humidity conditions. The aqueous atmospheric aerosols offer a conducive surface for adsorption/absorption of organic molecules and viruses onto them, facilitating a pathway for higher rate of transmission under favourable environmental conditions. This mechanism partially explains the role of polluted air besides the exacerbation of chronic respiratory diseases in the rapid transmission of the virus amongst the public. Hence, it is stressed that more ambitious policies towards a cleaner environment are required globally to nip in the bud what could be the seeds of a fatal outbreak such as COVID-19.

Winter Is Coming: A Southern Hemisphere Perspective of the Environmental Drivers of SARS-CoV-2 and the Potential Seasonality of COVID-19.

SARS-CoV-2 virus infections in humans were first reported in December 2019, the boreal winter. The resulting COVID-19 pandemic was declared by the WHO in March 2020. By July 2020, COVID-19 was present in 213 countries and territories, with over 12 million confirmed cases and over half a million attributed deaths. Knowledge of other viral respiratory diseases suggests that the transmission of SARS-CoV-2 could be modulated by seasonally varying environmental factors such as temperature and humidity. Many studies on the environmental sensitivity of COVID-19 are appearing online, and some have been published in peer-reviewed journals. Initially, these studies raised the hypothesis that climatic conditions would subdue the viral transmission rate in places entering the boreal summer, and that southern hemisphere countries would experience enhanced disease spread. For the latter, the COVID-19 peak would coincide with the peak of the influenza season, increasing misdiagnosis and placing an additional burden on health systems. In this review, we assess the evidence that environmental drivers are a significant factor in the trajectory of the COVID-19 pandemic, globally and regionally. We critically assessed 42 peer-reviewed and 80 preprint publications that met qualifying criteria. Since the disease has been prevalent for only half a year in the northern, and one-quarter of a year in the southern hemisphere, datasets capturing a full seasonal cycle in one locality are not yet available. Analyses based on space-for-time substitutions, i.e., using data from climatically distinct locations as a surrogate for seasonal progression, have been inconclusive. The reported studies present a strong northern bias. Socio-economic conditions peculiar to the ‘Global South’ have been omitted as confounding variables, thereby weakening evidence of environmental signals. We explore why research to date has failed to show convincing evidence for environmental modulation of COVID-19, and discuss directions for future research. We conclude that the evidence thus far suggests a weak modulation effect, currently overwhelmed by the scale and rate of the spread of COVID-19. Seasonally modulated transmission, if it exists, will be more evident in 2021 and subsequent years.

Vaccines against Genital Herpes: Where Are We?

Genital herpes is a venereal disease caused by herpes simplex virus (HSV). Although HSV symptoms can be reduced with antiviral drugs, there is no cure. Moreover, because HSV infected individuals are often unaware of their infection, it is highly likely that they will transmit HSV to their sexual partner. Once infected, an individual has to live with HSV for their entire life, and HSV infection can lead to meningitis, encephalitis, and neonatal herpes as a result of vertical transmission. In addition, HSV infection increases the rates of human immunodeficiency virus (HIV) infection and transmission. Because of the high burden of genital herpes, HSV vaccines have been developed, but none have been very successful. In this review, we discuss the current status of genital herpes vaccine development.

Social Distancing Metrics and Estimates of SARS-CoV-2 Transmission Rates: Associations Between Mobile Telephone Data Tracking and R.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative agent of coronavirus disease 2019 (COVID-19). In the absence of robust preventive or curative strategies, the implementation of social distancing has been a key component of limiting the spread of the virus. Daily estimates of R(t) were calculated and compared with measures of social distancing made publicly available by Unacast. Daily generated variables representing an overall grade for distancing, changes in distances traveled, encounters between individuals, and daily visitation, were modeled as predictors of average R value for the following week, using linear regression techniques for 8 counties surrounding the city of Syracuse, New York. Supplementary analysis examined differences between counties. A total of 225 observations were available across the 8 counties, with 166 meeting the mean R(t) < 3 outlier criterion for the regression models. Measurements for distance (β = 1.002, P = .012), visitation (β = .887, P = .017), and encounters (β = 1.070, P = .001) were each predictors of R(t) for the following week. Mean R(t) drops when overall distancing grades move from D+ to C-. These trends were significant (P < .001 for each). Social distancing, when assessed by free and publicly available measures such as those shared by Unacast, has an impact on viral transmission rates. The scorecard may also be useful for public messaging about social distance, in hospital planning, and in the interpretation of epidemiological models.

Plant virus infection modifies plant pigment and manipulates the host preference behavior of an insect vector

AbstractInsect‐borne plant viruses may modify the phenotype of their host plants and thus influence the responses of insect vectors. When a plant virus modifies host preference behavior of a vector, it can be expected to influence the rate of virus transmission. In this study, we examined the effect of Maize Iranian mosaic virus (MIMV) infection on host preference behavior of the nymphs and adults of its vector, the small brown planthopper, Laodelphax striatellus Fallén (Hemiptera: Delphacidae), feeding on barley plants (Hordeum vulgare L., Poaceae). We found that both viruliferous nymphs and adults significantly preferred healthy plants, whereas non‐viruliferous planthoppers preferred virus‐infected barley. Further investigations revealed significant reductions in the chlorophyll and carotenoid contents of infected barley leaves. Based on these results, a possible association between insect host preferences and the pigment contents of the plants was observed. In summary, we suggest that host preference of L. striatellus could be affected by the propagative plant virus, possibly through association of this modification with some phenotypic traits of infected plants. These effects may have a critical impact on MIMV transmission rate, with significant implications for the development of virus epidemics.

Understanding Covid-19 transmission: The effect of temperature and health behavior on transmission rates.

BackgroundCovid-19 pandemic is an uncharted territory for the world's population. Countries are seeing measures they would have never considered under democratic governance in an attempt to contain case numbers. The role of outside air temperatures have been implicated as a potential factor involved in disease transmission. However, to this date, there has been no clear evidence to suggest either way. Along with temperatures, infection control and protection measures as well as how well people adopt these measures are likely to play a role in disease transmission and case growth rates seen across countries.MethodsThe current study uses panel data estimation for the original EU-15 countries in an attempt to explain the role of outside air temperatures, health behavior and government-imposed containment measures on Covid-19 transmission rates.ResultsThe preliminary evidence suggests that containment measures are highly effective in slowing down the spread of Covid-19. Years of education also appears to have a small but negative association with disease transmission rates suggesting that populations with higher educational attainments may be doing a better job of self-protection. Temperature appears to have a very small, but statistically significant impact on the viral transmission rate where a 1 °C increase in temperatures is estimated to reduce Covid-19 transmission by 0.9 percent.ConclusionResults are robust and clear. Temperature plays a small but significant role on Covid-19 transmission rates. However, it is quite possible that we may not have yet reached temperatures which may exert more pronounced effects on viral activity. Further research is warranted when more data becomes available, especially covering the months of July and August.

A review of COVID-19: Molecular basis, diagnosis, therapeutics and prevention

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the confirmed viral pathogen of COVID-19, a pandemic originated from Wuhan, China at the end of 2019. Since then, SARS-CoV-2 has rapidly spread across the globe with over 8 million confirmed cases and more than 430.000 deaths worldwide as of mid-June 2020. Similar to other strains of coronavirus, the envelope of SARS-CoV-2 comprises of three structural proteins: S protein (spike), E protein (envelope) and M glycoprotein (membrane). SARS-CoV-2 capsids are spherical or pleomorphic. Each capsid contains a positive-sense single-stranded RNA (+ssRNA-Class IV-Baltimore) associated with nucleoprotein N. The viral RNA genome is approximately 30 kb in length and contains 14 open reading frames (ORFs). The binding affinity of the viral S protein to the ACE2 (angiotensin-converting enzyme 2) receptor facilitates the attachment of SARS-CoV-2 to human epithelial cells. Upon binding, SARS-CoV-2 spike protein is cleaved and activated by TMPRSS2 (transmembrane protease, serine 2) or by cathepsin L at the cleavage site S2', and also by furin at the cleavage site S1/S2. The furin cleavage motif RR_R is a notable feature, firstly found in SARS-CoV-2 S protein, which may increase virus transmission rate. This feature and many others might result from several evolution events in SARS-CoV-2 genome. These events could occur when coronaviruses, including SARS-CoV-2, spread from one host to another. They can be causative to high virulence and transmission rate of future coronavirus strains, which may require the development of newer vaccine generations. To understand of SARS-CoV-2’s structure, infection mechanism, diagnosis, treatment, and vaccine development strategies, a review of current literature is of highly importance to disease control in Vietnam.

Community Pharmacy and COVID-19-The Unsung Heroes on Our High Streets.

Coronavirus Disease 2019 (COVID-19) is a transmittable infection caused by a new coronavirus. The virus has been transmitting in the community and within families, including in the UK, and was categorised as a pandemic on 11 March 2020. In the UK, the government’s aim has been to reduce the rate of virus transmission so that it takes place over months rather than weeks. This is to prevent the health services from becoming overwhelmed with multiple cases needing treatment all at the same time. The government’s meaning of ‘health services’ in this context, certainly at the start of the crisis, is the care given in hospitals by nurses and intensive-care specialists. And in the community, mitigating the impact of COVID-19 has to date focussed largely on general practitioners (GPs). This is unsurprising to those in the pharmacy profession who have long considered policy makers to overlook them. Yet, community pharmacists, a vital part of the health workforce and trusted by many people6, are also facing huge additional pressures because of COVID-19 and struggle to highlight their plight. This article considers the work pharmacists have been completing on their own, not necessarily with government support.

Risk Stratification in COVID-19

Following the first few reports of a novel coronavirus affecting a large number of Chinese residents in the city of Wuhan, it was rapidly clear that the disease did not affect everyone to the same degree. Often this is based on socio-political factors, leadership and resilience of the public health infrastructure. The predicted surge in infections due to high viral transmission rates threatened to overwhelm every healthcare system in the world. However, it has become clear that the experience of different population groups or subsets with variable characteristics was not the same. This review assesses pre-existing conditions that were identified as pathophysiological or sociodemographic risk factors of COVID-19. This will allow policymakers to decide what mitigation is needed to reduce those risks and protect the public from infections.

Impacts of social and economic factors on the transmission of coronavirus disease 2019 (COVID-19) in China

This study models local and cross-city transmissions of the novel coronavirus in China between January 19 and February 29, 2020. We examine the role of various socioeconomic mediating factors, including public health measures that encourage social distancing in local communities. Weather characteristics 2 weeks prior are used as instrumental variables for causal inference. Stringent quarantines, city lockdowns, and local public health measures imposed in late January significantly decreased the virus transmission rate. The virus spread was contained by the middle of February. Population outflow from the outbreak source region posed a higher risk to the destination regions than other factors, including geographic proximity and similarity in economic conditions. We quantify the effects of different public health measures in reducing the number of infections through counterfactual analyses. Over 1.4 million infections and 56,000 deaths may have been avoided as a result of the national and provincial public health measures imposed in late January in China.

Relationships of virus titers and transmission rates among sympatric and allopatric virus isolates and thrips vectors support local adaptation

Plant viruses rely on insect vectors for transmission among plant hosts, but many of the specifics of virus-vector interactions are not fully understood. Thrips tabaci, which transmits Tomato spotted wilt virus (TSWV) in a persistent and propagative manner, varies greatly in its ability to transmit different isolates of TSWV. Similarly, TSWV isolates are transmitted at different efficiencies by different populations of T. tabaci. This study characterizes differences in virus titers in the vector among TSWV isolate-T. tabaci isoline pairings in relation to differences in transmission rates, and demonstrates that although transmission rates were higher for sympatric than allopatric TSWV isolate-T. tabaci isoline pairings, virus titers in the thrips vector were significantly lower in the sympatric pairings. Results further demonstrate that TSWV titers in the vector were unrelated to virus titers in the leaf tissue from which they acquired the virus and provide evidence for the importance of specific vector-virus interactions and local adaptation in determining transmission efficiency of TSWV by T. tabaci.

A Social Network Model of COVID-19

I construct a dynamic social-network based model of the COVID-19 epidemic which embeds the SIR epidemiological model onto a graph of person-to-person interactions. The standard SIR framework assumes uniform mixing of infectious persons in the population. This abstracts from important elements of realism and locality: (i) people are more likely to interact with members of their social networks and (ii) health and economic policies can affect differentially the rate of viral transmission via a person's social network vs. the population as a whole. The proposed network-augmented (NSIR) model allows the evaluation, via simulations, of (i) health and economic policies and outcomes for all or subset of the population: herd immunity, testing, contact tracing, lockdown/distancing; (ii) behavioral responses and/or imposing or lifting policies at a specific time or conditional on observed states. As the NSIR model keeps track of individual states, an economic cost-benefit module and agent heterogeneity (e.g., in savings, employment status; ability to pay bills) is easily incorporated. I find that viral transmission over a network-connected population can proceed slower and reach lower peak than transmission via uniform contacts. The resulting longer epidemic duration may imply larger overall economic costs, e.g., if accompanied by prolonged lockdown policies. If lifted early, distancing policies mostly shift the infection peak into the future with associated economic costs. Delayed or intermittent (on-off-on) interventions or endogenous behavioral responses can lead to a twin-peaked infection rate, a form of 'curve flattening', but may have costlier economic consequences by prolonging the epidemic duration.

Seasonality of Respiratory Viral Infections.

The seasonal cycle of respiratory viral diseases has been widely recognized for thousands of years, as annual epidemics of the common cold and influenza disease hit the human population like clockwork in the winter season in temperate regions. Moreover, epidemics caused by viruses such as severe acute respiratory syndrome coronavirus (SARS-CoV) and the newly emerging SARS-CoV-2 occur during the winter months. The mechanisms underlying the seasonal nature of respiratory viral infections have been examined and debated for many years. The two major contributing factors are the changes in environmental parameters and human behavior. Studies have revealed the effect of temperature and humidity on respiratory virus stability and transmission rates. More recent research highlights the importance of the environmental factors, especially temperature and humidity, in modulating host intrinsic, innate, and adaptive immune responses to viral infections in the respiratory tract. Here we review evidence of how outdoor and indoor climates are linked to the seasonality of viral respiratory infections. We further discuss determinants of host response in the seasonality of respiratory viruses by highlighting recent studies in the field.

Aleurothrixus trachoides (Back) can transmit begomovirus from Duranta to potato, tomato and bell pepper

Solanum whitefly, Aleurothrixus trachoides (Back). (Hemiptera: Aleyrodidae) was considered as a non-virus vector by European and Mediterranean Plant Protection Organization (EPPO) reports. However, in the present study it was found to transmit Duranta leaf curl virus (DLCV) to tomato, bell pepper and potato. A. trachoides infested field samples of Duranta sp (100%) and tomato (20%) tested positive for begomovirus by PCR using begomovirus degenerate primers and primers specific to Tomato leaf curl New Delhi virus showing amplicon of 520 bp and 2.7 Kb respectively. The DNA samples of A. trachoides collected from virus positive duranta and tomato plants also tested positive for the virus. Virulent whiteflies from duranta could successfully transmit DLCV to bell pepper (26%) and tomato (13 %) plants as confirmed by Rolling Circle Amplification. The rate of virus transmission by A. trachoides from DLCV inoculated tomato to bell pepper and tomato to potato was 100% and tomato to tomato was 80%. The results suggest whitefly A. trachoides as the vector for DLCVand to the best of our knowledge, this is the first report for A. trachoides as vector of begomovirus. These findings suggest need for reconsideration of A. trachoides as a virus-vector. This will have great impact on solanaceous vegetable cultivation in India and other parts of the world.

Impact of Mutations in Arabidopsis thaliana Metabolic Pathways on Polerovirus Accumulation, Aphid Performance, and Feeding Behavior.

During the process of virus acquisition by aphids, plants respond to both the virus and the aphids by mobilizing different metabolic pathways. It is conceivable that the plant metabolic responses to both aggressors may be conducive to virus acquisition. To address this question, we analyze the accumulation of the phloem-limited polerovirus Turnip yellows virus (TuYV), which is strictly transmitted by aphids, and aphid’s life traits in six Arabidopsis thaliana mutants (xth33, ss3-2, nata1, myc234, quad, atr1D, and pad4-1). We observed that mutations affecting the carbohydrate metabolism, the synthesis of a non-protein amino acid and the glucosinolate pathway had an effect on TuYV accumulation. However, the virus titer did not correlate with the virus transmission efficiency. Some mutations in A. thaliana affect the aphid feeding behavior but often only in infected plants. The duration of the phloem sap ingestion phase, together with the time preceding the first sap ingestion, affect the virus transmission rate more than the virus titer did. Our results also show that the aphids reared on infected mutant plants had a reduced biomass regardless of the mutation and the duration of the sap ingestion phase.

Broad dengue neutralization in mosquitoes expressing an engineered antibody.

With dengue virus (DENV) becoming endemic in tropical and subtropical regions worldwide, there is a pressing global demand for effective strategies to control the mosquitoes that spread this disease. Recent advances in genetic engineering technologies have made it possible to create mosquitoes with reduced vector competence, limiting their ability to acquire and transmit pathogens. Here we describe the development of Aedes aegypti mosquitoes synthetically engineered to impede vector competence to DENV. These mosquitoes express a gene encoding an engineered single-chain variable fragment derived from a broadly neutralizing DENV human monoclonal antibody and have significantly reduced viral infection, dissemination, and transmission rates for all four major antigenically distinct DENV serotypes. Importantly, this is the first engineered approach that targets all DENV serotypes, which is crucial for effective disease suppression. These results provide a compelling route for developing effective genetic-based DENV control strategies, which could be extended to curtail other arboviruses.

Vector competence of anthropophilic mosquitoes for a new mesonivirus in Senegal

ABSTRACT The mesoniviruses (MESOVs) belong to the newly described Mesoniviridae family (Order: Nidovirales). They have never been reported in Senegal until recently during a study in arbovirus emergence with the detection of a new species of MESOV named Dianke virus (DKV) from common mosquitoes from eastern Senegal. Actually, their vector competence for this newly described DKV is unknown. We, therefore, estimated the vector competence of Culex tritaeniorhynchus, Culex quinquefasciatus, Aedes aegypti, and Anopheles gambiae mosquitoes collected in Senegal for DKV using oral infection. Whole bodies, legs/wings, and saliva samples were tested for DKV by RT–PCR to estimate infection, dissemination, and transmission rates. The infectivity of virus particles in the saliva was confirmed by infecting C6/36 cells. Virus transmission rates were up to 95.45% in Culex tritaeniorhynchus, 28% in Cx. quinquefasciatus and 9.09% in Aedes aegypti. Viral particles in the saliva were confirmed infectious by C6/36 cell culture. An. gambiae was able to disseminate DKV only at 20 days post-infection. This study shows that Culex mosquitoes are more competent than Ae. aegypti for DKV, while Anopheles gambiae is not likely a competent vector.

Effect of isolation practice on the transmission of middle east respiratory syndrome coronavirus among hemodialysis patients: A 2-year prospective cohort study.

Hemodialysis (HD) patients had a high rate of infection transmission and mortality during the middle east respiratory syndrome coronavirus (MERS-CoV) outbreak in Saudi Arabia. A standardized guideline on isolation technique for exposed HD patients is not available. Thus, this study aimed to evaluate the effect of different isolation strategies on the prevention of secondary viral transmission and clinical outcomes among exposed HD patients.During the 2015 MERS-CoV outbreak in Korea, 116 patients in 3 HD units were incidentally exposed to individuals with confirmed MERS-CoV infection and underwent different types of isolation, which were as follows: single-room isolation (n = 54, 47%), cohort isolation (n = 46, 40%), and self-imposed quarantine (n = 16, 13%). The primary outcome was rate of secondary viral transmission. The secondary outcome measures were changes in clinical and biochemical markers during the isolation period, difference in clinical and biochemical markers according to the types of isolation practice, and effect of isolation practice on patient survival.During a mean isolation period of 15 days, no further cases of secondary transmission were detected among HD patients. Plasma hemoglobin, serum calcium, and serum albumin levels and single-pool Kt/V decreased during the isolation period but normalized thereafter. Patients who were subjected to self-imposed quarantine had higher systolic and diastolic blood pressure, lower total cholesterol level, and lower Kt/V than those who underwent single-room or cohort isolation. During the 24-month follow-up period, 12 patients died. However, none of the deaths occurred during the isolation period, and no differences were observed in patient survival rate according to different isolation strategies.Although 116 participants in 3 HD units were incidentally exposed to MERS-CoV during the 2015 outbreak in Korea, strict patient surveillance and proper isolation practice prevented secondary transmission of the virus. Thus, a renal disaster protocol, which includes proper contact surveillance and isolation practice, must be established in the future to accommodate the needs of HD patients during disasters or outbreaks.

BRAZIL AND COVID-19: ONE COUNTRY, SEVERAL EPIDEMICS / BRASIL E COVID-19: UM PAÍS, VÁRIAS EPIDEMIAS

In Brazil, the first case of Covid-19 was confirmed on February 26, 2020, in the State of São Paulo. The first case of infected indigenous people was registered on April 1, in the state of Amazonas. On June 19, Brazil reached the mark of one million cases of Covid-19. Thus, the objective of this work was to show the profile of the pandemic in Brazilian territory, as well as among the general population and the original peoples, at a time when Brazil surpassed the mark of one million confirmed cases of Covid-19. This is a descriptive, retrospective study, conducted with secondary data available online related to confirmed cases of Covid-19 in the country. The variables of interest were: incidence, mortality, testing, effective reproduction rate (Rt). From February 25 to Jul 07, 2020 (28th epidemiological week), Brazil recorded 1.672.998 confirmed cases of Covid-19, 66.828 deaths, 976.977 of recovered cases. The highest mortality rates are in states in the North Region and the lowest in states in the South Region. Regarding indigenous groups, 8.098 confirmed cases and 184 deaths. Underreporting harms the estimates of health indicators, as well as the estimation of mathematical models predictive of the virus transmission rate. Epidemiological surveillance, testing and adequate treatment are essential at this time, as well as a regionalized look at a country of continental dimensions (with actions in the present scenario as for the future), with regard to the needs of beds, supplies and professionals and awareness of the population regarding adherence to protective measures recommended by WHO.