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Introduction: COVID-19 is a major public health concern in this century. The causative agent SARS-CoV-2, is highly contagious and spreads continuously across territories. Spatial analysis is of enormous importance in the process of understanding the disease and its transmission mechanisms. We aimed to identify the risk areas for COVID-19 and analyze their association with social vulnerability in Maceió, Alagoas. The study was conducted in 2020., Methodology: This is an ecological study to evaluate the incidence, mortality and case fatality rate of COVID-19 and their relationship with 12 indicators of human development and social vulnerability. Multivariate and spatial statistics were applied. A 95% confidence interval and a 5% confidence level were considered., Results: The spatial scan statistic revealed the existence of six high-risk clusters for the incidence of COVID-19. The regression model showed that social indicators, such as literacy of people, residents of private households, households with more than four residents, and resident brown population, were associated with COVID-19 transmission in Maceió-AL. The disease affected localities whose populations are exposed to a context of intense socioeconomic vulnerability., Conclusions: Based on the results, it is necessary to adopt measures that take into account the social determinants of health in order to minimize the damage caused by the pandemic., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Cicera Maria Alencar do Nascimento, Carlos Dornels Freire De Souza, Lucas Emanuel de Oliveira Silva, Wedja Oliveira Silva, Nicolas Amaro Barbosa, Rodrigo Feliciano do Carmo, Esdras de Lima Andrade, Sergio Henrique de Oliveira Teixeira, Thiago Jose Matos Rocha.)

Currently, the world is facing a severe pandemic caused by the new severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. Although the WHO has recommended preventive measures to limit its spread, Brazil has neglected most of these recommendations, and consequently, our country has the second largest number of deaths from COVID-19 worldwide. In addition, recent studies have shown the relationship between socioeconomic inequalities and the risk of severe COVID-19 infection. Herein, we aimed to assess the spatiotemporal distribution of mortality and lethality rates of COVID-19 in a region of high social vulnerability in Brazil (Northeast region) during the first year of the pandemic. A segmented log-linear regression model was applied to assess temporal trends of mortality and case fatality rate (CFR) and according to the social vulnerability index (SVI). The Local Empirical Bayesian Estimator and Global Moran Index were used for spatial analysis. We conducted a retrospective space-time scan to map clusters at high risk of death from COVID-19. A total of 66,358 COVID-19-related deaths were reported during this period. The mortality rate was 116.2/100,000 inhabitants, and the CFR was 2.3%. Nevertheless, CFR was > 7.5% in 27 municipalities (1.5%). We observed an increasing trend of deaths in this region (AMCP = 18.2; P = 0.001). Also, increasing trends were observed in municipalities with high (N = 859) and very high SVI (N = 587). We identified two significant spatiotemporal clusters of deaths by COVID-19 in this Brazilian region (P = 0.001), and most high-risk municipalities were on the coastal strip of the region. Taken together, our analyses demonstrate that the pandemic has been responsible for several deaths in Northeast Brazil, with clusters at high risk of mortality mainly in municipalities on the coastline and those with high SVI.

Clinical manifestations of COVID-19 are varied in the general population. This study aimed to systematize the literature regarding clinical manifestations of patients with confirmed COVID-19. A systematic review of the literature was conducted. A total of 8070 scientific productions were found in the databases. Among the studies, 184 met the initial inclusion criteria, with a total of 114,046 patients. After complete reading, 32 studies that did not report clinical manifestations were excluded. The 152 publications finally included a total of 41,409 individuals from at least 23 countries and 26 different clinical manifestations were reported. In percentage terms, 6 symptoms had a general prevalence greater than or equal to 25%, namely, fever (58.66%), cough (54.52%), dyspnea (30.82%), malaise (29.75%), fatigue (28.16%) and sputum/secretion (25.33%). Neurological symptoms (20.82%), dermatological manifestations (20.45%), anorexia (20.26%), myalgia (16.9%), sneezing (14.71%), sore throat (14.41%), rhinitis (14.29%), goosebumps (13.49%), headache (12.17%), chest pain (11.49%) and diarrhea (9.59%) were other common symptoms. Only one study reported dermatological manifestations. The least frequent sign/symptom was hemoptysis (1.65%). In studies with more than 100 patients, the 3 main symptoms were fever (57.93%), cough (54.21%), and dyspnea (30.64%). Dermatological manifestations do not appear among the main symptoms. The identification of all clinical manifestations of COVID-19 is essential for an early diagnosis and the adoption of preventive measures.

Aim: Older adults are the main risk group for coronavirus disease 2019 (COVID-19). This study aimed to describe the clinical manifestations and factors associated with mortality from COVID-19 among older adults in Brazil., Methods: A cross-sectional observational study was carried out with data from 9807 cases of COVID-19 among older adults in the state of Alagoas, Brazil. We determined the case fatality rate between age groups and clinical factors associated with mortality., Results: A total of 52.5% (n = 5145) were women, and with an average age of 70.21 ± 8.37 years. The fatality rate was 11.9%, with a higher rate in men (14.4%) compared with women (9.8%). The fatality rate increased with age. The most common manifestations were fever (n = 4926; 50.2%), cough (n = 5737; 58.5%), headache (n = 1980; 20.2%) and fatigue (n = 2022; 20.6%). The most prevalent comorbidities were diabetes (n = 1528; 5.6%), cardiovascular disease (n = 1528; 15.6%) and systemic arterial hypertension (n = 597; 6.1%). The factors associated with mortality were male sex (OR 1.54), age ≥75 years (OR 2.40), dyspnea (OR 2.92), diabetes (OR 2.33), hypertension (OR 1.53) and chronic kidney disease (OR 2.02)., Conclusions: The profile and the risk factors evidenced show the need to adopt mechanisms to protect the elderly population., (© 2020 Japan Geriatrics Society.)