Intraregional propagation of Covid-19 cases in Pará, Brazil: assessment of isolation regime to lockdown– CORRIGENDUM

16 17 Due to the high incidence of COVID-19 case numbers internationally, the World Health 18 Organization (WHO) declared a Public Health Emergency of global relevance, advising 19 countries to follow protocols to combat pandemic advance through actions that can 20 reduce spread and consequently avoid a collapse in the local health system. On March 21 18, 2020, Pará notified the first case of COVID-19. After seven weeks, the number of 22 confirmed cases reached 4,756 with 375 deaths. Knowing that infected people may be 23 2 asymptomatic, the disease symptomatology absence and the population's neglect of isolation influence the spread, and factors such as chronic pneumonia, high age, obesity, chronic kidney diseases and other comorbidities favor the mortality rate. On the other hand, social isolation, quarantine and lockdown seek to contain the intraregional 27 contagion advance. This study analyzes the dynamics of COVID-19 new cases advance 28 among municipalities in the state of Pará, Brazil. The results show it took 49 days for 29 81% of the state's municipalities to register COVID-19 cases. The association between 30 social isolation, quarantine and lockdown as an action to contain the infection was 31 effective in reducing the region's new cases registration of COVID-19 in the short-term. 32 33

In Northern Brazil, the federative units most affected on May 5, 2020, in terms 1 2 1 of the spatial distribution of registered cases of COVID-19 with an incidence and 1 2 2 mortality rate per 1,000,000 inhabitants, were Amazonas (2327.5 and 251.7) and Pará  Predictive studies in Brazil report smaller records of new cases of COVID-19 at 1 2 7 temperatures around 25.8ºC, reducing the behavior of curve growth (Prata et al., 2020).
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(which was not certified by peer review)
The copyright holder for this preprint this version posted June 12, 2020. . https://doi.org/10.1101/2020 Since SARS-CoV-2 may be vulnerable to fluctuations in environmental conditions 1 2 9 similar to other coronaviruses (Le et al., 2020). It is important to note that 1 3 0 climatological factors variability can interfere with the curve behavior even at higher The northern region of Brazil has an equatorial climate ranging from humid to 1 3 3 semi-arid, with temperatures ranging from 20 to 35 ºC. In the state of Pará, the 1 3 4 temperature presents spatial and seasonal homogeneity, with an average variation of 25 1 3 5 ºC to 35 ºC. In the region, there are two distinct periods of temperature ranges, 1 3 6 classified as rainier between December to May and less rainy between June to 1 3 7 November, according to rainfall variation that occurs in the Amazon. The metropolitan 1 3 8 region of Belém city in the period between January 1, 2020, to May 5, 2020, presented 1 3 9 temperature variation between 24 ºC to 31 ºC and relative humidity between 70 to 80%. In this period, the number of new cases and mortality due to COVID-19 has risen since 1 4 1 the first case notification on March 18, 2020, with the first death recorded on April 1,  . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 12, 2020. The North region was in 3 rd place in cases number with approximately 16% of March 18, 2020, in Belém city, capital of the state. These records occurred when the 1 5 2 average temperature of the region, for the period considered to be the rainiest in the 1 5 3 region, was 27.9 ºC and the air relative humidity ranging from 70 to 80%. The first 1 5 4 notification of death occurred on April 1, 2020, and since then the curve of new cases 1 5 5 and deaths incidence have been frequent and registered with high rates in the region.

5 6
A priori it is suggested that there is no inverse relationship between ambient in the Amazon region. Therefore, there is no evidence to suppose that in regions with 1 5 9 warm climates, low relative humidity and high rainfall variation, the cases number is 1 6 0 lower compared to regions with moderate and/or cold climates. Similar results were 1 6 1 obtained by Jahangiri, Jarangiri, Njafgholipour (2020) in the transmission rate   The analysis was carried out after seven weeks of the first COVID-19 case . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The women were 2,320 (48.8%) infected cases with an average age of 47.4 years. It is 1 7 1 reported that 15 registered cases did not present notification regarding gender and were 1 7 2 considered as unidentified (Fig. 3A). Similar results of higher COVID-19 cases  In Pará, 75% were under 58 years old. Only 25% of infected cases were elderly 1 7 6 and 1.6% of those diagnosed infected were children from 0 to 10 years old. Only 26 1 7 7 (0.5%) registered cases had no age identified and were considered in terms of 1 7 8 registration as "unidentified" (Fig. 3B).

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In terms of the sample of the infected population age range, negative asymmetric  In Iran, the cases concentration was between 30 and 70 years old for 79.1% of COVID-   and inland towns, such as Santo Antonio do Tauá, Vigia de Nazaré and Breves. The lockdown arises when the state of Pará registered a COVID-19 rate in the order of 1 9 3 51/100,000 inhabitants, higher than the national rate. The municipalities affected by the 1 9 4 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 12, 2020. . https://doi.org/10.1101/2020.06.10.20127886 doi: medRxiv preprint restriction presented rates of 75/100,000 inhabitants, higher than that registered by the 1 9 5 state. 1 9 6 1 9 7 1 9 8 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 12, 2020.   Despite the restrictions having focused on only 10 municipal regions, it is worth 2 0 4 mentioning that when the lockdown was set, more than 70% of the municipalities  The regional disease expansion and the high registration rates in the BMR have  In the Pará state, severe cases of COVID-19 and mortality records are related to 2 1 1 several comorbidities, the most commons are associated with heart disease, diabetes, 2 1 2 kidney disease, pneumonia, immunodeficiency, asthma, obesity, neurological disease, 2 1 3 hematological disease and illness hepatic; the most frequent ones being associated with 2 1 4 heart disease and diabetes (Fig. 4). CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 12, 2020. . https://doi.org/10.1101/2020.06.10.20127886 doi: medRxiv preprint 1 2 respiratory diseases, hypertension, cardiovascular diseases, kidney diseases and cancer, 2 1 9 these comorbidities were also observed in cases of deaths (Nikpouraghdam et al. 2020). corroborating with the results occurred in this study region.  tests to identify infected patients, contributed to COVID-19 advance in the region. Associated with these problems, there is still an insufficient hospital beds number inhabitants, which represents a ratio of 1/30,445.98 bed/inhabitants, such fact leads the . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

(which was not certified by peer review)
The copyright holder for this preprint this version posted June 12, 2020. . https://doi.org/10.1101/2020 1 3 system to collapse in a short period during a pandemic, contributing to the disease and 2 3 5 the number of deaths progress. Collapsing is already experienced in pediatric clinic beds 2 3 6 (Table 1).

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Due to the risk of COVID-19 infected people promoting the disease advance   Results show that a week after the first notified case, only 0.82% of the 2 4 8 municipalities had infected people, in the second week of contagion they already had 2 4 9 5.56%, in the third 15.3%, in the fourth 24.3%, in the fifth 46.5%, in the sixth 69.4% 2 5 0 and the seventh week after the first notified case, there were already 81.8% of the 2 5 1 municipalities in the state of Pará with notified COVID-19 cases (Fig.7). The highest 2 5 2 concentration of registered cases was in the Metropolitan Region of Belém, constituted 2 5 3 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 12, 2020. Izabel do Pará, Castanhal.

5 5
The measure of containment by social isolation in the region did not have an 2 5 6 expected effect on the curve of new cases for the period under study, mainly due to the 2 5 7 low rate of population adherence. However, the lockdown instituted on May 5, 2020, following week of decreed intervention, with a 10.07% reduction compared to the 2 6 0 accumulated record in the week previous epidemiologic (Fig. 5). In the long-term, the 2 6 1 reduction of the cases may be more significant, given the greater respect and adherence 2 6 2 of the population to isolation policies.