Overview on COVID-19 outbreak indicators across Brazilian federative units

Background: The 2019 coronavirus disease pandemic (COVID 19) spread rapidly across Brazil. The country has 27 federative units, with wide regional differences related to climate, lifestyle habits, socioeconomic characteristics and population density. Therefore, we aimed to document and monitor the increase in COVID 19 cases across each federative unit in Brazil, by tracking its progression from inception to 15 May 2020. Methods: Observational study. Results: The first confirmed COVID 19 case in the country was notified in Sao Paulo on 26 February, while the first death occurred on 17 March, in Rio de Janeiro. Since then, there has been a dramatic increase in both confirmed cases and deaths from the disease. Sao Paulo, in the Southeast region, was initially considered the COVID 19 epidemic epicentre in Brazil. However, 10 states in the North and Northeast regions were ranked among the 14 highest incidences (over 100 cases per 100,000 people) observed on 15 May. Higher incidence rates (>100 cases per 100,000) were associated to higher rates of inadequate water supply and sewerage (OR, 5.83 (95% CI, 1.08 to 29.37, P=0.041)). North and Northeast states with the highest social vulnerability index scores had higher increases in the incidence rate between 14 April and 15 May. States with medium human development index (HDI) showed higher incidence increases from 14 April to 15 May, being seven of them with ratios in the range from 27.49 to 63.73 times. Conclusion: Spreading of COVID 19 in Brazil differs across both regions and federative units, being influenced by different socioeconomic contexts.