Epidemiological characterization of COVID-19 cases in Maranhão: a brief analysis

Introduction : In this study, we analyzed the epidemiological profile of case reports of the novel coronavirus (SARS-CoV-2) in the State of Maranhão. Outline : It is an epidemiological survey of cases and deaths by COVID-19 reported in the state of Maranhão, from March to April 2020. The data were analyzed from the reports of the epidemiological health bulletin of the state of Maranhão, together with information made available by the state's regional health headquarters. The cases were analyzed using the variables: sex (female / male), age group (in years), origin, and presence or not of comorbidities. Results: 2,105 cases of COVID-19 were confirmed. The region most affected was São Luís with 89% of cases, with most of the patients being female (52%) and aged between 30 and 49 years (53.1%). The cases of male patients had a higher death rate (62%), prevalence of age 60 years or older (66%), regional origin of São Luís (60%) and various comorbidities (78%), with cardiovascular and immunological diseases standing out . Implications : T he behavior of the pandemic is upward in the state, which highlights the need for more containment measures.


INTRODUCTION
Since the end of 2019, several epidemiological concerns have arisen regarding the novel coronavirus (SARS-CoV-2), discovered in China.Information on the incubation period, clinical manifestations, transmissibility, infectivity, prevention, treatment, and lethality are still not completely elucidated, despite great efforts in different continents.
] Among the measures taken, we can mention: coughing etiquette and hand hygiene, use of masks, routine cleaning of environments and surfaces, social isolation (vertical and horizontal), closing of trade / industry considered non-essential, monitoring of borders and sanitary barriers. 3hese measures, which are considered to be non-pharmacological, are necessary in view of the growing number of notifications of the disease, absence of previous immunity in the population and unavailability of vaccine.These factors cause the incidence rates of the disease to grow in large proportions in a short period of time. 4e number of cases of infection with the novel coronavirus (SARS-CoV-2) has grown worldwide and, together with global statistics, underreporting is considered to exist, which can exponentially increase the real number of sick people and deaths.According to the WHO, until April 23, 2020, there were 2,544,792 confirmed cases of the disease in the world. 1 In Brazil, until April 23, 2020, confirmed cases across the territory reached 49,492 people, with a lethality of 6.7% . 2 Thus, filling the knowledge gaps about the disease is essential to start discussions about the end of the movement restriction measures adopted so far and to minimize the possibilities of report of new cases, reinfections and deaths caused by the disease.were discarded in the state of Maranhão (Graph 1).
Graph 1 -Distribution of the number of suspected, confirmed and discarded cases of COVID-19 in the state of Maranhão, Brazil, 2020.
Source: Epidemiological bulletin of the state of Maranhão / SES-MA.
Regarding the profile of patients with confirmed cases of COVID-19, there was a slight predominance of women (52%) and people in the age group of 30 to 39 years (28.4%).Regarding the distribution of notifications by regional health centers, the city of São Luís (89.2%) had the greatest number of cases, followed by Imperatriz (3.9%) and Rosário (1.6%) (Table 1).In relation to the profile of patients who died, there was a predominance of males (62%), aged 60 years or over (66%) and patients with various comorbidities (78%).The municipality with the highest occurrence of deaths was São Luís (60%), followed by São José de Ribamar (5%) (Table 2).patients who died during the study period (Table 3).

DISCUSSION
In the state of Maranhão, the regional health headquarters most affected was São Luís.This city is a large metropolis, with greater population density and concentration of many industries.It is the main point of production flow as well, with direct influence on the state's economy, and has the highest concentration of income in the Maranhão territory. 7ch facts may be related to the ease of transmissibility of the disease at the regional headquarters due to the large flow of people at bus stations, river ports, and airport, which offer mobility to nearby regions and other Brazilian states and, also, connection with other countries. 8 December 2019, the regional headquarters in question had 53.29% coverage of primary care.
Regarding the hospital network, data from February 2020 show this regional headquarters as having the largest number of hospital beds, with 4,007 beds registered, of which This fact is justified by the greater offer of several health services of low and high complexity, considering that this regional headquarters emerges as the main reference for the North Macroregion, which is composed of nine regional health departments and 32 municipalities. 10n addition, the São Luís regional health department presents a greater strengthening of the network of care for chronic diseases, which is one of the priority points in monitoring acute and chronic conditions. 11out the analysis of the sex of the diagnosed individuals, there is a predominance of cases of females.This finding was also observed in a study conducted in the state of Mato Grosso, 12 while 56% of the cases were male 13 in Wuhan, China.In this situation, it is assumed that women seek health services more frequently than men.Possibly, due to this, there may be underreporting of cases in the male population, as, historically, men seek less health services, which can lead to worsening of the disease, late treatment, and evolution to death.
Concerning the age group, there was a predominance of patients from 30 to 49 years.These findings are similar to the ones found in a study 14 conducted in Wenzhou, China, which showed 58.9% of confirmed cases in individuals of this age group.It is worth emphasizing the importance of endorsing non-pharmacological measures in order to reduce the number of people with the disease in this age group.
It is important to note that this population is in the economically active range, 15 which reinforces the adoption of socioeconomic measures to combat the novel coronavirus (SARS-CoV-2).
As to deaths, the predominant age group of patients was 60 years old or more.These data corroborate the data obtained in a study 16 conducted in Italy, according to most patients who died were on average 80 years old.There was a need for health care among patients in the age group of 67 years on average.In view of this, it is possible to infer the importance of care directed to the elderly population, which must occur through the application of public protective measures that reinforce the need for social and health care.

Graph 2 -
Distribution of COVID-19 cases in the state of Maranhão, Brazil, 2020.Source: Epidemiological bulletin of the state of Maranhão / SES-MA.

Table 1 -
Distribution and epidemiological profile of patients in confirmed cases of COVID-19 in the state of Maranhão, Brazil, 2020.N= 2,105.
Source: Epidemiological bulletin of the state of Maranhão / SES-MA.The spatial distribution of cases of deaths by COVID-19, in the state of Maranhão, by municipalities, had a higher incidence in São Luís in the period studied (Graph 2).