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Letter to the Editor: Environmental Effects on Reported Infections and Death Rates of COVID-19 Across 91 Major Brazilian Cities

2020; Mary Ann Liebert, Inc.; Volume: 21; Issue: 4 Linguagem: Inglês

10.1089/ham.2020.0168

1557-8682

Erica Lin, Andy Goren, Carlos Gustavo Wambier,

COVID-19 epidemiological studies

High Altitude Medicine & BiologyVol. 21, No. 4 Letters to the EditorFree AccessLetter to the Editor: Environmental Effects on Reported Infections and Death Rates of COVID-19 Across 91 Major Brazilian CitiesErica Miyake Lin, Andy Goren, and Carlos WambierErica Miyake LinThe Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.Search for more papers by this author, Andy GorenApplied Biology, Irvine, California, USA.Search for more papers by this author, and Carlos WambierAddress correspondence to: Carlos Wambier, MD, PhD, Department of Dermatology Rhode Island Hospital, Brown University Warren Alpert Medical School, 593 Eddy Street, Ambulatory Patient Center, 10th Floor, Providence, RI 02903, USA E-mail Address: [email protected]Department of Dermatology, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.Search for more papers by this authorPublished Online:21 Dec 2020https://doi.org/10.1089/ham.2020.0168AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail Dear Editor,In the past few months, Brazil has become an epicenter of the coronavirus disease 2019 (COVID-19) pandemic. When compared with prior epicenters, Brazil's diverse climate and geographic location in the southern hemisphere serves as unique lens to investigate associations between environmental determinants and COVID-19 disease burden. In this letter, we report an analysis of environmental conditions in cities across Brazil and COVID-19 disease outcomes between March and May 2020.The most populous Brazilian cities (>300,000 inhabitants) were determined using Brazilian Institute of Geography and Statistics (IGBE) demographic data. COVID-19 infection and death rates for the 91 identified cities were obtained from Brazil's Ministry of Health coronavirus panel. Altitude (median [M]: 376 m, interquartile range [IQR]: 746), average monthly wind speed (M: 8.63 km/h, IQR: 4.2), and length of daylight (M: 11.64 hours/day, IQR: 0.28) were collected from IGBE, World Weather Online, and the Brazil National Institute of Meteorology. Population density data (M: 1215.69 persons/km2, IQR: 2765.17) from IGBE was included in the study due to faster COVID-19 spread in denser environments (Fig. 1). Data set medians were used as cutoffs and the analysis was conducted through a multivariate logistic regression model in R (Version 4.0.1).FIG. 1. Map of 91 cities included in the study. Cities: Ananindeua, Anápolis, Aparecida de Goiânia, Aracaju, Bauru, Belém, Belford Roxo, Belo Horizonte, Betim, Blumenau, Boa Vista, Brasília, Campina Grande, Campinas, Campo Grande, Campos dos Goytacazes, Canoas, Carapicuíba, Cariacica, Caruaru, Cascavel, Caucaia, Caxias do Sul, Contagem, Cuiabá, Curitiba, Diadema, Duque de Caxias, Feira de Santana, Florianópolis, Fortaleza, Franca, Goiânia, Guarujá, Guarulhos, Itaquaquecetuba, Jaboataão dos Guararapes, João Pessoa, Joinville, Juiz de Fora, Jundiaí, Limeira, Londrina, Macapá, Maceió, Manaus, Maringá, Mauá, Mogi das Cruzes, Montes Claros, Natal, Niterói, Nova Iguaçu, Olinda, Osasco, Paulista, Pelotas, Petrolina, Petrópolis, Piracicaba, Ponta Grossa, Porto Alegre, Porto Velho, Praia Grande, Recife, Ribeirão das Neves, Ribeirão Preto, Rio Branco, Rio de Janeiro, Salvador, Santarém, Santo André, Santos, São Bernardo do Campo, São Gonçalo, São João de Meriti, São José do Rio Preto, São José dos Campos, São José dos Pinhais, São Luís, São Paulo, São Vicente, Serra, Sorocaba, Taubaté, Teresina, Uberaba, Uberlândia, Vila Velha, Vitória, and Vitória da Conquista.Infections per 1000 inhabitants ranged from 0 to 10.07, whereas deaths per 1000 inhabitants ranged from 0 to 0.88. Altitude and density were the most highly associated factors with infections and deaths, respectively; low altitude (<375 m) had an odds ratio (OR) of 6.16 (95% confidence interval [CI]: 2.28–17.97; p < 0.001) for infections and an OR of 8.17 (95% CI: 2.75–27.96; p < 0.001) for deaths; high density (>1200 persons/km2) had an OR of 4.80 (95% CI: 1.71–14.73; p = 0.004) for infections and an OR of 9.09 (95% CI: 3.18–29.29; p < 0.001) for deaths; high wind speed (>8.5 km/h) had an OR of 2.38 (95% CI: 0.86–6.97; p = 0.10) for infections and an OR of 1.12 (95% CI: 0.37–3.30; p = 0.84) for deaths; and low daylight (<11.63 hours/day) had an OR of 0.43 (95% CI: 0.14–1.24; p = 0.13) for infections and an OR of 1.33 (95% CI: 0.43–4.34; p = 0.63) for deaths.Previous studies have found that environmental characteristics play a significant role in influenza epidemic seasonality in Brazil, even more so than other nonenvironmental factors such as travel and population density (Alonso et al., 2007). The findings in this study suggest that environmental conditions may have a similar effect on COVID-19 disease burden in Brazil. In particular, what we observed is that high population density and low altitude were strongly associated with COVID-19 deaths. These findings support previous studies that suggested high altitude may be an independent protective factor (Arias-Reyes et al., 2020). Daylight did not seem to significantly affect COVID-19 outcomes, probably due to minimal variation in daylight during the period analyzed. Pun et al. (2020) have highlighted that other environmental features, including seasonal weather patterns and temperature, at different latitudes may be important in viral transmission, which can explain why these results differ from those in Woolcott and Bergman's study on United States and Mexico outcomes. As the COVID-19 pandemic continues to engulf the world, it would be informative to continue studying associations between environmental conditions and COVID-19 disease burden.Authors' ContributionsConcept, acquisition and analysis of data, statistical analysis, and article creation were by all authors. All coauthors have reviewed and approved of the article before submission.Author Disclosure StatementNo competing financial interests exist.Funding InformationNo funding was received for this article.ReferencesAlonso WJ, Viboud C, Simonsen L, Hirano EW, Daufenbach LZ, and Miller MA. (2007). Seasonality of influenza in Brazil: A traveling wave from the Amazon to the subtropics. Am J Epidemiol 165:1434–1442. Crossref, Medline, Google ScholarArias-Reyes C, Zubieta-DeUrioste N, Poma-Machicao L, Aliaga-Raduan F, Carvajal-Rodriguez F, Dutschmann M, Schneider-Gasser EM, Zubieta-Calleja G, and Soliz J. (2020). Does the pathogenesis of SARS-CoV-2 virus decrease at high-altitude? Respir Physiol Neurobiol 277:103443. Google ScholarPun M, Turner R, Strapazzon G, Brugger H, and Swenson ER. (2020). Lower incidence of COVID-19 at high altitude: Facts and confounders. High Alt Med Biol 21:217–222. Link, Google ScholarWoolcott OO, and Bergman RN. (2020). Mortality attributed to COVID-19 in high-altitude populations. High Alt Med Biol 21:409–416. Link, Google ScholarFiguresReferencesRelatedDetailsCited byApplication of Machine Learning to Predict COVID-19 Spread via an Optimized BPSO Model28 September 2023 | Biomimetics, Vol. 8, No. 6Diabetes increases the risk of COVID-19 in an altitude dependent manner: An analysis of 1,280,806 Mexican patients3 August 2021 | PLOS ONE, Vol. 16, No. 8Menor frecuencia y letalidad en mujeres y en la altura por COVID-19: dos caras de una misma monedaArchivos de Bronconeumología, Vol. 57 Volume 21Issue 4Dec 2020 InformationCopyright 2020, Mary Ann Liebert, Inc., publishersTo cite this article:Erica Miyake Lin, Andy Goren, and Carlos Wambier.Letter to the Editor: Environmental Effects on Reported Infections and Death Rates of COVID-19 Across 91 Major Brazilian Cities.High Altitude Medicine & Biology.Dec 2020.431-433.http://doi.org/10.1089/ham.2020.0168Published in Volume: 21 Issue 4: December 21, 2020Online Ahead of Print:October 8, 2020 TopicsCOVID-19 PDF download