COVID-19 Results Briefing: Brazil December 17, 2020 Current

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COVID-19 Results Briefing: Brazil December 17, 2020 This document contains summary information on the latest projections from the IHME model on COVID-19 in Brazil. The model was run on December 16, 2020. Current situation • Daily reported cases in the last week increased to 41,000 per day on average compared to 33,600 the week before (Figure 1). • Daily deaths in the last week increased to 600 per day on average compared to 570 the week before (Figure 2). This makes COVID-19 the number 1 cause of death in Brazil this week (Table 1). • Effective R, computed using cases, hospitalizations, and deaths, is greater than 1 in 14 states (Figure 3).

• We estimated that 26% of people in Brazil have been infected as of December 14 (Figure 4). • The daily death rate is greater than 4 per million in Amapá, Espírito Santo, Mato Grosso do Sul, Paraná, Rio de Janeiro, Rio Grande do Sul, and Santa Catarina (Figure 6). Trends in drivers of transmission • In the last week, no new mandates have been imposed. No mandates have been lifted this week (Table 2). • Mobility last week was 9% lower than the pre-COVID-19 baseline (Figure 8). Mobility was near baseline (within 10%) in Acre, Alagoas, Amapá, Amazonas, Ceará, Distrito Federal, Espírito Santo, Goiás, Maranhão, Mato Grosso, Mato Grosso do Sul, Minas Gerais, Pará, Paraíba, Rio Grande do Norte, Rondônia, Roraima, Sergipe, and Tocantins. Mobility was lower than 30% of baseline in no locations. • As of December 14 we estimated that 59% of people always wore a mask when leaving their home (Figure 9), the same as last week. Mask use was lower than 50% in Maranhão. • There were 49 diagnostic tests per 100,000 people on December 14 (Figure 10). • The fraction of the population who are open to receiving a COVID-19 vaccine ranges from 87% in Maranhão to 89% in Distrito Federal (Figure 12). • 21.5 million are expected to be vaccinated by April 1 (Figure 13). With faster scale-up, the number vaccinated could reach 53.6 million. Projections

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• In our reference scenario, which represents what we think is most likely to happen, our model projects 242,000 cumulative deaths on April 1, 2021. This represents 60,000 additional deaths from December 14 to April 1 (Figure 14). Daily deaths will peak at 690 on January 5, 2021 (Figure 15).

• The reference scenario assumes that 5 states will re-impose mandates by April 1, 2021. • If universal mask coverage (95%) were attained in the next week, our model projects 25,000 fewer cumulative deaths compared to the reference scenario on April 1, 2021. • Under our mandates easing scenario, our model projects 247,000 cumulative deaths on April 1, 2021.

• By April 1 2021, we project that 1,500 lives will be saved by the projected vaccine rollout. If rapid rollout of vaccine is achieved, 5,000 lives will be saved compared to a no vaccine scenario. Rapid rollout targeting high-risk individuals only could save, compared to a no vaccine scenario, 8,200 lives.

• Figure 21 compares our reference scenario forecasts to other publicly archived models. Forecasts are widely divergent. • 16 states will have high or extreme stress on hospital beds at some point in December through April (Figure 22). 26 states will have high or extreme stress on ICU capacity in December through April (Figure 23). Model updates See the briefs for December 4 (https://www.healthdata.org/covid/updates/archive) for details on how vaccination has been incorporated into our reference and alternative scenarios. In this week’s release, we have reflected the survey evidence that 25% of those surveyed indicated that they intend to stop wearing a mask after receiving the second dose of their vaccination.

covid19.healthdata.org 2 Institute for Health Metrics and Evaluation Brazil CURRENT SITUATION

Current situation

Figure 1. Reported daily COVID-19 cases

60,000

40,000 Count

20,000

Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 Nov 20 Dec 20 Month

Daily cases

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Table 1. Ranking of COVID-19 among the leading causes of mortality this week, assuming uniform deaths of non-COVID causes throughout the year

Cause name Weekly deaths Ranking COVID-19 4,174 1 Ischemic heart disease 3,293 2 Stroke 2,519 3 Lower respiratory infections 1,705 4 Chronic obstructive pulmonary disease 1,321 5 Interpersonal violence 1,267 6 Diabetes mellitus 1,257 7 Alzheimer’s disease and other dementias 1,050 8 Road injuries 856 9 Chronic kidney disease 814 10

Figure 2a. Reported daily COVID-19 deaths

1,500

1,000 Daily deaths 500

Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 Nov 20 Dec 20

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Figure 2b. Estimated cumulative deaths by age group

5 Share of cumulative deaths, % deaths, Share of cumulative

<5 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 99 Age group

Figure 3. Mean effective R on December 03, 2020. The estimate of effective R is based on the combined analysis of deaths, case reporting, and hospitalizations where available. Current reported cases reflect infections 11-13 days prior, so estimates of effective R can only be made for the recent past. Effective R less than 1 means that transmission should decline, all other things being held the same.

<0.85 0.85−0.88 0.89−0.91 0.92−0.95 0.96−0.99 1−1.03 1.04−1.07 1.08−1.1 1.11−1.14 >=1.15

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Figure 4. Estimated percent of the population infected with COVID-19 on December 14, 2020

<5 5−9.9 10−14.9 15−19.9 20−24.9 25−29.9 30−34.9 35−39.9 40−44.9 45−49.9 >=50

Figure 5. Percent of COVID-19 infections detected. This is estimated as the ratio of reported daily COVID-19 cases to estimated daily COVID-19 infections based on the SEIR disease transmission model.

10 Percent of infections detected of infections Percent

0 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 Nov 20 Dec 20

Argentina United States of America Colombia Mexico Brazil

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Figure 6. Daily COVID-19 death rate per 1 million on December 14, 2020

<1 1 to 1.9 2 to 2.9 3 to 3.9 4 to 4.9 5 to 5.9 6 to 6.9 7 to 7.9 >=8

covid19.healthdata.org 7 Institute for Health Metrics and Evaluation Brazil CRITICAL DRIVERS

Critical drivers

Table 2. Current mandate implementation All nonessential businesses closed All nonessential businesses restricted businesses Any gatherings Any restricted Mask use School closure home order Stay limits Travel Acre Alagoas Amapá Amazonas Bahia Ceará Distrito Federal Espírito Santo Goiás Maranhão Mato Grosso Mato Grosso do Sul Minas Gerais Paraná Paraíba Pará Pernambuco Piaui Rio Grande do Norte Rio Grande do Sul Rio de Janeiro Rondônia Roraima Santa Catarina Sergipe São Paulo Tocantins

Mandate in place No mandate Mandate in place (imposed this week) No mandate (lifted this week)

covid19.healthdata.org 8 Institute for Health Metrics and Evaluation Brazil CRITICAL DRIVERS

Figure 7. Total number of social distancing mandates (including mask use)

Mandate imposition timing Acre Alagoas Amapá Amazonas Bahia Ceará Distrito Federal # of mandates Espírito Santo 0 Goiás Maranhão 1 Mato Grosso Mato Grosso do Sul 2 Minas Gerais Paraná 3 Paraíba 4 Pará Pernambuco 5 Piaui Rio Grande do Norte 6 Rio Grande do Sul Rio de Janeiro 7 Rondônia Roraima Santa Catarina Sergipe São Paulo Tocantins

Jul 20 Feb 20 Mar 20 Apr 20May 20 Jun 20 Aug 20 Sep 20 Oct 20 Nov 20 Dec 20

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Figure 8a. Trend in mobility as measured through smartphone app use compared to January 2020 baseline

−20

−40

−60 Percent reduction from average mobility reduction from average Percent −80 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 Nov 20 Dec 20 Jan 21

Argentina United States of America Colombia Mexico Brazil

Figure 8b. Mobility level as measured through smartphone app use compared to January 2020 baseline (percent) on December 14, 2020

=<−50 −49 to −45 −44 to −40 −39 to −35 −34 to −30 −29 to −25 −24 to −20 −19 to −15 −14 to −10 >−10

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Figure 9a. Trend in the proportion of the population reporting always wearing a mask when leaving home

25 Percent of population Percent

0 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 Nov 20 Dec 20

Argentina United States of America Colombia Mexico Brazil

Figure 9b. Proportion of the population reporting always wearing a mask when leaving home on December 14, 2020

<45% 45 to 49% 50 to 54% 55 to 59% 60 to 64% 65 to 69% 70 to 74% 75 to 79% 80 to 84% >=85%

covid19.healthdata.org 11 Institute for Health Metrics and Evaluation Brazil CRITICAL DRIVERS

Figure 10a. Trend in COVID-19 diagnostic tests per 100,000 people

400

300

200

100 Test per 100,000 population Test

0 Jan 20 Feb 20 Mar 20 Apr 20 May 20 Jun 20 Jul 20 Aug 20 Sep 20 Oct 20 Nov 20 Dec 20

Argentina United States of America Colombia Mexico Brazil

Figure 10b. COVID-19 diagnostic tests per 100,000 people on December 10, 2020

<5 5 to 9.9 10 to 24.9 25 to 49 50 to 149 150 to 249 250 to 349 350 to 449 450 to 499 >=500

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Figure 11. Increase in the risk of death due to pneumonia on February 1 2020 compared to August 1 2020

<−80% −80 to −61% −60 to −41% −40 to −21% −20 to −1% 0 to 19% 20 to 39% 40 to 59% 60 to 79% >=80%

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Figure 12. This ﬁgure shows the estimated proportion of the adult (18+) population that is open to receiving a COVID-19 vaccine based on Facebook survey responses

<50% 50−59% 60−69% 70−74% 75−79% 80−84% >85%

Figure 13. The number of people who receive any vaccine and those that are immune accounting for eﬃcacy, loss to follow up for 2 dose vaccines, and a 28 day delay between ﬁrst dose and immunity for 2 dose vaccines. Percent of adult population 30

40,000,000 20

People 20,000,000 10

0 0

Dec 20 Jan 21 Feb 21 Mar 21 Apr 21

Reference rollout Rapid rollout

Solid lines represent the total vaccine doses, dashed lines represent effective vaccination

covid19.healthdata.org 14 Institute for Health Metrics and Evaluation Brazil PROJECTIONS AND SCENARIOS

Projections and scenarios

We produce six scenarios when projecting COVID-19. The reference scenario is our forecast of what we think is most likely to happen. We assume that if the daily mortality rate from COVID-19 reaches 8 per million, social distancing (SD) mandates will be re-imposed. The mandate easing scenario is what would happen if governments continue to ease social distancing mandates with no re-imposition. The universal mask mandate scenario is what would happen if mask use increased immediately to 95% and social distancing mandates were re-imposed at 8 deaths per million. These three scenarios assume our reference vaccine delivery scale up where vaccine delivery will scale to full capacity over 90 days. The rapid vaccine rollout scenario assumes that vaccine distribution will scale up to full delivery capacity in half the time as the reference delivery scenario and that the maximum doses that can be delivered per day is twice as much as the reference delivery scenario. The rapid vaccine rollout to high-risk populations scenario is the same but high-risk populations are vaccinated before essential workers or other adults. The no vaccine scenario is the same as our reference scenario but with no vaccine use.

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Figure 14. Cumulative COVID-19 deaths until April 01, 2021 for six scenarios

250,000 Cumulative deaths per 100,000

200,000 90

150,000 60 100,000

30 Cumulative deaths Cumulative 50,000

0 0 Oct 20 Nov 20 Dec 20 Jan 21 Feb 21 Mar 21 Apr 21

Reference scenario Rapid rollout Universal mask use Rapid rollout to high−risk Continued SD mandate easing No vaccine

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Figure 15. Daily COVID-19 deaths until April 01, 2021 for six scenarios

0.5 Daily deaths per 100,000 900 0.4

0.3 600

0.2 Daily deaths 300 0.1

0 0.0 Feb 20 Apr 20 Jun 20 Aug 20 Oct 20 Dec 20 Feb 21 Apr 21

Reference scenario Rapid rollout Universal mask use Rapid rollout to high−risk Continued SD mandate easing No vaccine

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Figure 16. Daily COVID-19 infections until April 01, 2021 for six scenarios

150 300,000 Daily infections per 100,000

100 200,000

100,000 50 Daily infections

0 0 Feb 20 Apr 20 Jun 20 Aug 20 Oct 20 Dec 20 Feb 21 Apr 21

Reference scenario Rapid rollout Universal mask use Rapid rollout to high−risk Continued SD mandate easing No vaccine

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Figure 17. Susceptible population, accounting for infections and people immune through vaccination

100 200,000,000 Percent susceptible 75 150,000,000

50 100,000,000

People susceptible People 50,000,000 25

0 0 Oct 20 Nov 20 Dec 20 Jan 21 Feb 21 Mar 21 Apr 21

Reference scenario Rapid rollout Universal mask use Rapid rollout to high−risk Continued SD mandate easing No vaccine

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Figure 18. Month of assumed mandate re-implementation. (Month when daily death rate passes 8 per million, when reference scenario model assumes mandates will be re-imposed.)

December 2020 January 2021 February 2021 March 2021 No mandates before April 1 2021

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Figure 19. Forecasted percent infected with COVID-19 on April 01, 2021

<5 5−9.9 10−14.9 15−19.9 20−24.9 25−29.9 30−34.9 35−39.9 40−44.9 45−49.9 >=50

Figure 20. Daily COVID-19 deaths per million forecasted on April 01, 2021 in the reference scenario

<1 1 to 1.9 2 to 2.9 3 to 3.9 4 to 4.9 5 to 5.9 6 to 6.9 7 to 7.9 >=8

covid19.healthdata.org 21 Institute for Health Metrics and Evaluation Brazil PROJECTIONS AND SCENARIOS

Figure 21. Comparison of reference model projections with other COVID modeling groups. For this comparison, we are including projections of daily COVID-19 deaths from other modeling groups when available: Delphi from the Massachussets Institute of Technology (Delphi; https://www.covidanalytics.io/home), Imperial College London (Imperial; https://www.covidsim.org), The Los Alamos National Laboratory (LANL; https://covid-19.bsvgateway.org/), and the SI-KJalpha model from the University of Southern California (SIKJalpha; https://github.com/scc-usc/ReCOVER-COVID-19). Daily deaths from other modeling groups are smoothed to remove inconsistencies with rounding. Regional values are aggregates from availble locations in that region.

1,500

Models

IHME 1,000 Imperial LANL Daily deaths SIKJalpha

500

Jan 21 Feb 21 Mar 21 Apr 21 Date

covid19.healthdata.org 22 Institute for Health Metrics and Evaluation Brazil PROJECTIONS AND SCENARIOS

Figure 22. The estimated inpatient hospital usage is shown over time. The percent of hospital beds occupied by COVID-19 patients is color coded based on observed quantiles of the maximum proportion of beds occupied by COVID-19 patients. Less than 5% is considered low stress, 5-9% is considered moderate stress, 10-19% is considered high stress, and greater than 20% is considered extreme stress. All hospital beds

Acre

Alagoas

Amapá

Amazonas

Bahia

Ceará

Distrito Federal

Espírito Santo

Goiás

Maranhão

Mato Grosso

Mato Grosso do Sul Stress level Minas Gerais Low

Paraná Moderate High Paraíba Extreme Pará

Pernambuco

Piauí

Rio Grande do Norte

Rio Grande do Sul

Rio de Janeiro

Rondônia

Roraima

Santa Catarina

Sergipe

São Paulo

Tocantins

Apr 20 Jun 20 Aug 20 Oct 20 Dec 20 Feb 21 Apr 21

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Figure 23. The estimated intensive care unit (ICU) usage is shown over time. The percent of ICU beds occupied by COVID-19 patients is color coded based on observed quantiles of the maximum proportion of ICU beds occupied by COVID-19 patients. Less than 10% is considered low stress, 10-29% is considered moderate stress, 30-59% is considered high stress, and greater than 60% is considered extreme stress. Intensive care unit beds

Acre

Alagoas

Amapá

Amazonas

Bahia

Ceará

Distrito Federal

Espírito Santo

Goiás

Maranhão

Mato Grosso

Mato Grosso do Sul Stress level Minas Gerais Low

Paraná Moderate High Paraíba Extreme Pará

Pernambuco

Piauí

Rio Grande do Norte

Rio Grande do Sul

Rio de Janeiro

Rondônia

Roraima

Santa Catarina

Sergipe

São Paulo

Tocantins

Apr 20 Jun 20 Aug 20 Oct 20 Dec 20 Feb 21 Apr 21

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Table 3. Ranking of COVID-19 among the leading causes of mortality in the full year 2020. Deaths from COVID-19 are projections of cumulative deaths on Jan 1, 2021 from the reference scenario. Deaths from other causes are from the Global Burden of Disease study 2019 (rounded to the nearest 100).

Cause name Annual deaths Ranking COVID-19 193,183 1 Ischemic heart disease 171,200 2 Stroke 131,000 3 Lower respiratory infections 88,600 4 Chronic obstructive pulmonary disease 68,700 5 Interpersonal violence 65,900 6 Diabetes mellitus 65,400 7 Alzheimer’s disease and other dementias 54,600 8 Road injuries 44,500 9 Chronic kidney disease 42,300 10

covid19.healthdata.org 25 Institute for Health Metrics and Evaluation Brazil MORE INFORMATION

More information

Data sources: Mask use data sources include PREMISE; Facebook Global symptom survey (This research is based on survey results from University of Maryland Social Data Science Center) and the Facebook United States symptom survey (in collaboration with Carnegie Mellon University); Kaiser Family Foundation; YouGov COVID-19 Behaviour Tracker survey. Vaccine hesitancy data are from the COVID-19 Beliefs, Behaviors, and Norms Study, a survey conducted on Facebook by the Massachusetts Institute of Technology (https://covidsurvey.mit.edu/). Data on vaccine candidates, stages of development, manufacturing capacity, and pre-purchasing agreements are primarily from Linksbridge and supplemented by Duke University. A note of thanks: We wish to warmly acknowledge the support of these and others who have made our covid-19 estimation eﬀorts possible. More information: For all COVID-19 resources at IHME, visit http://www.healthdata.org/covid. Questions? Requests? Feedback? Please contact us at https://www.healthdata.org/covid/contact-us.

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