LAUSR

It has been ∼4 months since the first case of coronavirus disease 2019 (COVID-19) was reported in Wuhan, China including a total of ∼82,000 patients and 3,341 deaths. Until April 14, 2020, COVID-19 has affected ∼1,950,000 patients in 210 countries and territories around the world and 2 international conveyances and caused ∼122,000 deaths in 162 countries/territories. However, the epidemiologic data differs across countries. Although China showed the first case and a higher rate of morbidity and mortality than other sites, the number of new cases per day in China has been less than that elsewhere since February 26, 2020. Further studies and continued monitoring are needed to better understand the underlying mechanism of COVID-19. In addition, United States of America (USA) exceeded the number of cases observed in China on March 28, 2020 with more than 590,000 COVID-19 patients and ∼24,000 deaths, followed by Spain (∼172,000 patients and ∼18,000 deaths), Italy (∼160,000 patients and ∼20,000 deaths), France (∼137,000 patients and ∼15,000 deaths), Germany (∼130,000 patients and ∼3,000 deaths), United Kingdom (∼94,000 patients and ∼12,000 deaths) and Iran (∼75,000 patients and ∼4,700 deaths) by April 14, 2020. Several effective measures including restricting travel from China, controlling the distribution of masks, extensive research of COVID-19 spread, and government efforts to inform and educate the public were aggressively conducted in Taiwan. This is probably the reason why there were only 39 cases (until February 29, 2020) with a daily cumulative index of one case per day in Taiwan, which was much lower than that of nearby countries, such as Republic of Korea and Japan. In Brazil, the number of COVID-19 cases is increasing daily and by April 14, 2020, 23,955 positive cases have emerged. The number of deaths has also increased to 1,361 COVID-19 patients in the country so far. Deaths are mainly located in São Paulo, which is the most populated state in Brazil. China has managed to greatly reduce the SARS-CoV-2 virus transmission mostly with three effective measures (WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19): (a) protect health professionals with personal protective equipment; (b) identify quickly symptomatic patients by real-time polymerase chain reaction (RT-PCR) test and isolate them; (c) identify the patients’ close contacts and quarantine them. Italy has different demographics and social behavior than China and other countries like Germany that coped with the higher ratio of infection and it exceeded the capacity of the health system. Italy showed a lower testing capacity than China and other countries such as Germany during the first weeks of COVID-19 pandemic, but the capacity to perform RT-PCR has improved, giving better epidemiologic data of less severe cases and asymptomatic individuals carrying the SARS-CoV-2 virus in the population. However, as a final scenario, USA has shown the highest number of deaths related with COVID-19. In Brazil, until April 14, 2020, the mortality rate was 1,361/23,955 (5.68%). Italy was the first country to reach the mark of ten thousand COVID-19 related deaths as described by Boccia et al., which showed a 11.90% of mortality (13,155/110,574). As discussed by the authors, some conditions are closely related to the Italian situation such as the size of the aged population (23.1% of citizens from Italy versus 13.5% in Brazil), the presence of concomitant serious diseases such as chronic obstructive pulmonary disease, ischemic heart disease, smoking habit, number of intensive care units (ICUs) beds and sub intensive care beds along with the quality of the health service. In addition, characteristics of COVID-19 disease in Italy highlights the importance of increasing the number of diagnostic tests performed in the population, to encourage more healthy life styles of individuals who are subject to quarantine measures and ICU admittance, raising awareness about the seasonal flu that can maximize the number of patients visiting hospital and reaching the SARS-CoV-2 virus colonization acting as a vector, protecting medical personnel who could contribute to dissemination of the infection and avoiding simultaneous transmission which can cause momentary health system failure. The experience of dealing with COVID-19 in Brazil may give a new perspective since the country is dealing with many issues at the same time including social, political and genetics (admixed population with high variability at genome level) aspects, as follow: