Volume 13, Issue 3 (9-2025)                   JoMMID 2025, 13(3): 185-196 | Back to browse issues page


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Paiva Almeida A, Massahiro Shimaoka A, Bandiera Paiva P, Lopes L. COVID-19 in the State of São Paulo, Brazil: Epidemiological Analysis and Ongoing Challenges. JoMMID 2025; 13 (3) :185-196
URL: http://jommid.pasteur.ac.ir/article-1-724-en.html
Department of Health Informatics, Paulista School of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
Abstract:   (852 Views)
The COVID-19 pandemic, which began in early 2020, became a challenge for healthcare systems, especially in Brazil and the state of São Paulo. Non-pharmaceutical interventions, such as lockdowns and face masks, helped reduce transmission when combined with testing and tracing but were not sufficient alone to prevent high case numbers and deaths. In May 2023, due to the sustained decline in severe cases and deaths, and an increase in global immunity through vaccination and prior infection, the World Health Organization (WHO) declared that COVID-19 no longer constituted a Public Health Emergency of International Concern (PHEIC). Despite this change in status, the pandemic persists, and the emergence of new SARS-CoV-2 variants continues to highlight the need for ongoing vaccination efforts. Additionally, post-acute sequelae of SARS-CoV-2 infection—commonly referred to as long COVID—have affected a significant portion of the infected population, adding to the burden on public health systems. Given this complex scenario, the present study presents a comparative epidemiological analysis of COVID-19 in São Paulo state across three key phases: pre-vaccination, mass vaccination, and the post-PHEIC period. Public data indicated that although immunization campaigns contributed to reduced cases, hospitalizations, and deaths, COVID-19 still caused more deaths than most infectious diseases during the analyzed period. The persistence of the pandemic occurred concurrently with declining vaccination coverage following the PHEIC declaration. To address this ongoing public health challenge, more effective policies are needed, including immediate sustained vaccination efforts, variant surveillance, public awareness campaigns, and long-term health system strengthening.
 
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Type of Study: Original article | Subject: Infectious diseases and public health
Received: 2025/04/2 | Accepted: 2025/09/10 | Published: 2025/12/2

References
1. World Health Organization. WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020 [Internet]. Geneva: World Health Organization; 2020 Mar [cited 2025 Oct 4]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020
2. Filip R, Puscaselu RG, Anchidin-Norocel L, Dimian M, Savage WK. Global challenges to public health care systems during the COVID-19 pandemic: a review of pandemic measures and problems. J Pers Med. 2022; 12 (8): 1295. [DOI:10.3390/jpm12081295] [PMID] [PMCID]
3. Garbin JRT, Leite FMC, Dell'Antonio CSS, Dell'Antonio LS, dos Santos APB, Lopes-Júnior LC. Hospitalizations for coronavirus disease 2019: an analysis of the occurrence waves. Sci Rep. 2024; 14 (1): 5777. [DOI:10.1038/s41598-024-56289-7] [PMID] [PMCID]
4. Neiva MB, Carvalho I, Costa Filho EDS, Barbosa-Junior F, Bernardi FA, Sanches TLM, et al. Brazil: the emerging epicenter of COVID-19 pandemic. Rev Soc Bras Med Trop. 2020; 53: e20200550. [DOI:10.1590/0037-8682-0550-2020] [PMID] [PMCID]
5. de Lima OACP, Kruger E, Tennant M. São Paulo urban health index: measuring and mapping health disparities. Rev Bras Epidemiol. 2022; 25: e220005. [DOI:10.1590/1980-549720220005] [PMID]
6. Imai N, Gaythorpe KAM, Abbott S, Bhatia S, van Elsland S, Prem K, et al. Adoption and impact of non-pharmaceutical interventions for COVID-19. Wellcome Open Res. 2020; 5: 59. [DOI:10.12688/wellcomeopenres.15808.1] [PMID] [PMCID]
7. Lai S, Ruktanonchai NW, Zhou L, Prosper O, Luo W, Floyd JR, et al. Effect of non-pharmaceutical interventions to contain COVID-19 in China. Nature. 2020; 585 (7825): 410-3. [DOI:10.1038/s41586-020-2293-x] [PMID] [PMCID]
8. Perra N. Non-pharmaceutical interventions during the COVID-19 pandemic: A review. Phys Rep. 2021; 913: 1-52. [DOI:10.1016/j.physrep.2021.02.001] [PMID] [PMCID]
9. Lopes LR, Campos JH, Chaves AFA. From SARS to COVID-19: lessons we should have learned (but we did not). J Evid-Based Healthc. 2021; 3: e3837. [DOI:10.17267/2675-021Xevidence.2021.e3837]
10. Silveira MM, Conrad NL, Leivas Leite FP. Effect of COVID-19 on vaccination coverage in Brazil. J Med Microbiol. 2021; 70 (11). [DOI:10.1099/jmm.0.001466]
11. Albrecht D. Vaccination, politics and COVID-19 impacts. BMC Public Health. 2022; 22 (1): 96. [DOI:10.1186/s12889-021-12432-x] [PMID] [PMCID]
12. Suthar AB, Wang J, Seffren V, Wiegand RE, Griffing S, Zell E. Public health impact of covid-19 vaccines in the US: observational study. BMJ. 2022; 377: e069317. [DOI:10.1136/bmj-2021-069317] [PMID] [PMCID]
13. Zhu C, Pang S, Liu J, Duan Q. Current Progress, Challenges and Prospects in the Development of COVID-19 Vaccines. Drugs. 2024; 84 (4): 403-23. [DOI:10.1007/s40265-024-02013-8] [PMID]
14. Aiyegbusi OL, Hughes SE, Turner G, Rivera SC, McMullan C, Chandan JS, et al. Symptoms, complications and management of long COVID: a review. J R Soc Med. 2021; 114 (9): 428-42. [DOI:10.1177/01410768211032850] [PMID] [PMCID]
15. Bonifácio LP, Csizmar VNF, Barbosa-Júnior F, Pereira APS, Koenigkam-Santos M, Wada DT, et al. Long-term symptoms among COVID-19 survivors in prospective cohort study, Brazil. Emerg Infect Dis. 2022; 28 (3): 730-3. [DOI:10.3201/eid2803.212020] [PMID] [PMCID]
16. Parotto M, Gyöngyösi M, Howe K, Myatra SN, Ranzani O, Shankar-Hari M, et al. Post-acute sequelae of COVID-19: understanding and addressing the burden of multisystem manifestations. Lancet Respir Med. 2023; 11 (8): 739-54. [DOI:10.1016/S2213-2600(23)00239-4] [PMID]
17. Ministério da Saúde. Portaria Nº 913, de 22 de abril de 2022 [Internet]. Brasília: Ministério da Saúde; 2022 [cited 2025 Aug 9]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/gm/2022/prt0913_22_04_2022.html
18. Shapiro SS, Wilk MB. An Analysis of Variance Test for Normality (Complete Samples). Biometrika. 1965; 52 (3-4): 591-611. [DOI:10.1093/biomet/52.3-4.591]
19. Kruskal WH, Wallis WA. Use of Ranks in One-Criterion Variance Analysis. J Am Stat Assoc. 1952; 47 (260): 583-621. [DOI:10.1080/01621459.1952.10483441]
20. Dunn OJ. Multiple comparisons using rank sums. Technometrics. 1964; 6 (3): 241-52. [DOI:10.1080/00401706.1964.10490181]
21. Garcia MH, Bandiera-Paiva P, Lopes LR. Concerns about the dengue epidemic. Einstein (Sao Paulo). 2025; 23: eCE1632. [DOI:10.31744/einstein_journal/2025CE1632] [PMID] [PMCID]
22. Crane MA, Shermock KM, Omer SB, Romley JA. Change in reported adherence to nonpharmaceutical interventions during the COVID-19 pandemic, April-November 2020. JAMA. 2021; 325 (9): 883-5. [DOI:10.1001/jama.2021.0286] [PMID] [PMCID]
23. World Health Organization. Pandemic fatigue: reinvigorating the public to prevent COVID-19: policy framework for supporting pandemic prevention and management: revised version November 2020 [Internet]. Geneva: World Health Organization; 2020 Dec [cited 2025 Aug 9]. Available from: https://www.who.int/europe/publications/i/item/WHO-EURO-2020-1573-41324-56242
24. Szwarcwald CL, Boccolini CS, de Almeida WDS, Filho AMS, Malta DC. COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management. Arch Public Health. 2022; 80 (1): 255. [DOI:10.1186/s13690-022-01012-z] [PMID] [PMCID]
25. Berra TZ, Alves YM, Popolin MAP, da Costa FBP, Tavares RBV, Tártaro AF, et al. The COVID-19 pandemic in Brazil: space-time approach of cases, deaths, and vaccination coverage (February 2020 - April 2024). BMC Infect Dis. 2024; 24 (1): 704. [DOI:10.1186/s12879-024-09598-1] [PMID] [PMCID]
26. Buckell J, Jones J, Matthews PC, Diamond SI, Rourke E, Studley R, et al. COVID-19 vaccination, risk-compensatory behaviours, and contacts in the UK. Sci Rep. 2023 May 25;13(1):8441.
27. Liu B, Stepien S, Dobbins T, Gidding H, Henry D, Korda R, et al. Effectiveness of COVID-19 vaccination against COVID-19 specific and all-cause mortality in older Australians: a population based study. Lancet Reg Health West Pac. 2023; 40: 100928. [DOI:10.1016/j.lanwpc.2023.100928] [PMID] [PMCID]
28. Tregoning JS, Flight KE, Higham SL, Wang Z, Pierce BF. Progress of the COVID-19 vaccine effort: viruses, vaccines and variants versus efficacy, effectiveness and escape. Nat Rev Immunol. 2021; 21 (10): 626-36. [DOI:10.1038/s41577-021-00592-1] [PMID] [PMCID]
29. Beesley LJ, Moran KR, Wagh K, Castro LA, Theiler J, Yoon H, et al. SARS-CoV-2 variant transition dynamics are associated with vaccination rates, number of co-circulating variants, and convalescent immunity. eBioMedicine. 2023; 91: 104534. [DOI:10.1016/j.ebiom.2023.104534] [PMID] [PMCID]
30. Khandia R, Singhal S, Alqahtani T, Kamal MA, El-Shall NA, Nainu F, et al. Emergence of SARS-CoV-2 Omicron (B.1.1.529) variant, salient features, high global health concerns and strategies to counter it amid ongoing COVID-19 pandemic. Environ Res. 2022; 209: 112816. [DOI:10.1016/j.envres.2022.112816] [PMID] [PMCID]
31. Sheward DJ, Kim C, Ehling RA, Pankow A, Dopico XC, Martin D, et al. Variable loss of antibody potency against SARS-CoV-2 B.1.1.529 (Omicron). bioRxiv [Preprint]. 2021. [DOI:10.1101/2021.12.19.473354]
32. Dhawan M, Saied AA, Mitra S, Alhumaydhi FA, Emran TB, Wilairatana P. Omicron variant (B.1.1.529) and its sublineages: What do we know so far amid the emergence of recombinant variants of SARS-CoV-2? Biomed Pharmacother. 2022; 154: 113522. [DOI:10.1016/j.biopha.2022.113522] [PMID] [PMCID]
33. Wolter N, Jassat W, Walaza S, Welch R, Moultrie H, Groome M, et al. Early assessment of the clinical severity of the SARS-CoV-2 omicron variant in South Africa: a data linkage study. Lancet. 2022; 399 (10323): 437-46. [DOI:10.1016/S0140-6736(22)00017-4] [PMID]
34. Bajema KL, Bui DP, Yan L, Li Y, Rajeevan N, Vergun R, et al. Severity and long-term mortality of COVID-19, influenza, and respiratory syncytial virus. JAMA Intern Med. 2025; 185 (3): 324-34. [DOI:10.1001/jamainternmed.2024.7452] [PMID]
35. Bager P, Svalgaard IB, Lomholt FK, Emborg HD, Christiansen LE, Soborg B, et al. The hospital and mortality burden of COVID-19 compared with influenza in Denmark: a national observational cohort study, 2022-24. Lancet Infect Dis. 2025; 25 (6): 616-24. [DOI:10.1016/S1473-3099(24)00806-5] [PMID]
36. Greenhalgh T, Sivan M, Perlowski A, Nikolich JŽ. Long COVID: a clinical update. Lancet. 2024; 404 (10453): 707-24. [DOI:10.1016/S0140-6736(24)01136-X] [PMID]
37. Pavli A, Theodoridou M, Maltezou HC. Post-COVID syndrome: incidence, clinical spectrum, and challenges for primary healthcare professionals. Arch Med Res. 2021; 52 (6): 575-81. [DOI:10.1016/j.arcmed.2021.03.010] [PMID] [PMCID]
38. Bowe B, Xie Y, Al-Aly Z. Postacute sequelae of COVID-19 at 2 years. Nat Med. 2023; 29 (9): 2347-57. [DOI:10.1038/s41591-023-02521-2] [PMID] [PMCID]
39. Adjaye-Gbewonyo D, Vahratian A, Perrine CG, Bertolli J. Long COVID in adults: United States, 2022. NCHS Data Brief. 2023; (480): 1-8. [DOI:10.15620/cdc:132417]
40. Makhluf H, Madany H, Kim K. Long COVID: long-term impact of SARS-CoV2. Diagnostics. 2024; 14 (7): 711. [DOI:10.3390/diagnostics14070711] [PMID] [PMCID]
41. Li J, Jia H, Tian M, Wu N, Yang X, Qi J, et al. SARS-CoV-2 and emerging variants: unmasking structure, function, infection, and immune escape mechanisms. Front Cell Infect Microbiol. 2022; 12: 869832. [DOI:10.3389/fcimb.2022.869832] [PMID] [PMCID]
42. Lopes LR, Cardillo GM, de Lucca Pina NC, da Silva Junior AC, Kasinski SK, Bandiera-Paiva P. Prediction of SARS-CoV-2 hosts among Brazilian mammals and new coronavirus transmission chain using evolutionary bioinformatics. Anim Dis. 2021; 1 (1): 20. [DOI:10.1186/s44149-021-00020-w] [PMID] [PMCID]
43. Hammer AS, Quaade ML, Rasmussen TB, Fonager J, Rasmussen M, Mundbjerg K, et al. SARS-CoV-2 Transmission between Mink (Neovison vison) and humans, Denmark. Emerg Infect Dis. 2021; 27 (2): 547-51. [DOI:10.3201/eid2702.203794] [PMID] [PMCID]
44. Oude Munnink BB, Sikkema RS, Nieuwenhuijse DF, Molenaar RJ, Munger E, Molenkamp R, et al. Transmission of SARS-CoV-2 on mink farms between humans and mink and back to humans. Science. 2021; 371 (6525): 172-7. [DOI:10.1126/science.abe5901] [PMID] [PMCID]
45. Pickering B, Lung O, Maguire F, Kruczkiewicz P, Kotwa JD, Buchanan T, et al. Divergent SARS-CoV-2 variant emerges in white-tailed deer with deer-to-human transmission. Nat Microbiol. 2022; 7 (12): 2011-24. [DOI:10.1038/s41564-022-01268-9] [PMID] [PMCID]
46. Lopes LR. Should the susceptibility of cervid to coronaviruses be a matter of concern? Res Sq [Preprint]. 2021. [DOI:10.21203/rs.3.rs-798964/v1]
47. de Vivo M, Carmignotto AP, Gregorin R, Hingst-Zaher E, Iack-Ximenes GE, Miretzki M, et al. Checklist dos mamíferos do Estado de São Paulo, Brasil. Biota Neotrop. 2011; 11 (suppl 1): 111-31. [DOI:10.1590/S1676-06032011000500007]
48. Lopes LR. Cervids ACE2 Residues that Bind the Spike Protein can Provide Susceptibility to SARS-CoV-2. EcoHealth. 2023; 20 (1): 9-17. [DOI:10.1007/s10393-023-01632-z] [PMID] [PMCID]
49. Bistagnino F, Subramanian A, Tovani-Palone MR. Navigating the (Post-) Pandemic Landscape: An Analysis of COVID-19's Current Status and Future Implications. Disaster Med Public Health Prep. 2025; 19: e44. [DOI:10.1017/dmp.2025.10] [PMID]
50. Sarker R, Roknuzzaman ASM, Hossain MJ, Bhuiyan MA, Islam MR. The WHO declares COVID-19 is no longer a public health emergency of international concern: benefits, challenges, and necessary precautions to come back to normal life. Int J Surg. 2023; 109 (9): 2851-2. [DOI:10.1097/JS9.0000000000000513] [PMID] [PMCID]

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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.