More than half of COVID-19 patients in Brazil came from Italy

By Angela Betsaida B. Laguipo, BSNApr 8 2020

Italy has grappled with the coronavirus disease (COVID-19), with more than 139,000 people infected and more than 17,000 people dead. In the first week of March, the number of cases in Italy skyrocketed before the lockdown was set in place. Prior to the country shutting down its border, many people had already left, flocking to other countries in an attempt to escape the virus.

A new study shows that Italy was the primary origin of people who first brought the novel coronavirus to Brazil, which has sparked the spread of the disease starting between February and early March.

"In contrast with China and other countries, where the outbreak began slowly with a small number of cases, it was started in Brazil by more than 300 people, most of whom came from Italy. The virus spread very quickly as a result," Ester Sabino, a professor at the University of São Paulo's Medical School (FM-USP), said.

The first cases

Most of the individuals who came from Italy and traveled to São Paulo City were the first cases of COVID-19 were reported in Brazil. Some of these individuals went traveled onto other destinations, such as the Porto Alegre, Curitiba, Salvador, Rio de Janeiro, Belo Horizonte, Recife, Fortaleza, Vitória, and Florianópolis, triggering the nationwide spread of the novel coronavirus, now officially called the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

Somma Lombardo, Italy, 03/27/2020, Terminal 2 Malpensa airport during the coronavirus covid-19 outbreak. Image Credit: Marco Solbiata / Shutterstock

The first case in Latin American was confirmed on Feb. 26 in the São Paulo metropolis, the most populated city in the Southern hemisphere, where about 11 million people live. This first case, based on the self-declared travel history and subsequent genetic analyses, was traced to Northern Italy, the epicenter of the COVID-19 pandemic in Europe. As of writing, Italy's death toll has reached 17,669, and the case toll has surpassed 135,000, although it now appears to be slowing down.

The researchers of the study, published in the Journal of Travel Medicine, estimate that about 54.8 percent of all patients who are infected in Brazil came from Italy by Mar. 5. Only 9.3 percent came from China, where Wuhan City Hubei Province, where the virus first emerged, and about 8.3 percent came from France.  

The team also said that about 24.9 percent of all infected people going to Brazil traveled from Italy to São Paulo. Further, Italy was the origin of five of the ten main routes for travelers infected with the coronavirus disease or COVID-19 coming to Brazil, via France, China, South Korea, Spain, and Switzerland.

Identifying main routes

The researchers wanted to determine the main routes that could have brought the infection into the country. To arrive at this finding, the team studied the data between February and March 2020 for travelers going to any airport in Brazil from 29 countries with COVID-19 cases.

The team used travel data on all air travel that had a Brazilian city as their final destination between February and March 2019. The researchers focused on 29 countries that had reported cases of COVID-19 by Mar. 5. To land to their findings, the team collated the total number of passengers going to any airports in Brazil during the period, including other details, such as country population size for 2019 from the United Nations World Population Prospects database, and the WHO-reported number of COVID-19 cases.

The estimates were validated by the Brazilian Ministry of Health's official data on notified cases, revealing that 14 of the first 29 COVID-19 positive patients in Brazil had just been to Italy. Six of them or 23.1 percent were notified on São Paulo, making the city as the epicenter of the outbreak in Brazil.

"It was very clear that São Paulo would be the epicenter of the epidemic in Brazil because it was the final destination for the largest number of infected people coming mainly from Italy," Sabin said.

COVID-19 global status

Italy is one of the hardest-hit countries during the COVID-19 global pandemic. It records the highest death toll, while the United States has the highest number of infections, with over 432,000 confirmed cases.

Other countries reporting high infection rates include Spain, with nearly 150,000 cases, France with 113,982 cases, and Germany with about 113,296 cases. China, Iran, and the United Kingdom have 82,867, 64,586, and 61,474 cases, respectively.