ASPECTOS CLÍNICO-EPIDEMIOLÓGICOS E DISTRIBUIÇÃO ESPAÇO-TEMPORAL DA COVID-19 NO ESTADO DO MARANHÃO

Abstract

In view of the rapid human dissemination in the global context of COVID-19 and the historical contribution of spatial and space-time analyzes to the understanding of the dynamics of infectious diseases, this work aimed to analyze the clinical epidemiological aspects and the space-time distribution of cases of COVID-19 in the state of Maranhão. This is an ecological and time-series study, using the state's regional health units as ecological units. All new cases of COVID-19 registered between March 2020 and January 2022, obtained from the Maranhão COVID-19 Notification System (SNC-19 MA), collected in February 2022, were considered for the study. clinical-epidemiological characteristics of the cases under investigation were expressed using descriptive statistics. The incidence was calculated each month, by health region, and the trend in the incidence of COVID-19 was estimated using Prais Winsten regressions, processed using SPSS 24.0 software. Incidence rates were spatially distributed through area analysis and were divided into first wave (March/2020 to October/2020), second wave (November/2020 to August/2021) and post second wave (September/2020 to January /2022). The scanning analysis technique was employed with a view to detecting clusters in space-time using the SaTScan® software version 9.2, considering the discrete Poisson model. Thematic maps of the space-time analyzes carried out were prepared using the ArcGIS® 10.8 software. The research was approved by the Research Ethics Committee of the Federal University of Maranhão under opinion No. 4,227,396. A total of 386,567 cases were registered, of which the majority were female (56.30%), mixed race/color (46.60%), aged between 30 and 39 years (21.30%), with laboratory diagnosis criteria ( 99.00%) carried out in a public laboratory (89.90%), without comorbidity (75.60%) and without evolution to death (96.90%). A heterogeneous distribution of incidence rates was evident, in which during the first wave there was a peak in June 2020, with an average rate for the state of 695.00/100,000 inhabitants, with emphasis on the Santa Inês region with the largest (1,314.70/100,000 inhabitants). In the second wave, there was a higher incidence in the Balsas region in August 2021 (858.96/100,000 inhabitants). In the period after the second wave, the regional Barra do Corda was highlighted in September 2021 with a rate of 582.90/100 thousand inhabitants. The trend in the incidence of COVID-19 showed a stable behavior in all health regions in the state over the period analyzed. The space-time sweep statistics revealed four clusters in space-time of relative high risk distributed among the regions of Timon and Caxias, São Luís and Pinheiro, Imperatriz and Açailândia and Santa Inês. The clinical-epidemiological aspects and heterogeneously distributed space-time risk areas and the stable trend of COVID-19 evidenced in this investigation can help the management of health systems and services in the planning and implementation of measures aimed at mitigation, surveillance and control of the disease in the state of Maranhão.