PONE-D-20-39302

DISSEMINATION OF COVID-19 IN INLAND CITIES OF NORTHEASTERN BRAZIL

PLOS ONE

Dear Dr.Sanderson Assis,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Interesting because representing a secondary data analysis relating to smaller cities in the interior of NE Brazil and correlates the spread of the disease to socio-demographic indicators.

To make the article suitable for publication, it is necessary to perform the following actions:

1. To improve the description of the socio-economic and demographic context both of the examined region and of the whole of Brazil in relation to the Covid 19 pandemic

2. To add to the bibliography articles regarding socio-demographic studies carried out in Brazil and use of the indicators cited (HDI, GINI and poverty rate)

3. To improve the description of the data and the methods of analysis

4. To improve the number of observations.

5. To improve the discussion and the validity of the proposed model, include in the discussion the evaluation of the temporary political and social measures and the mandatory use of masks in the incidence of Covid cases 19 (see: IHME Covid-19 Projections: https://covid19.healthdata.org/global?view=total-deaths&tab=trend)

6. Line 97: correct 20202 with 2020

The decision is justified on PLOS ONE’s publication criteria 

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We look forward to receiving your revised manuscript.

Kind regards,

Filomena Pietrantonio

Academic Editor

PLOS ONE

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Additional Editor Comments:

The article is interesting because it represents a secondary data analysis relating to smaller cities in the interior of NE Brazil and correlates the spread of the disease to socio-demographic indicators.

To make the article suitable for publication, it is necessary to perform the following actions:

1. To improve the description of the socio-economic and demographic context both of the examined region and of the whole of Brazil in relation to the Covid 19 pandemic

2. To add to the bibliography articles regarding socio-demographic studies carried out in Brazil and use of the indicators cited (HDI, GINI and poverty rate)

3. To improve the description of the data and the methods of analysis

4. To improve the number of observations.

5. To improve the discussion and the validity of the proposed model, include in the discussion the evaluation of the temporary political and social measures and the mandatory use of masks in the incidence of Covid cases 19 (see: IHME Covid-19 Projections: https://covid19.healthdata.org/global?view=total-deaths&tab=trend)

6. Line 97: correct 20202 with 2020

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: This is an important paper that presents findings relating to smaller cities in the interior of NE Brazil. The question it asks are important. However, the paper needs major revision in order to clarify and sustain its arguments. The soundness of the argument and the treatment of the data go hand in hand here. In brief, the paper attempts to derive statistically sound conclusions from a very small number of observations. This is possible, but complicated, and the authors need to do more to convince the reader that their approach is truly sound. For instance, the claim that the "independent" variables are independent of one another is perhaps technically true at .05 sig. but p-values should never be taken as the final arbiter or shortcut to this conclusion. Two substantive recommendations: 1) include access to the raw data and/or a table of values so that readers can assess these issues directly; 2) include scatter-plots rather than or in addition to the graphs in the paper (which are hard to read and need not be presented in three-dimensional representations). Including a more robust description of the data and the methods of analysis will greatly enhance this important paper. Finally, as for the independent variables, it seems that a basic demographic profile should also be included. As it stands, the authors have just used the 18 data points for Gini, HDI, and Poverty (54 data points total) as independent variables--all of which are easily obtained from official data sources. Given that the spread and morbidity of Covid-19 is clearly correlated with demographic factors, at the very least this should be controlled for. It is possible that all the 18 cities have the same demographic profile, but this should be tested and shown, not assumed.

Reviewer #2: In this manuscript, the authors explore the impact of the spread of the SARS-CoV-2 virus on cities in the northeast of Brazil. Using a mixed statistical set of methods including times-series analysis, the authors find that the distribution of the spread of COVID-19 cases is uneven and depends on a variety of mitigating factors such as inequality and vulnerability of the population. The authors conclude the public health officials in small cities need additional support to address the public health crisis.

This manuscript is timely and adds to our understanding about the current global pandemic in the developing world. The research methods are appropriate, and the conclusions are sound.

I recommend that the authors add some additional information about the socioeconomic and political situation in Brazil to add context in the introduction section. Specifically, I recommend the following minor revisions:

1. Define the geography of the Northeastern and situate it into the larger context of Brazil

2. Provide some basic demographic characteristics of this region in Brazil and how they compare to the country as a whole, including race/ethnicity, population, and income distribution

3. Reflect on the socio-political situation in Brazil and how it contributed to the pandemic worsening in Brazil. The COVID crisis in Brazil has been exacerbated by the political crisis in Brazil and lack of political leadership of science.

4. Integrate some scholarly literature that adds to the understanding of modern Brazil today. There is a vast literature on Brazil's development as a new global power, including "Brazil: A Biography" by Schwarcz and Starling; "Brazil: The Troubled Rise of a Global Power" by Michael Reid; "Brazil on the Rise" by Larry Rohter, among many others. A brief reflection on the context of Brazil in the world will improve the readability of the article for an international audience.

I recommend a minor revision and look forward to reading the published article. Thank you.

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Reviewer #1: No

Reviewer #2: No

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DISSEMINATION OF COVID-19 IN INLAND CITIES OF NORTHEASTERN BRAZIL

PONE-D-20-39302R1

Dear Dr. Sanderson José Costa de Assis,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Filomena Pietrantonio

Academic Editor

PLOS ONE

Additional Editor Comments :

The revised paper has responded to all reviewers' requests and therefore can be accepted for publication.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

The revised paper has responded to all reviewers' requests and therefore can be accepted for publication.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The revised paper is strong and convincing. While one may always quibble about data display (I follow Tufte in avoiding three dimensional mass plots when possible), the research question, data, and discussion are all presented clearly. In addition, this is very important and timely research with possible public health ramifications.

Reviewer #2: All comments have been addressed. The authors have incorporated relevant literature and further contextualized the case of the Brazil for an international audience. Thank you.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No