PONE-D-20-27148

Spatial pattern of COVID-19 deaths and infections in small areas of Brazil

PLOS ONE

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Reviewers' comments:

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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: Yes

Reviewer #2: Partly

Reviewer #3: No

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

Reviewer #1: Yes

Reviewer #2: No

Reviewer #3: 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: Yes

Reviewer #2: Yes

Reviewer #3: 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

Reviewer #3: No

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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: The paper describes the geographic distribution of COVID-19 throughout Brazil, attributing non-homogeneity to demographics specifically age. Specific comments and edits to conform to standard North American English are included in the attached document.

Reviewer #2: The manuscript presents interesting findings. But it needs to include essential confounding variables in the spatial analysis. Regarding mortality, the essential variable in this spatial analysis is the access to intensive care beds. This may explain part of the higher mortality in the north and northeast, which has the lowest number of beds per 100k of the country. It is important in this spatial analysis to incorporate this variable, perhaps it is more important than the distribution by sex and age in these regions. Another variable that can impact mortality is the coverage of primary care and coverage of supplementary private health. In addition, the analysis has to adjust the 558 558 micro-regions for the moment of the first case and count the same first days for the different regions. Only in this way is it possible to verify regional differences in terms of mortality and infection risks.

Reviewer #3: I recommend (i) to make (indirect) standardization by agegroup in the different region to support the analysis comparing the microregions among the Brazilian regions, apparently they may be so different (example: North (Amazon) Region with SouthWest region). (ii) The primary sample unit used did not match with the terciary (i.e ITU bed) health care service provided in macro or microregion defined by Brazilian Health System (SUS) (iii) The authors did not adjust by co-morbidities, however the Brazilian MoH conducted national surveys about non communicable diseases, with data available to make adjust about these diseases; (iv) In other hand, there is available data regarding National health care survey (PNAS) about health services provided by microregion (or cities)...the analysis conducted did not support the conclusions.

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Reviewer #1: No

Reviewer #2: Yes: Julio Croda

Reviewer #3: No

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Attachments

Attachment

Submitted filename: PONE-D-20-27148__PlosOne Brazil 9-2020 reviewer-1.docx

Spatial pattern of COVID-19 deaths and infections in small areas of Brazil

PONE-D-20-27148R1

Dear Dr. Baptista,

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.

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Kind regards,

Albert Schriefer, M.D., Ph.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #3: 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 #3: Yes

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

Reviewer #3: Yes

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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 #3: 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 #3: Yes

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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 #3: The majority of the comments were included in the manuscript. I believe that this manuscript will help to improve the discussion about an uncommon level related to Unified Health System in the Brazil.

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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 #3: Yes: WILDO NAVEGANTES DE ARAUJO