Author: Nelson, Bruce ; Carvalho, Maria do P. S. S. ; Malta, Frederico S. V. ; Wu, Chieh-Hsi ; Manuli, Erika R. ; Del Caro, Valentina S. ; Claro, Ingra M. ; Ramundo, Mariana S. ; Schnekenberg, Ricardo P. ; Pereira, Rafael H. M. ; Bhatt, Samir ; de Lima, Aline B. ; Loman, Nick J. ; Miscouridou, Xenia ; dos Santos, Helem M. ; Gaburo, Nelson ; Mishra, Swapnil ; Hawryluk, Iwona ; Andrade, Pamela S. ; Crispim, Myuki A. E. ; Flaxman, Seth ; Vollmer, Michaela ; Ferreira, Giulia M. ; Pond, Sergei L. K. ; Kraemer, Moritz U. G. ; Lemey, Philippe ; Coletti, Thais M. ; Ferguson, Neil M. ; Sonabend, Raphael ; Pybus, Oliver G. ; Rocha, Esmenia C. ; dos Santos, Ana L. P. ; Sabino, Ester C. ; Faria, Nuno R. ; Aguiar, Renato S. ; Monod, Mélodie ; Araujo, Leonardo J. T. ; Bowden, Thomas A. ; Proença-Modena, José L. ; Peixoto, Pedro S. ; Coupland, Helen ; Rambaut, Andrew ; Silva, Camila A. M. ; Mellan, Thomas A. ; de Pinho, Mariana C. ; Souza, William M. ; Walker, Patrick G. T. ; Sales, Flavia C. S. ; Dye, Christopher ; Nascimento, Vitor H. ; Vidal, Maria S. ; Franco, Lucas A. M. ; Gandy, Axel ; Schlüter, Hannah M. ; Hoeltgebaum, Henrique ; de Souza, Leandro M. ; Fraiji, Nelson A. ; Whittaker, Charles ; Suchard, Marc A. ; Candido, Darlan da S. ; Filho, Rosinaldo M. F. ; de Jesus, Jaqueline G. ; Silva, Joice do P. ; Laydon, Daniel J. ; Ratmann, Oliver ; Hulswit, Ruben J. G. ; Prete, Carlos A. ; Hay, James A. ; Zauli, Danielle A. G. ; Ferreira, Alessandro C. de S. ; McCrone, John T. ; Camilo, Cecilia da C.

Unmitigated spread in Brazil Despite an extensive network of primary care availability, Brazil has suffered profoundly during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Using daily data from state health offices, Castro et al. analyzed the pattern of spread of COVID-19 cases and deaths in the country from February to October 2020. Clusters of deaths before cases became apparent indicated unmitigated spread. SARS-CoV-2 circulated undetected in Brazil for more than a month as it spread north from Sã o Paulo. In Manaus, transmission reached unprecedented levels after a momentary respite in mid-2020. Faria et al. tracked the evolution of a new, more aggressive lineage called P.1, which has 17 mutations, including three (K417T, E484K, and N501Y) in the spike protein. After a period of accelerated evolution, this variant emerged in Brazil during November 2020. Coupled with the emergence of P.1, disease spread was accelerated by stark local inequalities and political upheaval, which compromised a prompt federal response. Science , abh1558 and abh2644, this issue p. 821 and p. 815

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