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In the early days of the Covid-19 pandemic in Brazil in March 2020, a group of epidemiologists, led by the Federal University of Pelotas, home to one of the most prestigious epidemiology centers in the country, met to discuss the possible contributions it could make to the Brazilian people at that time of health emergency. There was consensus that, at that time, population-based data on the magnitude and speed of spread of Covid-19 in Brazil, its symptoms, and associated factors were essential for better coping with the pandemic in Brazil.
The proposal was initially presented to the State Government of Rio Grande do Sul and was immediately put into practice. Between April 2020 and April 2021, ten rounds of a population-based study were conducted covering the nine intermediate regions of Rio Grande do Sul.
In March 2020, with the approach of the first round of the study in Rio Grande do Sul, there was contact between the Secretary of Primary Health Care (SAPS) of the Ministry of Health and the coordination of EPICOVID-19 to expand the study to the entire national territory. Within weeks, the methodology was adapted, and data collection began. In the national study, each round included 133 cities, representing all states of the Federation, with a sample including 33,250 households.
As of June 2020, after successive reformulations at the Ministry of Health, EPICOVID-19 lost space on the ministry’s priority agenda. Other sources of funding were sought, enabling two more rounds of national EPICOVID-19 to be carried out, the last one in the first quarter of 2021.
In early 2023, EPICOVID 2.0 was proposed to the Brazilian Ministry of Health, whose main objective was to carry out a population-based survey that could assess the real impact of COVID-19 in Brazil. Sociodemographic aspects and family and household composition were investigated; post-COVID-19 symptoms and complications; previous COVID-19 infections, their symptoms, treatment, and search for health care; financial, food, educational, behavioral impacts, as well as mental and physical health impacts; vaccination against COVID-19.
EPICOVID 2.0 was a nationwide survey that encompassed all 26 Brazilian states and the Federal District. The Brazilian Institute of Geography and Statistics (IBGE) divides the country into 133 intermediate regions, and the survey included the urban area of the most populous city within each intermediate region. The cities included are shown in Figure 1 and listed in Supplementary Material 1.
Figure 1. Location of the 133 cities included in the EPICOVID 2.0 study.
The survey design employed a multi-stage probabilistic sampling method. Within each city, 25 urban census tracts, a small permanent geographic area used to collect census data, were selected with a probability proportional to their size. Ten households were randomly chosen from each census tract, using maps and household registers provided by the IBGE, resulting in 250 households per municipality. The survey was conducted between March and June 2024. During the initial phases of the research, the Brazilian Ministry of Health provided crucial support, facilitating contact with municipal health departments and obtaining authorization to conduct the study. This collaboration likely increased participants; willingness to get involved, ensuring successful implementation of the study in all counties. The study team visited the selected households and recorded the ages and genders of the family members. One family member was randomly selected to participate, with a second member also randomly selected if the first one refused to participate. If both individuals refused, the study team proceeded to the next neighboring house on the right. If the household consisted of only one person and that person refused, the study team moved on to the next household. The projected sample size of the study was 33,250 individuals, which was successfully achieved at the end of the fieldwork.
Data collection and analysis
A smartphone application was used for data collection following a computer-assisted personal interview protocol. This application was developed in a data collection system managed by the company LGA, which was the winner of the bid to conduct the EPICOVID 2.0 data collection. The questionnaire, consisting of 215 questions, was divided into four sections:
1. General block: contained the list of all residents of the household in order to enable the drawing of lots for the research participant. Specific questions about the head of household and the selected participant were investigated, including age, sex, color/race, education, occupation, and household assets;
2. COVID-19 symptoms and post-COVID clinical manifestations: symptoms that the participant has experienced in the last 3 months, as well as issues related to previous COVID-19 infections, were investigated. For each previous infection, the participants diagnostic method, symptoms, medication use, and hospitalization were investigated.
3. Impacts of COVID-19 on the individual’s life: some impacts that the pandemic and COVID-19 have caused on the participant’s life were investigated. Issues related to the death of relatives, financial and educational losses, food insecurity, weight and behavior changes, diagnosis of diseases, mental health, sources of information, and use of masks during the pandemic.
4. COVID-19 vaccination history: Questions were asked about flu and COVID-19 vaccination, including the number of doses and the name of the vaccine that was administered. The complete questionnaire can be obtained in the Downloads section.
Ethical aspects
Ethical approval for this study was obtained from the Ethics Committee of the School of Physical Education of the Federal University of Pelotas [CAAE: 68382923.8.0000.5313]. Written informed consent was obtained from all adult
participants and the parents or legal guardians of the minor participants.
2023
Nunes, B., Silva, I. C., Mielke, G. I., Vidaletti, L. P., Silveira, M. F., & Hallal, P. (2023). Social inequalities in the misbelief of chloroquines protective effect against COVID-19: results from the EPICOVID-19 study in Brazil. In bioRxiv. https://doi.org/10.1101/2023.05.29.23290677
2022
Horta, B. L., Silveira, M. F., Barros, A. J. D., Hartwig, F. P., Dias, M. S., Menezes, A. M. B., & Hallal, P. C. (2022). COVID-19 and outpatient care: a nationwide household survey. Cadernos de Saude Publica, 38(4), e00194121.
Jacques, N., Silveira, M. F. da, Hallal, P. C., Menezes, A. M. B., Horta, B. L., Mesenburg, M. A., Hartwig, F. P., & Barros, A. J. D. (2022). Mask use during the COVID-19 pandemic in Brazil: results of the EPICOVID19-BR study. Cadernos de saude publica, 38(6), e00271921.
2021
Barros, F. C., Hartwig, F. P., Barros, A. J. D., Menezes, A. M. B., Horta, B. L., Struchiner, C. J., Vidaletti, L. P., Silveira, M. F., Mesenburg, M. A., Delagostin, O. A., Hallal, P. C., & Victora, C. G. (2021). COVID-19 and social distancing among children and adolescents in Brazil. Revista de Saude Publica, 55, 42.
Hallal, P. C., Silveira, M. F., Menezes, A. M. B., Horta, B. L., Barros, A. J. D., Pellanda, L. C., Victora, G. D., Dellagostin, O. A., Struchiner, C. J., Burattini, M. N., Mesenburg, M. A., Jacques, N., Vidaletti, L. P., Ambros, E. L., Berlezi, E. M., Schirmer, H., Renner, J. D. P., Collares, K., Ikeda, M. L. R., … Victora, C. G. (2021). Slow spread of SARS-CoV-2 in southern Brazil over a 6-month period: Report on 8 sequential statewide serological surveys including 35 611 participants. American Journal of Public Health, 111(8), 1542–1550.
Hallal, P. C., Victora, C. G., Silveira, M. F., Barros, A. J. D., Menezes, A. M. B., Horta, B. L., Struchiner, C. J., Hartwig, F. P., Victora, G. D., Pellanda, L. C., Burattini, M. N., Dellagostin, O. A., & Barros, F. C. (2021). The challenge of conducting epidemiological research in times of pandemic and denialism: 1-year anniversary of the EPICOVID-19 project in Brazil. International Journal of Epidemiology, 50(4), 1049–1052.
Menezes, Ana M. B., Victora, C. G., Hartwig, F. P., Silveira, M. F., Horta, B. L., Barros, A. J. D., Mesenburg, M. A., Wehrmeister, F. C., Pellanda, L. C., Dellagostin, O. A., Struchiner, C. J., Burattini, M. N., Barros, F. C., & Hallal, P. C. (2021). High prevalence of symptoms among Brazilian subjects with antibodies against SARS-CoV-2. Scientific Reports, 11(1), 13279.
Menezes, Ana Maria Baptista, Hallal, P. C., Silveira, M. F., Wehrmeister, F. C., Horta, B. L., Barros, A. J. D. de, Hartwig, F. P., Oliveira, P. D., Vidaletti, L. P., Mesenburg, M. A., Jacques, N., Barros, F. C., & Victora, C. G. (2021). Influenza vaccination in the elderly in the COVID-19 pandemic: a population-based study in 133 Brazilian cities. Ciência & saúde coletiva, 26(8), 2937–2947.
Mesenburg, M. A., Hallal, P. C., Menezes, A. M. B., Barros, A. J. D., Horta, B. L., Barros, F. C. de, Hartwig, F. P., Jacques, N., & Silveira, M. F. da. (2021). Chronic non-communicable diseases and covid-19: results of the Epicovid-19 Brazil study. Revista de Saúde Pública, 55, 38.
Mesenburg, M. A., Hallal, P. C., Menezes, A. M. B., Barros, A. J. D., Horta, B. L.,Hartwig, F. P., Jacques, N., Pellanda, L. C., Zelmanowicz, A. de M., Vergani, D. O. P.,Ries, E. F., Harter, J., Martínez-Mesa, J., Carneiro, M., Estima, S. L., Heck, T. G., &Silveira, M. F. da. (2021). Prevalence of characteristic symptoms of covid-19 in Rio Grande do Sul: results of a population-based study with 18 thousand participants. Journal of Public Health, 55, 82.
Silveira, M. F., Mesenburg, M. A., Dellagostin, O. A., de Oliveira, N. R., Maia, M. A., Santos, F. D., Vale, A., Menezes, A. M. B., Victora, G. D., Victora, C. G., EPICOVID-19 Group, Barros, A. J., Vidaletti, L. P., Hartwig, F. P., Barros, F. C., Hallal, P. C., & Horta, B. L. (2021). Time-dependent decay of detectable antibodies against SARS-CoV-2: A comparison of ELISA with two batches of a lateral-flow test. The Brazilian Journal of Infectious Diseases: An Official Publication of the Brazilian Society of Infectious Diseases, 25(4), 101601.
Silveira, M. F., Tonial, C. T., Goretti K Maranhão, A., Teixeira, A. M. S., Hallal, P. C., Maria B Menezes, A., Horta, B. L., Hartwig, F. P., Barros, A. J. D., & Victora, C. G. (2021). Missed childhood immunizations during the COVID-19 pandemic in Brazil: Analyses of routine statistics and of a national household survey. Vaccine, 39(25), 3404–3409.
2020
Barros, A. J. D., Victora, C. G., Menezes, A. M. B., Horta, B. L., Hartwig, F., Victora, G., Pellanda, L. C., Dellagostin, O. A., Struchiner, C. J., Burattini, M. N., Gonçalves, M. R., Possuelo, L. G., Weber, L. P., Estima, S. L., Jacques, N., Härter, J., Silva, S. G., Frizzo, M., & Lima, R. C. (2020). Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study. Revista de saude publica, 54, 75.
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