Epidemiology

Internal medicine

Pathology

Sociology

Social distance

Disease

Coronavirus disease 2019 (COVID-19)

Infectious disease (medical specialty)

Evolutionary biology

Biology

Pandemic

Phylogenetics

Gene

Demography

Engineering

Virology

Geography

Geotechnical engineering

Lineage (genetic)

Persistence (discontinuity)

Clade

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)

Genetics

Medicine

Nature Medicine

The northern state of Amazonas is among the regions in Brazil most heavily affected by the COVID-19 epidemic and has experienced two exponentially growing waves, in early and late 2020. Through a genomic epidemiology study based on 250 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) genomes from different Amazonas municipalities sampled between March 2020 and January 2021, we reveal that the first exponential growth phase was driven mostly by the dissemination of lineage B.1.195, which was gradually replaced by lineage B.1.1.28 between May and June 2020. The second wave coincides with the emergence of the variant of concern (VOC) P.1, which evolved from a local B.1.1.28 clade in late November 2020 and replaced the parental lineage in &lt;2 months. Our findings support the conclusion that successive lineage replacements in Amazonas were driven by a complex combination of variable levels of social distancing measures and the emergence of a more transmissible VOC P.1 virus. These data provide insights to understanding the mechanisms underlying the COVID-19 epidemic waves and the risk of dissemination of SARS-CoV-2 VOC P.1 in Brazil and, potentially, worldwide. Analysis of circulating SARS-CoV-2 viruses during the first and second waves of COVID-19 in Amazonas, Brazil, shows successive lineage replacements led to predominance of the variant of concern P.1 and are associated with variable levels of social distancing.

COVID-19 in Amazonas, Brazil, was driven by the persistence of endemic lineages and P.1 emergence