1/6 Revista da Sociedade Brasileira de Medicina Tropical Journal of the Brazilian Society of Tropical Medicine Vol.:53:(e20200354): 2020 https://doi.org/10.1590/0037-8682-0354-2020 Corresponding author: Luciano Pamplona de Góes Cavalcanti. e-mail: pamplona.luciano@gmail.com  https://orcid.org/0000-0002-3440-1182 Received 4 June 2020 Accepted 19 June 2020 Major Article www.scielo.br/rsbmt I www.rsbmt.org.br Health system collapse 45 days after the detection of COVID-19 in Ceará, Northeast Brazil: a preliminary analysis Daniele Rocha Queiros Lemos [1] , Sarah Mendes D’Angelo [2],[3] , Luis Arthur Brasil Gadelha Farias [3],[4] , Magda Moura Almeida [2],[3] , Ricristhi Gonçalves Gomes [2] , Geovana Praça Pinto [1] , Josafa Nascimento Cavalcante Filho [2] , Levi Ximenes Feijão [2] , Ana Rita Paulo Cardoso [2] , Thaisy Brasil Ricarte Lima [2] , Pâmela Maria Costa Linhares [2],[3] , Liana Perdigão Mello [5] , Tania Mara Coelho [3],[4] , Luciano Pamplona de Góes Cavalcanti [1],[3] [1]. Centro Universitário Christus, Faculdade de Medicina, Fortaleza, CE, Brasil. [2]. Secretaria de Saúde do Estado do Ceará, Fortaleza, CE, Brasil. [3]. Universidade Federal do Ceará, Faculdade de Medicina, Fortaleza, CE, Brasil. [4]. Hospital São José de Doenças Infecciosas, Fortaleza, CE, Brasil. [5]. Laboratório Central de Saúde Pública do Ceará, Fortaleza, CE, Brasil. Abstract Introduction: COVID-19 emerged in late 2019 and quickly became a serious public health problem worldwide. This study aim to describe the epidemiological course of cases and deaths due to COVID-19 and their impact on hospital bed occupancy rates in the frst 45 days of the epidemic in the state of Ceará, Northeastern Brazil. Methods: The study used an ecological design with data gathered from multiple government and health care sources. Data were analyzed using Epi Info software. Results: The frst cases were confrmed on March 15, 2020. After 45 days, 37,268 cases reported in 85.9% of Ceará’s municipalities, with 1,019 deaths. Laboratory test positivity reached 84.8% at the end of April, a period in which more than 700 daily tests were processed. The average age of cases was 67 (<1 - 101) years, most occurred in a hospital environment (91.9%), and 58% required hospitalization in an ICU bed. The average time between the onset of symptoms and death was 18 (1 - 56) days. Patients who died in the hospital had spent an average of six (0 - 40) days hospitalized. Across Ceará, the bed occupancy rate reached 71.3% in the wards and 80.5% in the ICU. Conclusions: The frst 45 days of the COVID-19 epidemic in Ceará revealed a large number of cases and deaths, spreading initially among the population with a high socioeconomic status. Despite the efforts by the health services and social isolation measures the health system still collapsed. Keyword: COVID-19. Ecological study. Epidemiology. Infectious diseases. Brazil. INTRODUCTION The novel coronavirus SARS-CoV-2, the etiological agent of COVID-19, emerged in Wuhan, China in December 2019 and quickly spread to other countries 1,2 . Due to the rapid increase in the number of cases, on March 11, 2020, the World Health Organization (WHO) declared it to be a pandemic 3 . One month after the declaration, more than two million people worldwide had been infected and 135,000 deaths had been registered across 213 countries 4 . Worldwide, health systems faced the need to adapt to a critical overload on services, and a shortage of health care professionals and personal protective equipment 5,6 . In Brazil, the frst case of COVID-19 was confrmed on February 26, 2020, and the frst death on March 17, both in the state of São Paulo 7 . Community transmission was offcially recognized in Brazil on March 20, 2020 8 . Through May 5, 2020, there were more than 110,000 confrmed cases and approximately 8,000 deaths, with a mortality rate of 6.9%. The three most affected states were São Paulo (34,053 deaths), Rio de Janeiro (12,391 deaths), and Ceará (11,470 deaths) 9 . The state of Ceará in Northeast Brazil was one of the frst to confrm sustained transmission. Within 45 days of confrmation of its frst case, Ceará had registered the third highest number of