Globally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic is in different stages of evolution, and local factors are expected to potentially mitigate or aggravate it. The situation has evolved quickly in Brazil. Three months after recognition of community transmission in Brazil, the country already ranked second in the world in confirmed cases and number of deaths (Johns Hopkins University & Medicine. COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University. https://coronavirus.jhu.edu/map.html, accessed on 09/Jun/2020) ¹1. Ministério da Saúde. Boletim epidemiológico 17. Situação epidemiológica da COVID-19: doença pelo coronavírus 2020. https://covid.saude.gov.br/ (acessado em 25/Mai/2020).
https://covid.saude.gov.br/... . Brazil’s profound social inequalities have the potential to further aggravate the situation, given that a significant portion of the population resides in precarious and crowed housing and has poor access to running water, factors that facilitate spread of the virus ²2. Werneck GL, Carvalho MS. A pandemia de COVID-19 no Brasil: crônica de uma crise sanitária anunciada. Cad Saúde Pública 2020; 36:e00068820._. One can thus raise the hypothesis that Brazil will experience epidemics with diverse evolutions in different socioeconomic strata.

One of the characteristics of the syndrome caused by SARS-CoV-2 (COVID-19) is that it most severely affects older people and those with preexisting chronic diseases. In Brazil, as of June 5, 2020, 86% of the deaths had occurred in persons aged 50 years or older ²2. Werneck GL, Carvalho MS. A pandemia de COVID-19 no Brasil: crônica de uma crise sanitária anunciada. Cad Saúde Pública 2020; 36:e00068820._. In addition to the biological vulnerability due to age, the epidemic has diverse implications for the older age groups. The first is ageism, i.e., stereotyping, prejudice, and discrimination against older persons ³3. Burnes D, Sheppard C, Henderson Jr. CR, Wassel M, Cope R, Barber C, et al. Interventions to reduce ageism against older adults: a systematic review and meta-analysis. Am J Public Health 2019; 109:e1-9.. This unacceptable notion can lead to “taking for granted” the loss of lives among the elderly, involving different conditions of social support, treatment, and prevention measures.

At least two other conditions make older persons more vulnerable to the SARS-CoV-2 epidemic. One of them is the higher prevalence of chronic diseases, which require monitoring and continuing use of medications (68% of Brazilian adults 50 years or older have two or more chronic diseases) ⁴4. Nunes NB, Batista SFF, Andrade FB, Souza Junior PR, Lima-Costa MF, Facchini LA. Multimorbidity: the Brazilian Longitudinal Study of Aging (ELSI-Brazil). Rev Saúde Pública 2018; 52 Suppl 2:10s.. Thus, one cannot overlook the possibility of these conditions worsening during the epidemic, due to difficulties in obtaining consultations and/or medications, or even the adoption of unhealthy behaviors. There is the additional possibility of new diseases emerging, such as cardiovascular and autoimmune diseases and mental health disorders due to the stress caused by the epidemic and social distancing or isolation ⁵5. Armitage R, Nellums LB. COVID-19 and the consequences of isolating the elderly. Lancet Public Health 2020; 5:e256._.

There still many unanswered questions on the behavior of SARS-CoV-2 in the population. One question is whether the epidemic will be contained in the first wave, or whether successive waves will occur ⁶6. Kissler SM, Tedjanto C, Goldstein E, Grad YH, Lipstich M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science 2020; 368:860-8. until an effective vaccine or other measures (still unknown) emerge, capable of containing the spread. There is thus a major need for transparent, timely, and quality information to inform society and back public policies for mitigation of the epidemic and its consequences in the short and long term.

These challenges motivated the creation of the ELSI-COVID-19 initiative, with the objective of producing information for a better understanding of the COVID-19 epidemic and its consequences for older Brazilians. This initiative is based on telephone interviews with participants in the Brazilian Longitudinal Study of Aging (ELSI-Brasil), conducted in a nationally representative sample of the population 50 years or older ⁷7. Lima-Costa MF, Andrade FB, Souza Jr. PRB, Neri AL, Duarte YAO, Castro-Costa E, et al. The Brazilian Longitudinal Study of Aging (ELSI-Brazil): objectives and design. Am J Epidemiol 2018; 187:1345-53..

This special Supplement of CSP presents the first results of the ELSI-COVID-19 initiative. The first article describes the initiative’s methodology. The subsequent articles address various subjects, such as social isolation, mental health, chronic diseases, use of medications, and use of health services, among other no less relevant topics. Since the world is engulfed in a health crisis that requires fast responses, some articles take the form of brief communications in order to streamline the publication process. The hope is that the publication of these initial results will elucidate the conditions in which older adults are living during this terrible epidemic and call the attention of society and the authorities to the need for urgent measures to mitigate the problems.

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