Rocha et al compiled data on state and municipal level indicators and used econometric methods to identify patterns in the spread of COVID-19 in Brazil. The authors found that socioeconomic vulnerabilities determined the initial spread of COVID-19 more than age structures or prevalence of health risk factors. States that were less socio-economically vulnerable were better able to increase hospital capacity, legislate COVID-19 measures, and achieve physical distancing in the community. States and municipalities that were more socio-economically vulnerable witnessed a disproportionate adverse burden of the pandemic. Targeted interventions to protect populations that are socioeconomically vulnerable are highly needed. Additionally, local government approaches and community behavior can help to counter-balance central government inactivity and strengthen health-systems in areas that are socio-economically vulnerable.