INTRODUCTION: COVID-19 is a respiratory disease caused by the SARS-CoV-2 virus, which belongs to the coronavirus family. SARS-CoV-2 is related to other viruses that cause severe acute respiratory syndrome. The emergence of cases of pneumonia of unknown origin triggered the largest viral pandemic in modern times, presenting major challenges to global public health. OBJECTIVE: To analyze the evolution of the COVID-19 pandemic in the state of São Paulo from 2020 to 2023, focusing on trends in incidence, mortality, and lethality. METHODS: Ecological study of time series of incidence, mortality and lethality by COVID-19 in the state of São Paulo using Prais-Winsten regression considering the Weekly Percentage Change (WPC) and probability values (p), considering a significance level of 95% (95% CI). To ensure the reliability of the entered data, double-blind typing was performed by different researchers in the same database extracted from the 2024 Ministry of Health Coronavirus dashboard. RESULTS: From February 2020 and the end of December 2023, 6,763,310 accumulated cases and 182,254 deaths were recorded. Stationary trends were observed for the year 2022, with a reduction in incidence and mortality in the year 2023. However, the epidemiological variable lethality showed a stationary trend. CONCLUSION: The analysis of the trends in incidence, mortality, and lethality revealed variable dynamics over time, with emphasis on the significant reduction of these indicators in 2023.