COVID-19 in the Indigenous Population of Brazil

Overview of the Indigenous health of the Yanomami ethnic group in Brazil: A Public Health Emergency

INTRODUCTION

The Indigenous population of the Yanomami ethnic group in Brazil is currently facing a public health emergency due to the high number of deaths, mainly of children. Taking that into consideration, this study aims to analyze this crisis impact on the health of this population in the period between 2018 and 2022.

METHODS

The data presented were collected from the report called Yanomami Mission ("Missão Yanomami") published by the Brazilian Ministry of Health and, from it, a descriptive analysis of the Indigenous individuals' health was carried out for (i) the geographical distribution; ii) the number of deaths; (iii) the child death rate; (iv) the deaths of Indigenous individuals from preventable causes; (v) the causes of preventable diseases related to hygiene and basic sanitation, and the distribution of diarrheal diseases according to age groups; (vi) evaluation of the nutritional classification; vii) the percentage (%) of the complete vaccination scheme, and (viii) the coverage of prenatal appointments of Indigenous pregnant women.

RESULTS

The report included 31,017 individuals belonging to the Yanomami ethnic group, most of the participants were up to 39 years old (N = 26,377; 85.0%) and men (N = 15,836; 51.1%). During the period described in the report, the number of deaths reached 1285/31,017 (4.1%). When analyzing the deaths, the most representative age groups were those of children under 1 year old (505/1285; 39.9%), from 1 to 4 years old (178/1285; 13.8%), and the elderly from 60 to 79 years old (150/1285; 11.6%). The Indigenous individuals from this ethnic group presented a child death rate ~ 1.5 to 3.5 higher than that of the total Indigenous population in the country. Regarding the child death rate, the neonatal component represented 57.8% of the deaths and, in 2022, 93.0% of the pregnant women had less than six prenatal appointments. This population shows a high number of deaths due to preventable causes (N = 538) and cases of illnesses associated with hygiene and sanitation, for example (N = 35,103 cases/notifications). As for vaccination, the full vaccination scheme targeting children below 5 years old has not been met since 2018.

CONCLUSION

In the Indigenous population of the Yanomami ethnic group, a high number of deaths was observed, which affected mainly individuals under 1 year old. Among the factors associated with the deaths, mainly in children under 5 years old, most cases have preventable causes, which could be reduced by proper action promoting their health and preventing diseases.

Impact of Coronavirus Disease (COVID)-19 on the Indigenous Population of Brazil: A Systematic Review

BACKGROUND

Indigenous peoples in Brazil were severely impacted by coronavirus disease (COVID)-19 pandemic, experiencing high rates of infection and mortality. Geographic isolation, limited access to healthcare, socio-economic disparities, and cultural factors, such as communal living and mistrust of state-led initiatives, heightened their vulnerability. Territorial invasions and oxygen shortages further exacerbated the crisis. Therefore, this systematic review aimed to explore the progression of COVID-19 in this population.

METHODS

A systematic review was conducted in PubMed-MEDLINE, SciELO (Scientific Electronic Library Online), and LILACS (Latin America and the Caribbean Health Sciences Literature) from the beginning of the pandemic in Brazil (2020) to March 2025. Studies addressing COVID-19 vaccination and epidemiological, social, and economic aspects among Indigenous populations in Brazil were included. Reviews and irrelevant studies were excluded. The quality of eligible studies was assessed using the Newcastle-Ottawa Scale.

RESULTS

A total of 50 relevant studies were included, grouped into thematic blocks: mortality/infection, symptoms, vaccination/testing, social impacts, and birth outcomes. Several studies highlighted that being male, of Indigenous or other racial minority background, and having comorbidities increased mortality risk. In contrast, asthma was associated with reduced mortality. Pregnant Indigenous women in rural areas had 33 times higher odds of dying than their urban counterparts. Furthermore, there is a higher likelihood of very low birth weight and inadequate prenatal care among Indigenous mothers. Vaccination reduced the risk of death, particularly after full immunization, though it did not prevent hospitalization. A cohort study of 389,753 Indigenous people showed a lower full vaccination rate (48.7%) compared to the general population (74.8%). Complete vaccination reduced the risk of death by 96% among hospitalized patients. Regarding seroprevalence, Indigenous people had a 5.4% positivity rate, much higher than other racial groups, and were 4.71 times more likely to test positive than White, Black, or Mixed Individuals. Socioeconomic disparities also correlated with increased infection risk.

CONCLUSIONS

The COVID-19 pandemic worsened health disparities among Indigenous peoples in Brazil, revealing systemic inequalities, weak public policies, and limited healthcare access. This review urges culturally sensitive, community-led responses and highlights the need for disaggregated data and equitable, inclusive health strategies.

Socioecology and Prevalence of SARS-CoV-2 Infection in Quilombolas Living in the Brazilian Amazon

OBJECTIVES

This cross-sectional study presents socioecological, epidemiological aspects, and the seroprevalence of immunoglobulin G (IgG) against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a group of quilombola (afro-derived) communities in the states of Pará and Tocantins, in the Brazilian Amazon, to evaluate the impact of SARS-CoV-2 prevalence among them.

METHODS

A total of 551 individuals participated. The detection of anti-SARS-CoV-2 antibodies was performed using an enzyme immunoassay. Socioeconomic and ecological data was collected from all participants 7 years of age or older who were not previously vaccinated.

RESULTS

The seroprevalence of antibodies in both states was 40.7% and was associated with factors such as age group, contact with infected individuals, and being in lockdown inside the quilombos. In Pará, a statistically significant association was observed between seroprevalence and females, and the age group of 12-18 years. In addition, seroprevalence in Pará was higher than in Tocantins, and the reported use of masks was a protective factor, while in Tocantins, the reported use of masks was associated with the presence of antibodies. There was no association between the prevalence of antibodies and the presence of COVID-19 symptoms in Pará. However, in Tocantins, diarrhea and loss of taste were associated with infection.

CONCLUSIONS

Quilombola are highly vulnerable groups due to the long history of enslavement in Brazil. This is the first investigation of SARS-CoV-2 seroprevalence and its impact in these groups in the Amazon. The study helps us to understand the relationship of socioecological differences, behavioral characteristics, and the dynamics of viral transmission associated with the risk of infection by SARS-CoV-2 among traditional populations, and can be useful to the planning of more culturally adequate public health policies for future epidemics.

Assessment of the BNT162B2 COVID-19 vaccine immune response in Brazilian indigenous adolescents

BACKGROUND

COVID-19 vaccination of minors is crucial for global pandemic control, especially among indigenous populations, who are often more vulnerable due to limited healthcare resources and communal living settings.

OBJECTIVES

To assess the immunogenicity responses of the BNT162b2 vaccine in immunized Brazilian indigenous adolescents.

METHODS

A cohort study was conducted with indigenous adolescents aged 12 to 18 years residing in the largest peri-urban indigenous region in Brazil. SARS-CoV-2-specific immune responses were analyzed before (D1) and after (D2) completion of the vaccination schedule. Demographic data were collected using a questionnaire.

RESULTS

Of the 129 adolescents invited, 98 (75.96 %) participated in the study. Most were of Guarani ethnicity, single, had lower incomes, and were educated only to the elementary level. Post-vaccination, a statistically significant increase was noted in IgG concentration (24.03 % to 37.02 %). Increases were observed in B lymphocytes (11.88 to 13.92 cells/mm3), memory B cells (13.58 to 15.96 cells/mm3), NK cells (20.23 to 24.08 cells/mm3), and non-classical monocytes (9.23 to 11.34 cells/mm3), while CD8+ T cells decreased (24.41 to 21.69 cells/mm3). Adolescents with prior exposure to the virus showed increased levels of B lymphocytes and CD8+ T cells. No significant changes were observed in other cell subpopulations from exposure to the virus.

CONCLUSION

Elevated levels of antibodies and certain cell subpopulations were observed in vaccinated adolescents, confirming the effectiveness of the BNT162b2 vaccine in maintaining humoral and cellular responses. This study is the first to describe data from indigenous minors vaccinated against COVID-19 with the BNT162b2 vaccine, highlighting the importance of vaccination efforts and the potential need for booster doses.

Health surveillance among indigenous populations in the context of COVID-19: a scoping review

The study aimed to identify protection strategies used by Indigenous peoples during the COVID-19 pandemic. Analyzing 56 articles from 2020 to May 2021 across four areas -community organization, governance, communication, and territorial approaches - it found that structural vulnerabilities shaped their responses. The spread of the virus was influenced by environmental, social, and cultural factors. Indigenous groups employed diverse strategies like collective decision-making and traditional knowledge. Challenges included data suppression and barriers to ethnic identification. The study emphasizes the need for greater Indigenous autonomy in data management and effective coordination among government, civil society, and Indigenous organizations.

Ethical guidelines for the allocation of scarce intensive care units during the COVID-19 pandemic: Discussing a Brazilian proposal

RATIONALE

In the context of a major health crisis, health professionals must first compare patients' recovery prospects, thus giving priority to the goal of saving the greatest number of lives.

AIMS AND OBJECTIVES

Critically evaluate a protocol for allocation of scarce intensive care units (ICU), which the authors proposed at the onset of the COVID-19 pandemic and originally published in two Brazilian newspapers; and compare that protocol with similar proposals, particularly with 2 successive protocols issued by the Brazilian Critical Care Association. The main objective is to highlight the advantages of the authors' approach and discuss some criticisms that has been levelled against the proposed protocol after its original publication in 2020.

METHOD

Comparative analysis of 3 different protocols (the authors' proposed protocol and 2 successive protocols issued by the Brazilian Critical Care Association) with regard to ethical principles.

RESULTS

The main objective of a healthcare system is to ensure a fair patient triage process when it is impossible to grant admission to all patients in need of treatment. Decision-making regarding the impartial prioritization of ICU admissions must be based primarily on clinical criteria. The Sequential Organ Failure Assessment (SOFA) is, for ethical and technical reasons, a useful tool for clinical assessments of patients. Based on three ranges of SOFA scores, patients can be classified into a "high", a "medium", and a "low" priority group. In the case of ties, the life cycle principle must be the tiebreaker. If the tie persists, a draw must be used.

CONCLUSION

The authors' proposed protocol has advantages over the other two protocols due to its greater practicality and capacity to account for egalitarian and consequentialist principles simultaneously. It aims at saving as many lives as possible within the constraints of fairness. Furthermore, the proposed protocol avoids discrimination against people with disabilities without, at the same time, promoting discrimination against the elderly.

COVID-19, SDGs and public health systems: Linkages in Brazil

Background

The global 2030 Agenda covers a range of interconnected issues which need interdisciplinary and holistic approaches to improve human well-being and protect the natural environment. The COVID-19 pandemic has brought to light critical inequities in society and policy gaps in health services. As highlighted through analyses of the interlinkages among the Sustainable Development Goals (SDGs), connections between human health and well-being and the environment, can help support new policy needs in addressing systemic health crises, including widespread pandemics.

Method

We identify links between the COVID-19 crisis and multiple SDGs in the context of Brazil based on a review of the current literature in the health sector.Findings: We identify synergistic connections between 88 out of 169 SDG targets and COVID-19, notably around themes such as City Environment, Contextual Policies and the value created by improved Information and Technology. Using the context of the Brazilian National Health Service (SUS) highlights recurrent interconnections from the focal point of target 3.8. This includes topics such as challenges for universal healthcare coverage, budget allocation, and universalisation.

Conclusions

The framework developed for supporting policy-making decisions and the design of toolkits for dealing with future health-related emergency scenarios offers a practical solution in the health sector. It is worth noting that progress and action on public health systems and policies must go hand in hand with addressing existing socio-economic vulnerabilities in society. This is vital for tackling future pandemics and simultaneously addressing the SDGs.

COVID-19 in Brazil: a 3-year update

Three years into the coronavirus disease (COVID)-19 pandemic and the world is still struggling with the aftermath of this global health crisis. In Brazil, we are witnessing serious economic, health, social, and political problems. The rapid spread of the virus in our country was the result of a shortage of vaccines and the lack of an effective national campaign to identify and report cases. This health crisis also intensified social inequalities, hitting Indigenous peoples hard due to the lack of access to health services. In addition, rising unemployment and overcrowding of the health system made contagion possible, especially among the most vulnerable, increasing the number of serious cases of the disease. It is important to highlight that emotional problems worsened, the educational system was severely affected, and domestic violence increased during the confinement period, in addition to the fact that the pandemic exposed the great disparities of regional inequalities that exist across the country, mainly concerning health management.

Climate change and mental health of Indigenous peoples living in their territory: a concept mapping study

BACKGROUND

The alarming increase in annual deforestation rates has had devastating consequences in climate change, and it is affecting Indigenous people, who depend entirely on the land for survival and has also weakened the rainforest's crucial role in stabilizing the global climate. Recognizing and respecting Indigenous people's needs and social, economic, and historical conditions influence health and healthcare. This study aimed to conduct online concept mapping workshops with university students to identify perceived important and feasible actions for improving the mental health of Indigenous people living in their territory in association with climate change.

METHODS

Concept mapping, a participatory mixed methodology, was conducted virtually with 20 Indigenous students at two universities in Brazil. A focus prompt was developed from consultations with Indigenous stakeholders and read-"To improve the mental health of Indigenous peoples in their territory during climate change crises, it is necessary to…."

RESULTS

University students organized 42 unique statements in 6 clusters that cover a wide range of topics: family support, 0.68 (SD 0.19); respect and understanding, 0.37 (SD 0.08); improvement actions, 0.52 (SD 0.07); public policies in favor of Indigenous people's mental health, 0.24 (0.09); health actions, 0.15 (SD 0.08); Indigenous training in health and its importance in improving mental health 0.32 (SD 0.07).

CONCLUSION

These clusters range from community initiatives, public policies, health actions, and strengthening professional services in Indigenous communities. These all provide numerous concrete ideas for developing interventions designed to address mental health challenges associated with climate change.

Genomic characterization of SARS-CoV-2 from an indigenous reserve in Mato Grosso do Sul, Brazil

Background

The COVID-19 pandemic had a major impact on indigenous populations. Understanding the viral dynamics within this population is essential to create targeted protection measures.

Methods

A total of 204 SARS-CoV-2 positive samples collected between May 2020 and November 2021 from an indigenous area in Mato Grosso do Sul (MS), Midwestern Brazil, were screened. Samples were submitted to whole genome sequencing using the Nanopore sequencing platform. Clinical, demographic, and phylogenetic data were analyzed.

Results

We found the co-circulation of six main SARS-CoV-2 lineages in the indigenous population, with the Zeta lineage being the most prevalent (27.66%), followed by B.1.1 (an ancestral strain) (20.21%), Gamma (14.36%) and Delta (13.83%). Other lineages represent 45.74% of the total. Our phylogenetic reconstruction indicates that multiple introduction events of different SARS-CoV-2 lineages occurred in the indigenous villages in MS. The estimated indigenous population mortality rate was 1.47%. Regarding the ethnicity of our cohort, 64.82% belong to the Guarani ethnicity, while 33.16% belong to the Terena ethnicity, with a slightly higher prevalence of males (53.43%) among females. Other ethnicities represent 2.01%. We also observed that almost all patients (89.55%) presented signs and symptoms related to COVID-19, being the most prevalent cough, fever, sore throat, and headache.

Discussion

Our results revealed that multiple independent SARS-CoV-2 introduction events had occurred through time, probably due to indigenous mobility, since the villages studied here are close to urban areas in MS. The mortality rate was slightly below of the estimation for the state in the period studied, which we believe could be related to the small number of samples evaluated, the underreporting of cases and deaths among this population, and the inconsistency of secondary data available for this study.

Conclusion

In this study, we showed the circulation of multiple SARS-CoV-2 variants in this population, which should be isolated and protected as they belong to the most fragile group due to their socioeconomic and cultural disparities. We reinforce the need for constant genomic surveillance to monitor and prevent the spread of new emerging viruses and to better understand the viral dynamics in these populations, making it possible to direct specific actions.

Suicide among Indigenous peoples in Brazil from 2000 to 2020: a descriptive study

Background

Previous studies in Australia, Canada, and Brazil, found that suicide among ethnic minority groups is higher than in the general population. Indigenous peoples in Brazil have been reported to have a high suicide rate, with reports of suicide clusters occurring in several communities. The objective of this study was to report trends in countrywide suicide rates among Indigenous peoples in Brazil between 2000 and 2020, and to compare these with the non-Indigenous population.

Methods

This ecological study used Indigenous suicide data collected from all regions of Brazil during a 21-year period, between 2000 and 2020. We used suicide estimates from the Mortality Information System (SIM), available at the Brazilian Health Ministry website (DATASUS). Suicide mortality rates by state and region were calculated using the estimated Indigenous population from the 2010 census, and estimated population proportions for the other years. We performed a trend analysis and compared trends in suicide between the Indigenous and non-Indigenous population during the period studied.

Findings

Suicide rates among Indigenous Brazilians have reached more than two and a half times the levels for the overall Brazilian population in 2020 (17.57 suicide deaths versus 6.35 suicide deaths per 100,000 inhabitants, respectively). The Central-West region of Brazil had the highest suicide rates among Indigenous Brazilians over the study period, reaching 58.8 deaths/100,000 inhabitants in 2008. The younger age group (10-24 years old) had the highest suicide rates for all the years studied. Time-series analyses showed a trend of statistically significant increases in suicide rates in Brazil for both the Indigenous and non-Indigenous population during the study period. The North region, and specifically Amazonas state, has shown a decisive increase in suicide rates among the Indigenous populations. The suicide rate for Indigenous people in Brazil, excluding cases in Amazonas and Mato Grosso do Sul states, were similar to those for the entire Brazilian population, showing that the Indigenous peoples who are the most vulnerable to suicide reside in these locations.

Interpretation

While there were statistically significant increases in suicide rates for all Brazilians over the study period, they remained alarmingly high among Indigenous people, compared to their non-Indigenous counterparts. The high suicide rates among Indigenous people, and younger individuals in particular (aged between 10 and 24), reinforces the need for specific prevention strategies for these populations. Further studies should be concentrated on determining risk factors in distinct ethnic groups, specifically within regions experiencing an elevated risk, such as the states of Amazonas and Mato Grosso do Sul.

Funding

Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health under award number R01MH128911-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Epidemiological Profile of Hospitalized Patients with Cystic Fibrosis in Brazil Due to Severe Acute Respiratory Infection during the COVID-19 Pandemic and a Systematic Review of Worldwide COVID-19 in Those with Cystic Fibrosis

Since the onset of the coronavirus disease, COVID-19 pandemic, concern arose for those who might be at higher risk of a worse COVID-19 prognosis, such as those with cystic fibrosis (CF). In this context, we evaluated the features of hospitalized patients with CF due to severe acute respiratory infection (SARI) in Brazil and we also performed a systematic review including all the studies published from the beginning of the first case of COVID-19 (17 November 2019) to the date of this search (23 May 2022) which included, concomitantly, patients with CF and COVID-19 in the worldwide population. In our Brazilian data, we evaluated the period from December 2019 to March 2022, and we included 33 demographical and clinical patients' features. We classified the patients into groups: (G1) SARI due to another viral infection than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (23; 5.4%), (G2) SARI due to an unknown etiological agent (286; 67.1%), and (G3) SARI due to SARS-CoV-2 infection (117; 27.5%). The individuals in G3 tended to be older, especially over 50 years old, and presented a higher prevalence of dyspnea, peripheral capillary oxygen saturation (SpO₂) <95%, and cardiopathy. The highest prevalence for intensive care unit (ICU) treatment (52; 44.4%) and invasive mechanical ventilation (29; 24.8%) was for patients in G3. Almost half of the patients in G3 died (51; 43.6%); in contrast, none in G1 died. However, we observed 43 (15.0%) deaths in G2. In addition, 12 (4.2%) and one (0.9%) death not associated with SARI occurred, respectively, in the G2 and G3. The patients who died due to SARS-CoV-2 infection had a higher frequency of SpO₂ <95% (46; 90.2%), ICU treatment (34; 66.7%), and invasive mechanical ventilation (27; 52.9%) when compared to those who recovered. The systematic review comprised a total of 31 papers published as observational studies. These studies comprised 661,386 patients in total, including children, adults, and elderly age groups. However, only 19,150 (2.9%) patients were diagnosed with CF and, from these patients, 2523 (0.4%) were diagnosed with both CF and COVID-19. It was observed that the most common outcome was the need for hospitalization (n = 322 patients with CF), and the need for oxygen support (n = 139 patients with CF). One hundred patients with CF needed intensive care units, fifty patients needed non-invasive mechanical ventilation support, and only three patients were described as receiving invasive mechanical ventilation support. Deaths were described in 38 patients with CF. Importantly, lung-transplanted patients with CF represented an increased risk of death in one publication; in accordance, another study described that lung transplantation and moderate to severe lung disease were independent risk factors for severe outcomes after SARS-CoV-2 infection. In contrast with the literature, in conclusion, Brazilian patients in G3 presented a severe phenotype, even though most of the other studies did not observe worse outcomes in patients with CF and COVID-19.

High SARS-CoV-2 infection rates and viral loads in community-dwelling individuals from rural indigenous and mestizo communities from the Andes during the first wave of the COVID-19 pandemic in Ecuador

Background

Neglected indigenous groups and underserved rural populations in Latin America are highly vulnerable to COVID-19 due to poor health infrastructure and limited access to SARS-CoV-2 diagnosis. The Andean region in Ecuador includes a large number of isolated rural mestizo and indigenous communities living under poverty conditions.

Objective

We herein present a retrospective analysis of the surveillance SARS-CoV-2 testing in community-dwelling populations from four provinces in the Ecuadorian Andes, carried out during the first weeks after the national lockdown was lifted in June 2020.

Results

A total number of 1,021 people were tested for SARS-CoV-2 by RT-qPCR, resulting in an overall high infection rate of 26.2% (268/1,021, 95% CI: 23.6-29%), which was over 50% in several communities. Interestingly, community-dwelling super spreaders with viral loads over 108 copies/mL represented 7.46% (20/268, 95% CI: 4.8-11.1%) of the SARS-CoV-2 infected population.

Conclusion

These results support that COVID-19 community transmission in rural communities from the Andean region was happening at the early stages of the COVID-19 pandemic in Ecuador and point out the weakness of the COVID-19 control program. Community-dwelling individuals in neglected rural and indigenous communities should be considered for a successful control and surveillance program in future pandemics in low- and middle-income countries.

Burnout syndrome in higher education health professionals working in indigenous health in Brazil

Abstract The aim of this study was to investigate the prevalence of burnout syndrome in higher education health professionals working in indigenous health in Brazil, and to identify associated factors. This is an observational, analytical, and cross-sectional study. Data collection was based on the application of a questionnaire (personal profile and MBI-HSS) and included 513 professionals. The prevalence of burnout was 65%. Greater likelihood of emotional exhaustion was observed among younger professionals, who had worked in indigenous health for longer time, in the care function and with lower level of tranquility when working during the pandemic. Lower likelihood of having low personal accomplishment at work was observed among older professionals, professionals who had worked in indigenous health for shorter time, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. Greater likelihood of depersonalization was found among married professionals, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. This study contributes with an important assessment of the existence of BS predictors in health professionals working in indigenous health.

Burnout syndrome in higher education health professionals working in indigenous health in Brazil

The aim of this study was to investigate the prevalence of burnout syndrome in higher education health professionals working in indigenous health in Brazil, and to identify associated factors. This is an observational, analytical, and cross-sectional study. Data collection was based on the application of a questionnaire (personal profile and MBI-HSS) and included 513 professionals. The prevalence of burnout was 65%. Greater likelihood of emotional exhaustion was observed among younger professionals, who had worked in indigenous health for longer time, in the care function and with lower level of tranquility when working during the pandemic. Lower likelihood of having low personal accomplishment at work was observed among older professionals, professionals who had worked in indigenous health for shorter time, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. Greater likelihood of depersonalization was found among married professionals, who worked in clinical care during the pandemic and those with lower level of tranquility when working during the pandemic. This study contributes with an important assessment of the existence of BS predictors in health professionals working in indigenous health.

Ethnic/Racial Disparity in Mortality from COVID-19: Data for the Year 2020 in Brazil

The study aimed to investigate ethnic/racial disparities in COVID-19 mortality in Brazilian federative units and their respective capitals in 2020. Population data and number of COVID-19 deaths were extracted by skin color (white, black, brown and indigenous) from all Brazilian states and their respective capitals. The mortality rate of COVID-19 by ethnicity in Brazilian states was higher between people from brown skin color, followed by indigenous and black. Only in one state, in the Federal District and in the federal capital, age-standardized mortality rates were higher among white's people. There is a high percentage of deaths from COVID-19 higher than expected among non-white individuals, especially in south-central states and capitals of the country. Mortality from COVID-19 affect ethnic-racial groups unevenly in Brazil and the number of excess deaths among non-whites was over 9000. Urgent government measures are needed to reduce the racial disparity in health indicators in Brazil.

Profile of coronavirus disease enlightened asthma as a protective factor against death: An epidemiology study from Brazil during the pandemic

INTRODUCTION

The possibility that asthma is not a risk factor for the worst outcomes due to coronavirus disease (COVID-19) is encouraged. The increase in Th2 response dominance can downregulate the late phase of hyperinflammation, which is typically the hallmark of more severe respiratory viral infections, alongside lower angiotensin-converting enzyme receptors in patients with asthma due to chronic inflammation. Few studies associated asthma diagnosis and COVID-19 outcomes. In this context, we aimed to associate the asthma phenotype with the clinical signs, disease progression, and outcomes in patients with COVID-19.

METHODS

We performed an epidemiologic study using patients' characteristics from OpenDataSUS to verify the severity of COVID-19 among Brazilian hospitalized patients with and without the asthma phenotype according to the need for intensive care units, intubation, and deaths. We also evaluated the demographic data (sex, age, place of residence, educational level, and race), the profile of clinical signs, and the comorbidities.

RESULTS

Asthma was present in 43,245/1,129,838 (3.8%) patients. Among the patients with asthma, 74.7% who required invasive ventilatory support evolved to death. In contrast, 78.0% of non-asthmatic patients who required invasive ventilatory support died (OR = 0.83; 95% CI = 0.79-0.88). Also, 20.0% of the patients with asthma that required non-invasive ventilatory support evolved to death, while 23.5% of non-asthmatic patients evolved to death (OR = 0.81; 95% CI = 0.79-0.84). Finally, only 11.2% of the patients with asthma who did not require any ventilatory support evolved to death, while 15.8% of non-asthmatic patients evolved to death (OR = 0.67; 95% CI = 0.62-0.72). In our multivariate analysis, one comorbidity and one clinical characteristic stood out as protective factors against death during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients with asthma were less prone to die than other patients (OR = 0.79; 95% CI = 0.73-0.85), just like puerperal patients (OR = 0.74; 95% CI = 0.56-0.97) compared to other patients.

CONCLUSION

Asthma was a protective factor for death in hospitalized patients with COVID-19 in Brazil. Despite the study's limitations on patients' asthma phenotype information and corticosteroid usage, this study brings to light information regarding a prevalent condition that was considered a risk factor for death in COVID-19, being ultimately protective.

Covid-19 Outbreak in Brazil: Health, Social, Political, and Economic Implications

COVID-19 outbreak quickly spread to all corners of the globe. In Brazil, the outbreak was particularly frightening because it worsened existing health, political, economic, and social problems. The results already observed show the contagion ripple-spreading process across the country, causing the death of thousands of people each day and counting, added to a very serious wave of unemployment, scientific denial, and social precariousness. Based on this, this study reviews recent research that looked at the role of the government, the Brazilian health system, and the main economic and social impacts fostered by the pandemic. We perform a scoping review according to the PRISMA-ScR to structure the qualitative synthesis of the 67 associated documents. The results reinforce the negative effects of the country's mismanagement and its consequent impacts on the Brazilian economy and society. The battleground against COVID-19 has fueled political tensions, shaken the health system, and unleashed social despair tinged with thousands of deaths. Finally, in the present scoping review, we discuss concerns about the impacts of the COVID-19 outbreak in Brazil and what the world hopes the country has learned from the current crisis.

Syndemic aspects between COVID-19 pandemic and social inequalities

Although the coronavirus disease 2019 (COVID-19) pandemic has reached all over the world population, it has demonstrated a heterogeneous impact on different populations. The most vulnerable communities which coexist daily with the social inequalities like low access to hygiene and personal protection products, crowded residences, and higher levels of chronic diseases have a higher risk of contact and the spread of infection, beyond unfavorable clinical outcomes. The elevation of the risk of infection exposure can be related to gender due to the presence of a larger contingent of women in essential services, as well as frontline and cleaning professionals who regardless of gender have the greatest exposure to the virus. Such exposures can contribute to the development of fear of contaminating themselves or their family members associated also with the work stress, both of which are related to the emergence of mental disturbances in these populations. Furthermore, conditions of unsanitary living and low socioeconomic status, populations at war, pre-existing social barriers, and ethnicity have contributed to more impact of the pandemic both in the exposure to the virus and access to health services, COVID-19 management, and management of other pathologies. At the same time, factors such as the closing of non-essential services, the loss of jobs, and the increase in household spending aggravated the social vulnerabilities and impacted the family economy. Lastly, the COVID-19 pandemic contributed still more to the impact on women's health since it propitiated a favorable environment for increasing domestic violence rates, through the segregation of women from social life, and increasing the time of the victims with their aggressors.

Characterization of demographic data, clinical signs, comorbidities, and outcomes according to the race in hospitalized individuals with COVID-19 in Brazil: An observational study

Background

Brazil is a multiracial country with five major official races: White, Black, individuals with multiracial backgrounds, Asian, and Indigenous. Brazil is also one of the epicentres of the Coronavirus Disease (COVID)-19 pandemic. Thus, we evaluated how the races of the Brazilian population contribute to the outcomes in hospitalized individuals with COVID-19, and we also described the clinical profile of the five official Brazilian races.

Methods

We performed an epidemiological analysis for the first 67 epidemiological weeks of the COVID-19 pandemic in Brazil (from February 22, 2020, to April 04, 2021) using the data available at OpenDataSUS of the Brazilian Ministry of Health, a data set containing data from Brazilian hospitalized individuals. We evaluated more than 30 characteristics, including demographic data, clinical symptoms, comorbidities, need for intensive care unit and mechanical ventilation, and outcomes.

Results

In our data, 585 655 hospitalized individuals with a positive result in SARS-CoV-2 real-time chain reaction (RT-PCR) were included. Of these total, 309 646 (52.9%) identified as White, 31 872 (5.4%) identified as Black, 7108 (1.2%) identified as Asian, 235 108 (40.1%) identified as individuals with multiracial background, and 1921 (0.3%) identified as Indigenous. The multivariate analysis demonstrated that race was significative to predict the death being that Black (OR = 1.43; 95% CI = 1.39-1.48), individuals with multiracial background (OR = 1.36; 95% CI = 1.34-1.38), and Indigenous (OR = 1.91; 95% CI = 1.70-2.15) races were more prone to die compared to the White race. The Asian individuals did not have a higher chance of dying due to SARS-CoV-2 infection compared to White individuals (OR = 0.99; 95% CI = 0.94-1.06). In addition, other characteristics contributed as such as being male (OR = 1.17; 95% CI = 1.16-1.19), age (mainly, +85 years old – OR = 23.02; 95% CI = 20.05-26.42) compared to 1-year-old individuals, living in rural areas (OR = 1.22; 95% CI = 1.18-1.26) or in peri-urban places (OR = 1.25; 95% CI = 1.11-1.40), and the presence of nosocomial infection (OR = 1.91; 95% CI = 1.82-2.01). Among the clinical symptoms, the main predictors were dyspnoea (OR = 1.25; 95% CI = 1.23-1.28), respiratory discomfort (OR = 1.30; 95% CI = 1.28-1.32), oxygen saturation <95% (OR = 1.40; 95% CI = 1.38-1.43). Also, among the comorbidities, the main predictors were the presence of immunosuppressive disorder (OR = 1.44; 95% CI = 1.39-1.49), neurological disorder (OR = 1.21; 95% CI = 1.17-1.25), hepatic disorder (OR = 1.41; 95% CI = 1.34-1.50), diabetes mellitus (OR = 1.40; 95% CI = 1.37-1.42), cardiopathy (OR = 1.13; 95%CI = 1.11-1.14), hematologic disorder (OR = 1.34; 95% CI = 1.24-1.43), Down syndrome (OR = 1.61; 95% CI = 1.43-1.81), renal disease (OR = 1.15; 95% CI = 1.11-1.18), and obesity (OR = 1.18; 95% CI = 1.15-1.21). Individuals on intensive care unit (OR = 2.25; 95% CI = 2.22-2.29) and on invasive (OR = 10.92; 95% CI = 10.66-11.18) or non-invasive (OR = 1.33; 95% CI = 1.30-1.35) mechanical ventilation were more prone to die.

Conclusions

Alongside several clinical symptoms and comorbidities, we associated race with an enhanced risk of death in Black individuals, individuals with multiracial backgrounds, and Indigenous peoples.

Epidemiologic Profile of Severe Acute Respiratory Infection in Brazil During the COVID-19 Pandemic: An Epidemiological Study

Background

The COVID-19 is a significant public health issue, and monitoring confirmed cases and deaths is an essential epidemiologic tool. We evaluated the features in Brazilian hospitalized patients due to severe acute respiratory infection (SARI) during the COVID-19 pandemic in Brazil. We grouped the patients into the following categories: Influenza virus infection (G1), other respiratory viruses' infection (G2), other known etiologic agents (G3), SARS-CoV-2 infection (patients with COVID-19, G4), and undefined etiological agent (G5).

Methods

We performed an epidemiological study using data from DataSUS (https://opendatasus.saude.gov.br/) from December 2019 to October 2021. The dataset included Brazilian hospitalized patients due to SARI. We considered the clinical evolution of the patients with SARI during the COVID-19 pandemic according to the SARI patient groups as the outcome. We performed the multivariate statistical analysis using logistic regression, and we adopted an Alpha error of 0.05.

Results

A total of 2,740,272 patients were hospitalized due to SARI in Brazil, being the São Paulo state responsible for most of the cases [802,367 (29.3%)]. Most of the patients were male (1,495,416; 54.6%), aged between 25 and 60 years (1,269,398; 46.3%), and were White (1,105,123; 49.8%). A total of 1,577,279 (68.3%) patients recovered from SARI, whereas 701,607 (30.4%) died due to SARI, and 30,551 (1.3%) did not have their deaths related to SARI. A major part of the patients was grouped in G4 (1,817,098; 66.3%) and G5 (896,207; 32.7%). The other groups account for &lt;1% of our sample [G1: 3,474 (0.1%), G2: 16,627 (0.6%), and G3: 6,866 (0.3%)]. The deaths related to SARI were more frequent in G4 (574,887; 34.7%); however, the deaths not related to SARI were more frequent among the patients categorized into the G3 (1,339; 21.3%) and G5 (25,829; 4.1%). In the multivariate analysis, the main predictors to classify the patients in the G5 when compared with G4 or G1-G4 were female sex, younger age, Black race, low educational level, rural place of residence, and the use of antiviral to treat the clinical signs. Furthermore, several features predict the risk of death by SARI, such as older age, race (Black, Indigenous, and multiracial background), low educational level, residence in a flu outbreak region, need for intensive care unit, and need for mechanical ventilatory support.

Conclusions

The possible COVID-19 underreporting (G5) might be associated with an enhanced mortality rate, more evident in distinct social groups. In addition, the patients' features are unequal between the patients' groups and can be used to determine the risk of possible COVID-19 underreporting in our population. Patients with a higher risk of death had a different epidemiological profile when compared with patients who recovered from SARI, like older age, Black, Indigenous, and multiracial background races, low educational level, residence in a flu outbreak region, need for intensive care unit and need for mechanical ventilatory support.

Severe Acute Respiratory Syndrome by SARS-CoV-2 Infection or Other Etiologic Agents Among Brazilian Indigenous Population: An Observational Study from the First Year of Coronavirus Disease (COVID)-19 Pandemic

Background

Indigenous peoples are vulnerable to pandemics, including to the coronavirus disease (COVID)-19, since it causes high mortality and specially, the loss of elderly Indigenous individuals.

Methods

The epidemiological data of severe acute respiratory syndrome (SARS) by SARS-CoV-2 infection or other etiologic agents (OEA) among Brazilian Indigenous peoples during the first year of COVID-19 pandemic was obtained from a Brazilian Ministry of Health open-access database to perform an observational study. Considering only Indigenous individuals diagnosed with SARS by COVID-19, the epidemiology data were also evaluated as risk of death. The type of sample collection for virus screening, demographic profile, clinical symptoms, comorbidities, and clinical evolution were evaluated. The primary outcome was considered the death in the Brazilian Indigenous individuals and the secondary outcome, the characteristics of Brazilian Indigenous infected by SARS-CoV-2 or OEA, as the need for intensive care unit admission or the need for mechanical ventilation support. The statistical analysis was done using Logistic Regression Model. Alpha of 0.05.

Findings

A total of 3,122 cases of Indigenous individuals with SARS in Brazil were reported during the first year of the COVID-19 pandemic. Of these, 1,994 were diagnosed with COVID-19 and 730/1,816 (40.2%) of them died. The death rate among individuals with SARS-CoV-2 was three-fold increased when compared to the group of individuals with OEA. Several symptoms (myalgia, loss of smell, and sore throat) and comorbidities (cardiopathy, systemic arterial hypertension, and diabetes mellitus) were more prevalent in the COVID-19 group when compared to Indigenous individuals with OEA. Similar profile was observed considering the risk of death among the Indigenous individuals with COVID-19 who presented several symptoms (oxygen saturation <95%, dyspnea, and respiratory distress) and comorbidities (renal disorders, cardiopathy, and diabetes mellitus). The multivariate analysis was significant in differentiating between the COVID-19-positive and non-COVID-19 patients [X²₍₇₎=65.187; P-value<0.001]. Among the patients’ features, the following contributed in relation to the diagnosis of COVID-19: age [≥43 years-old [y.o.]; OR=1.984 (95%CI=1.480-2.658)]; loss of smell [OR=2.373 (95%CI=1.461-3.854)]; presence of previous respiratory disorders [OR=0.487; 95%CI=0.287-0.824)]; and fever [OR=1.445 (95%CI=1.082-1.929)]. Also, the multivariate analysis was able to predict the risk of death [X²₍₉₎=293.694; P-value<0.001]. Among the patients’ features, the following contributed in relation to the risk of death: male gender [OR=1.507 (95%CI=1.010-2.250)]; age [≥60 y.o.; OR=3.377 (95%CI=2.292-4.974)]; the need for ventilatory support [invasive mechanical ventilation; OR=24.050 (95%CI=12.584-45.962) and non-invasive mechanical ventilation; OR=2.249 (95%CI=1.378-3.671)]; dyspnea [OR=2.053 (95%CI=1.196-3.522)]; oxygen saturation <95% [OR=1.691 (95%CI=1.050-2.723)]; myalgia [OR=0.423 (95%CI=0.191-0.937)]; and the presence of kidney disorders [OR=3.135 (95%CI=1.144-8.539)].

Interpretation

The Brazilian Indigenous peoples are in a vulnerable situation during the COVID-19 pandemic and presented an increased risk of death due to COVID-19. Several factors were associated with enhanced risk of death, as male sex, older age (≥60 y.o.), and need for ventilatory support; also, other factors might help to differentiate SARS by COVID-19 or by OEA, as older age (≥43 y.o.), loss of smell, and fever.

Funding

Fundação de Amparo à Pesquisa do Estado de São Paulo (Foundation for Research Support of the State of São Paulo; #2021/05810-7).

Seroprevalence and lethality by SARS-CoV-2 in indigenous populations of Latin America and the Caribbean: a systematic review

Background

Latin America and the Caribbean (LAC) has presented some of the highest numbers of cases and deaths due to COVID-19 in the world. Even though indigenous communities represent 8% of the total population in this region, the impact of COVID-19 on this historically vulnerable population has only been briefly explored. Thus, this study aimed to estimate the seroprevalence and lethality attributable to SARS-CoV-2 in the indigenous population of LAC.

Methods

A systematic review was conducted utilizing multiple databases (registry PROSPERO: CRD42020207862). Studies published in English, Spanish or Portuguese were selected between December 1st, 2019, and April 14^th, 2021. The evaluation of the quality of the study was carried out utilizing the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A qualitative synthesis of the data analyzed was conducted following the MOOSE and PRISMA declarations.

Results

Fifteen studies met the inclusion criteria. Eleven studies were carried out in a Brazilian population, three in a Mexican population, and one in a Colombian population. Four studies reported data about the seroprevalence of SARS-CoV-2 in indigenous populations of Brazil (range: 4.2–81.65%). Twelve studies reported lethality in indigenous people (eight in Brazil, three in Mexico, and one in Colombia). In Brazil, a lethality of 53.30% was described in a hospital setting and between 1.83% and 4.03% in community studies. In Mexico, the lethality of COVID-19 ranged between 16.5% and 19.9%. Meanwhile, in Colombia, a lethality of 3.41% was reported. Most studies were deemed to be of good quality.

Conclusions

Despite COVID-19 affecting indigenous populations of LAC, there is limited evidence of the seroprevalence and lethality of the infection by SARS-CoV-2 in this population. Future investigations should ensure standardized methods that allow comparability among studies and ensure the precision of the results obtained.

Covid-19 among the Brazilian Amazon indigenous people: factors associated with death

Abstract This case-control study paired by gender and age analyzes factors associated with the death of indigenous people from COVID-19 in the state of Amapá, Brazil. Data were collected from a public secondary database produced by the Amapá State Department of Health. Cases (n=29) were deaths of indigenous people from COVID-19 and controls were cures of the disease (n=87), recorded between April 2020 and January 2021. Data from individuals with active disease were excluded. Univariate analysis followed by multiple logistic regression were performed to study the independent variables associated with death. Most cases of death were women (51.7%), without comorbidities (62.1%), residing in cities of the Metropolitan Region of Macapá (RMM) (65.5%) and in urban areas (89.7%). Median age of the death group was 72 years (interquartile range=21.5). The final multiple model showed that indigenous individuals with cardiovascular comorbidity had a 4.01 times greater chance (95% confidence interval - 95% CI=1.05-15.36) of death by COVID-19 when compared with indigenous people without comorbidities. And that indigenous people residing in the RMM had a 2.90 times greater chance (95%CI = 1.10-7.67) of death when compared with indigenous residing in the countryside.

Covid-19 entre indígenas na Amazônia brasileira: fatores associados ao óbito

Resumo Este estudo objetiva analisar fatores associados ao óbito de indígenas pela covid-19 no estado do Amapá, Brasil. Trata-se de um estudo caso-controle emparelhado por sexo e idade, que utilizou um banco de dados secundários público, produzido pela Secretaria de Estado da Saúde do Amapá. Os casos (n=29) foram óbitos de indígenas pela covid-19 e os controles foram curas da doença (n=87), registrados entre abril de 2020 e janeiro de 2021. Dados de indivíduos com doença ativa foram excluídos da análise. Foram realizadas análises univariadas seguidas por regressão logística múltipla para estudo das variáveis independentes associadas ao desfecho de óbito. A maioria dos casos de óbito era do sexo feminino (51,7%), sem comorbidades (62,1%), residentes em municípios da Região Metropolitana de Macapá (RMM) (65,5%) e em área urbana (89,7%). A mediana das idades do grupo de óbitos foi de 72 anos (intervalo interquartil= 21,5). O modelo múltiplo final demonstrou que indígenas com comorbidade cardiovascular apresentaram chance 4,01 vezes (intervalo de confiança de 95% - IC 95%= 1,05-15,36) maior de óbito pela covid-19 quando comparados a indígenas sem comorbidades. E que indígenas residentes na RMM apresentaram chance 2,90 vezes (IC 95%= 1,10-7,67) maior de óbito quando comparados aos indígenas residentes no interior do estado Amapá.

COVID-19: Impact on linguistic and genetic isolates of India

The rapid expansion of coronavirus SARS-CoV-2 has impacted various ethnic groups all over the world. The burden of infectious diseases including COVID-19 are generally reported to be higher for the Indigenous people. The historical knowledge have also suggested that the indigenous populations suffer more than the general populations in the pandemic. Recently, it has been reported that the indigenous groups of Brazil have been massively affected by COVID-19. Series of studies have shown that many of the indigenous communities reached at the verge of extinction due to this pandemic. Importantly, South Asia also has several indigenous and smaller communities, that are living in isolation. Till date, despite the two consecutive waves in India, there is no report on the impact of COVID-19 for indigenous tribes. Since smaller populations experiencing drift may have greater risk of such pandemic, we have analysed Runs of Homozygosity (ROH) among South Asian populations and identified several populations with longer homozygous segments. The longer runs of homozygosity at certain genomic regions may increases the susceptibility for COVID-19. Thus, we suggest extreme careful management of this pandemic among isolated populations of South Asia.

COVID-19 pandemic evolution in the Brazilian Indigenous population

INTRODUCTION

The COVID-19 pandemic has affected several neglected populations such as the Indigenous peoples, which have suffered a high impact from the pandemic.

OBJECTIVES

To analyze the impact on the health and disease process according to the COVID-19 evolution in the Brazilian Indigenous population.

METHODS

Data was collected from press releases by the Health Ministry and a descriptive analysis of the numbers of Indigenous individuals infected with the SARS-CoV-2 in Brazil was carried out.

RESULTS

In February 2021, there were 41,855 confirmed cases of Indigenous individuals infected by the SARS-CoV-2, including 4,387 active cases, 36,809 recovered cases, and 549 deaths. The Brazilian Indigenous population is distributed in over 300 ethnic groups and, due to the high number of deaths by the COVID-19, many of these groups are endangered. The elderly are the most affected age group, and they play a fundamental role among the Indigenous population for transmitting their customs mainly orally. Indigenous populations do not have proper access to transport to specialized health centers, since many areas are inaccessible and other cases require air or river transportation, which many times results in late assistance. When managing the COVID-19, it is important to emphasize the need for social isolation to prevent the virus from spreading among the Indigenous groups, mainly due to their contact with other ethnic groups represented by missionaries, hunters, and wood explorers, among others.

CONCLUSION

The adoption of practices that can reduce the virus transmission among the Indigenous population and provide them with better access to treatment, mainly for the elderly, must be prioritized in Brazil.

Non-communicable diseases, sociodemographic vulnerability and the risk of mortality in hospitalised children and adolescents with COVID-19 in Brazil: a cross-sectional observational study

OBJECTIVES

To analyse how previous comorbidities, ethnicity, regionality and socioeconomic development are associated with COVID-19 mortality in hospitalised children and adolescents.

DESIGN

Cross-sectional observational study using publicly available data from the Brazilian Ministry of Health.

SETTING

Nationwide.

PARTICIPANTS

5857 patients younger than 20 years old, all of them hospitalised with laboratory-confirmed COVID-19, from 1 January 2020 to 7 December 2020.

MAIN OUTCOME MEASURE

We used multilevel mixed-effects generalised linear models to study in-hospital mortality, stratifying the analysis by age, region of the country, presence of non-communicable diseases, ethnicity and socioeconomic development.

RESULTS

Individually, most of the included comorbidities were risk factors for mortality. Notably, asthma was a protective factor (OR 0.4, 95% CI 0.24 to 0.67). Having more than one comorbidity increased almost tenfold the odds of death (OR 9.67, 95% CI 6.89 to 13.57). Compared with white children, Indigenous, Pardo (mixed) and East Asian had significantly higher odds of mortality (OR 5.83, 95% CI 2.43 to 14.02; OR 1.93, 95% CI 1.48 to 2.51; OR 2.98, 95% CI 1.02 to 8.71, respectively). We also found a regional influence (higher mortality in the North-OR 3.4, 95% CI 2.48 to 4.65) and a socioeconomic association (lower mortality among children from more socioeconomically developed municipalities-OR 0.26, 95% CI 0.17 to 0.38) CONCLUSIONS: Besides the association with comorbidities, we found ethnic, regional and socioeconomic factors shaping the mortality of children hospitalised with COVID-19 in Brazil. Our findings identify risk groups among children that should be prioritised for public health measures, such as vaccination.

The hindrances to perform the COVID-19 vaccination in Brazil

INTRODUCTION

Brazil is one of the epicenters of COVID-19 pandemic and faces several hindrances to make his COVID-19 vaccination plan efficient.

METHODS

The Brazilian COVID-19 vaccination plan was evaluated and the hindrances to make the COVID-19 vaccination plan efficient were described and discussed.

RESULTS

High territorial extension might contribute to a delay on the COVID-19 vaccination, due to difficulty in delivering vaccines to furthest Brazilian states and to all the interior cities. The choice among the vaccines should be done based on the type of storage and must consider the transport conditions necessary to maintain its effectiveness. The indigenous individuals were included with health-care workers as the first group to be vaccinated, inflaming the number of vaccines doses distributed in states where the indigenous population have higher prevalence. The antivaccine movement and the politicization of the vaccine are also hindrances to be overcome in Brazil. The COVID-19 incidence or mortality rate and the distribution of intensive care units (ICUs) are not a criterion to distribute the vaccines, as we did not identify a correlation between these markers and the number of vaccines. However, a strong or very strong correlation occurred between the number of COVID-19 vaccines and the number of COVID-19 cases, deaths by COVID-19, gross domestic product, as well as populational density. A total of 83,280,475 doses of COVID-19 vaccines were distributed in Brazil. In the first dose, the Coronavac (Sinovac™), AZD1222 (AstraZeneca/Oxford™), and BNT162b (Pfizer/BioNTech™) vaccines were responsible to vaccinate, respectively, 9.61%, 6.69%, and 0.35% of the Brazilian population. In the second dose, the Coronavac, AZD1222, and BNT162b vaccines were responsible to vaccinate, respectively, 7.52%, 0.53%, and <0.01% of the Brazilian population.

CONCLUSIONS

The Federal Government must evaluate the hindrances and propose solutions to maximize the immunization against COVID-19 on Brazil.

A decentralised point-of-care testing model to address inequities in the COVID-19 response

The COVID-19 pandemic is growing rapidly, with over 37 million cases and more than 1 million deaths reported by mid-October, 2020, with true numbers likely to be much higher in the many countries with low testing rates. Many communities are highly vulnerable to the devastating effects of COVID-19 because of overcrowding in domestic settings, high burden of comorbidities, and scarce access to health care. Access to testing is crucial to globally recommended control strategies, but many communities do not have adequate access to timely laboratory services. Geographic dispersion of small populations across islands and other rural and remote settings presents a key barrier to testing access. In this Personal View, we describe a model for the implementation of decentralised COVID-19 point-of-care testing in remote locations by use of the GeneXpert platform, which has been successfully scaled up in remote Aboriginal and Torres Strait Islander communities across Australia. Implementation of the decentralised point-of-care testing model should be considered for communities in need, especially those that are undertested and socially vulnerable. The decentralised testing model should be part of the core global response towards suppressing COVID-19.

Risk factors for critical illness and death among adult Brazilians with COVID-19

INTRODUCTION

Severe acute respiratory syndrome coronavirus 2 has infected more than 9,834,513 Brazilians up to February 2021. Knowledge of risk factors of coronavirus disease among Brazilians remains scarce, especially in the adult population. This study verified the risk factors for intensive care unit admission and mortality for coronavirus disease among 20-59-year-old Brazilians.

METHODS

A Brazilian database on respiratory illness was analyzed on October 9, 2020, to gather data on age, sex, ethnicity, education, housing area, and comorbidities (cardiovascular disease, diabetes, and obesity). Multivariate logistic regression analysis was performed to identify the risk factors for coronavirus disease.

RESULTS

Overall, 1,048,575 persons were tested for coronavirus disease; among them, 43,662 were admitted to the intensive care unit, and 34,704 patients died. Male sex (odds ratio=1.235 and 1.193), obesity (odds ratio=1.941 and 1.889), living in rural areas (odds ratio=0.855 and 1.337), and peri-urban areas (odds ratio=1.253 and 1.577) were predictors of intensive care unit admission and mortality, respectively. Cardiovascular disease (odds ratio=1.552) was a risk factor for intensive care unit admission. Indigenous people had reduced chances (odds ratio=0.724) for intensive care unit admission, and black, mixed, East Asian, and indigenous ethnicity (odds ratio=1.756, 1.564, 1.679, and 1.613, respectively) were risk factors for mortality.

CONCLUSIONS

Risk factors for intensive care unit admission and mortality among adult Brazilians were higher in men, obese individuals, and non-urban areas. Obesity was the strongest risk factor for intensive care unit admission and mortality.

Emerging complexities and rising omission: Contrasts among socio-ecological contexts of infectious diseases, research and policy in Brazil

In this article, we explore elements that highlight the interdependent nature of demands for knowledge production and decision-making related to the appearance of emerging diseases. To this end, we refer to scientific production and current contextual evidence to verify situations mainly related to the Brazilian Amazon, which suffers systematic disturbances and is characterized as a possible source of pathogenic microorganisms. With the acceleration of the Anthropocene's environmental changes, socio-ecological instabilities and the possibility of the emergence of infectious diseases merge into a background of a ´twin insurgency´. Furthermore, there is a tendency to impose economic hegemony in the current Brazilian context, corroborating discourses and pressures to a scientific simplification and denial. With this, we assert that developmental sectoral actions and monoculture of knowledge characterize an agenda of omission, that is, a process of decision making that indirectly reinforces ecological degradation and carelessness in the face of the possibility of the emergence and spreading of new diseases, such as COVID-19. Tackling the socio-ecological complexity inherent in the risk of the emergence of infectious diseases requires robust co-construction of scientific knowledge, eco-social approaches, and corresponding governance and sophisticated decision-making arrangements.