Primary health care and social isolation against COVID-19 in Northeastern Brazil: Ecological time-series study

Abstract

Background Brazil is witnessing a massive increase of corona virus disease (COVID-19). Its peculiar primary health care (PHC) system faces a burden due to the contagion occurring in the community environment. Then, the aim is to estimate the effect of the coverage of primary health care and social isolation on the evolution of confirmed cases and deaths by COVID-19, controlling sociodemographic, economic and health system aspects. Methods A time series design was designed with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capital cities of the Northeast region of Brazil. Independent variables such as PHC coverage, hospital beds, social isolation, demographic density, Gini index and other indicators were analyzed. A Autoregressive Generalized Linear Model method was applied for model the relationship. Results We identified an exponential growth of cases (y = 0.00250.71x; p-value<0,001). However, there is a high variability in the occurrence of outcomes. PHC coverage≥75% (χ2 = 9.27; p-value = 0.01) and social isolation rate (χ2 = 365.99; p-value<0.001) proved to be mitigating factors for the spread of COVID-19 and its deaths. Capitals with hospital beds ≥ 3.2 per thousand inhabitants had fewer deaths (χ2 = 9.02; p-value = 0.003), but this was influenced by PHC coverage (χ2 = 30,87; p-value<0.001). Conclusions PHC mitigates the occurrence of Covid-19 and its deaths in a region of social vulnerability in Brazil together with social isolation. However, it is not known until when the system will withstand the overload in view of the low adhesion to social isolation, the lack of support and appropriate direction from the government to its population.

COVID-19 in Brazilian cities: Impact of social determinants, coverage and quality of primary health care

“…However, these effects are minimized when PHC coverage is expanded. Based on these inferences, some social protection measures should be developed by the government in the current situation, such as 1) the provision of free and comprehensive tests, prioritizing communities that present a greater risk for the worsening and contagion of the disease, also the collection of sociodemographic data from individuals [26], 2) government officials, community leaders and the local media should consult and collaborate with specialists in medicine and public health to offer public health messages directed at low-income and high-risk populations [26]; 3) government officials must provide a minimum income for informal or unemployed workers to be able to achieve social isolation in an appropriate manner and in a timely manner; 4) alternative options for providing creative, flexible, and accessible health services to populations with difficult access to health services [27,28]. These measures must be taken by Government officials to reduce health inequities, which makes PHC and its teams essential for the effectiveness of social protection measures, as they are inserted in vulnerable communities, and have knowledge of the territory and the resident population and their risk factors.…”

“…Unfortunately, what we observe is a denial of the pandemic, reflecting the lack of interest by the Ministry of Health in proposing guidelines based on available scientific evidence. This reflected in the timely organization of PHC community services, which could be leveraged with appropriate investments as presented above until obtaining effective and effective vaccines for the population [28,29].…”

Trends in COVID-19 mortality and case-fatality rate in the State of Paraná, South Brazil: spatiotemporal analysis over one year of the Pandemic

“…The transmissibility and, consequently, the incidence are also influenced by social isolation or distancing measures 34 . Chen and colleagues 35 examined coronavirus transmission and associated factors in six countries (China, Korea, Japan, Italy, the USA, and Brazil).…”