Emergency Care Gap in Brazil: Geographical Accessibility as a Proxy of Response Capacity to Tackle COVID-19

Abstract

Background: The new coronavirus disease (COVID-19) has claimed thousands of lives worldwide and disrupted the health system in many countries. As the national emergency care capacity is a crucial part of the COVID-19 response, we evaluated the Brazilian Health Care System response preparedness against the COVID-19 pandemic.Methods: A retrospective and ecological study was performed with data retrieved from the Brazilian Information Technology Department of the Public Health Care System. The numbers of intensive care (ICU) and hospital beds, general or intensivist physicians, nurses, nursing technicians, physiotherapists, and ventilators from each health region were extracted. Beds per health professionals and ventilators per population rates were assessed. A health service accessibility index was created using a two-step floating catchment area (2SFCA). A spatial analysis using Getis-Ord Gi* was performed to identify areas lacking access to high-complexity centers (HCC).Results: As of February 2020, Brazil had 35,682 ICU beds, 426,388 hospital beds, and 65,411 ventilators. In addition, 17,240 new ICU beds were created in June 2020. The South and Southeast regions have the highest rates of professionals and infrastructure to attend patients with COVID-19 compared with the northern region. The north region has the lowest accessibility to ICUs.Conclusions: The Brazilian Health Care System is unevenly distributed across the country. The inequitable distribution of health facilities, equipment, and human resources led to inadequate preparedness to manage the COVID-19 pandemic. In addition, the ineffectiveness of public measures of the municipal and federal administrations aggravated the pandemic in Brazil.

Supply-demand balance and spatial distribution optimization of primary care facilities in highland cities from a resilience perspective: A study of Lhasa, China

“…The equilibrium of public service facilities is manifested on the one hand by the equilibrium between the supply capacity and demand level of healthcare services in a particular area, and on the other hand by the spatial distribution of the supply-demand relationship between different areas within the study's scope ( 71 , 97 , 98 ). The balance of supply and demand is intended to be the equilibrium between all products and services provided by society and social requirements in each period, as evidenced by the changes in product supply and social demands in response to product price changes, and at a certain price point ( 99 , 100 ).…”

“…Existing studies on the location and arrangement of public facilities can be divided into two categories: distribution evaluation and distribution optimization (62-64). Among them, most distribution evaluation studies are conducted from the perspective of spatial accessibility to calculate the transportation convenience from residences to facilities to accurately identify the areas lacking public services due to poor accessibility and to provide distribution optimization recommendations (65)(66)(67)(68)(69)(70)(71)(72). For instance, some scholars analyzed the accessibility of public playgrounds from the standpoint of spatial justice while taking numerous social potential aspects into account (67).…”

COVID-19 mortality in Brazil, 2020-21: consequences of the pandemic inadequate management

“…In turn, inadequate management of the COVID-19 epidemic caused an unprecedented crisis in Brazilian health. The unavailability of equipment, inpatient beds, places in ICUs, and health care teams to meet emergency health needs has undoubtedly aggravated the COVID-19 lethality in the country [33][34][35].…”

Better healthcare can reduce the risk of COVID-19 in-hospital post-partum maternal death: evidence from Brazil

“…There was an insufficient number of ICU beds and ventilators during the pandemic. 18 The Southeast Region was chosen as the reference group for location variables since it had the best and most accessible healthcare in the country. Hispanic/African was selected as the reference group for ethnicity as they formed the largest ethnic group in Brazil.…”