Deciphering Multifactorial Correlations of COVID-19 Incidence and Mortality in the Brazilian Amazon Basin

Abstract

Amazonas suffered greatly during the COVID-19 pandemic. The mortality and fatality rates soared and scarcity of oxygen and healthcare supplies led the health system and funerary services to collapse. Thus, we analyzed the trends of incidence, mortality, and lethality indicators of COVID-19 and the dynamics of their main determinants in the state of Amazonas from March 2020 to June 2021. This is a time-series ecological study. We calculated the lethality, mortality, and incidence rates with official and public data from the Health Department. We used the Prais–Winsten regression and trends were classified as stationary, increasing, or decreasing. The effective reproduction number (Rt) was also estimated. Differences were considered significant when p < 0.05. We extracted 396,772 cases of and 13,420 deaths from COVID-19; 66% of deaths were in people aged over 60; 57% were men. Cardiovascular diseases were the most common comorbidity (28.84%), followed by diabetes (25.35%). Rural areas reported 53% of the total cases and 31% of the total deaths. The impact of COVID-19 in the Amazon is not limited to the direct effects of the pandemic itself; it may present characteristics of a syndemic due to the interaction of COVID-19 with pre-existing illnesses, endemic diseases, and social vulnerabilities.

Analyzing the COVID-19 Transmission Dynamics in Acre, Brazil: An Ecological Study

“…The state of Acre presents a complex scenario influenced by multiple variables affecting the pandemic and the spread of COVID-19 [ 7 , 50 ], leading to numerous challenges impacting incidence, mortality, and lethality rates. Among its 22 municipalities, 14 are categorized as rural [ 11 ], where rivers serve as crucial transportation routes for people and goods, and in some areas, they represent the only form of access.…”

“…The northern Brazilian region is characterized by widespread poverty, with all states exhibiting poverty indicators surpassing the national average [ 6 , 7 , 8 ] and Acre ranking among the poorest states in the country [ 8 ]. These disparities have exacerbated the impact of respiratory illnesses on the healthcare system during the COVID-19 pandemic, particularly in areas facing limited healthcare resources [ 8 , 9 ] and discernible discrepancies in healthcare infrastructure and investment relative to other regions of Brazil [ 10 ].…”

Notification of malaria cases in the Brazilian Amazon Basin from 2010 to 2020: an analysis of the reporting times

“…Although the COVID-19 pandemic in 2020 might also help to enlarge reporting times in the Amazon basin due to the priorities in COVID-19 attention, Fig. 3 illustrates the increases in mean and standard deviation before COVID pandemic [ 22 ]. The malaria rebound between 2017 and 2019 might also explain the rise in reporting delay compared to previous years that obtained fewer cases [ 23 ].…”

Using a Syndemics Perspective to (Re)conceptualize Vulnerability during the COVID-19 Pandemic: A Scoping Review

“…Out of the 13 original research studies identified in this review, eight (8) collected primary data [23,35,37,38,49,54,56,57], four (4) relied exclusively on secondary data [24][25][26]34], and one (1) combined secondary and primary data [45]. None of the identified publications intended to demonstrate the existence of a particular syndemic; instead, they used syndemic theory as an interpretative lens (an approach, a theory, a concept, or a framework) to conceptualize and analyse emerging data.…”

“…Pre-existing socio-environmental vulnerabilities were defined in terms of people's exposure to poor sanitation systems and water and air pollutants, as well as consistently deficient access to health services, which particularly impacted those with higher exposure to NCDs such as undocumented migrants, indigenous communities, and workers linked with unregularized activities such as illegal mining and logging in the Brazilian Amazon [34]. Variations in these indicators were associated with increased difficulties in illness management and as such, described as amplifiers or generators of syndemic vulnerability in NCDs patients [35].…”