Under-Reporting of COVID-19 Cases Among Indigenous Peoples in Brazil: A New Expression of Old Inequalities

Abstract

Objective: To estimate the incidence, mortality and lethality rates of COVID-19 among Indigenous Peoples in the Brazilian Amazon. Additionally, to analyze how external threats can contribute to spread the disease in Indigenous Lands (IL).Methods: The Brazilian Amazon is home to nearly half a million Indigenous persons, representing more than 170 ethnic groups. As a pioneer in heading Indigenous community-based surveillance (I-CBS) in Brazil, the Coordination of the Indigenous Organizations of the Brazilian Amazon (COIAB) started to monitor Indigenous COVID-19 cases in March of 2020. Brazil's Ministry of Health (MOH) was the main source of data regarding non-Indigenous cases and deaths; to contrast the government's tally, we used the information collected by I-CBS covering 25 Special Indigenous Sanitary Districts (DSEI) in the Brazilian Amazon. The incidence and mortality rates of COVID-19 were calculated using the total number of new cases and deaths accumulated between the 9th and 40th epidemiological weeks. We studied (a) the availability of health care facilities to attend to Indigenous Peoples; (b) illegal mines, land grabbing, and deforestation to perform a geospatial analysis to assess how external threats affect Indigenous incidence and mortality rates. We used the Generalized Linear Model (GLM) with Poisson regression to show the results.Results: MOH registered 22,127 cases and 330 deaths, while COIAB's survey recorded 25,356 confirmed cases and 670 deaths, indicating an under-reporting of 14 and 103%, respectively. Likewise, the incidence and mortality rates were 136 and 110% higher among Indigenous when compared with the national average. In terms of mortality, the most critical DSEIs were Alto Rio Solimões, Cuiabá, Xavante, Vilhena and Kaiapó do Pará. The GLM model reveals a direct correlation between deforestation, land grabbing and mining, and the incidence of cases among the Indigenous.Conclusion: Through this investigation it was possible to verify that not only the incidence and mortality rates due to COVID-19 among Indigenous Peoples are higher than those observed in the general population, but also that the data presented by the federal government are underreported. Additionally, it was evident that the presence of illegal economic activities increased the risk of spreading COVID-19 in ILs.

Intergenerational Association of Short Maternal Stature with Stunting in Yanomami Indigenous Children from the Brazilian Amazon

“…Other potential threats help explain the precarious nutritional conditions of the Yanomami Brazilian children, such as the invasions of the traditional territories by illegal miners, loggers, grabbing, and other criminals searching of wealth in the Amazon Forest [45,46]. All factors previously mentioned can simultaneously increase the risks of food insecurity and the maintenance of stunting in children under five years of age and all family members living in the region.…”

Disparities in Excess Mortality Between Indigenous and Non-Indigenous Brazilians in 2020: Measuring the Effects of the COVID-19 Pandemic

“…For instance, Alves et al (2021) analyzed only the excess deaths from causes that are clinically similar to COVID-19, an approach that is more appropriate for investigating the level of under-reporting in mortality associated with COVID-19 [ 32 ]. A study conducted by Fellows et al (2021) observed an under-reporting of 14 and 103% in confirmed cases and deaths from COVID-19, respectively, among the Indigenous population living in the Brazilian Amazon [ 34 ]. In this study, we provide a comprehensive analysis of the impacts of the pandemic on Indigenous and non-Indigenous mortality, including data on deaths from all causes.…”

“…The hostile political agenda for Indigenous rights in Brazil and the recent weakening of environmental protection policies are likely to have increased the vulnerability of the Indigenous population to the pandemic. Evidence has shown that the incidence of COVID-19 cases among the Indigenous Peoples from the Amazon area is directly correlated with illegal activities in Indigenous territories such as land grabbing, mining, and deforestation [ 34 ]. Conflicts between Indigenous populations and invaders may represent an important source of exposure of Indigenous communities to the SARS-CoV-2.…”

“…We were not able to assess whether there were differences in excess deaths between rural and urban Indigenous populations due to the unavailability of such granular data. Due to a potential under-reporting of COVID-19 deaths among the Indigenous population, the estimates of excess deaths reported in this study may be conservative, especially regarding the Indigenous population [ 34 ]. Consequently, the disparities related to COVID-19 mortality between Indigenous and non-Indigenous Brazilians could be even greater than indicated by our findings.…”

Consequências e agravantes de saúde evidenciados pela COVID-19 em populações indígenas brasileiras: uma revisão integrativa

“…Título Ano Agravos evidenciados pela pandemia de Covid-19 mortes = 330) que indicaram a ocorrência de subnotificação de 14 contaminações e de 103% de mortes (Fellows et al, 2021).…”