More than 7.8 million Brazilians are at least four hours away from a town where high-complexity healthcare is available, such as an intensive care unit (ICU), suitable equipment and staff specialized in severe and acute respiratory diseases as the one caused by the Covid-19 epidemic. This is one of the main conclusions of the most recent analysis by the Institute of Scientific and Technological Communication and Information in Health (Icict), of Fiocruz.
Published on the technical note of the MonitoraCovid-19 system (bigdata-covid19.icict.fiocruz.br) titled Regions and Networks of Covid-19: Access to health services and flow of patients traveling in search of hospital admission, the analysis shows that the situation is worse in the states of Amazonas (1.3 million inhabitants) and Pará (2.3 millions), in the North, and Mato Grosso (888 thousand), in the Center-West region. In these three Brazilian states, more than 20% of the population live in places up to 4 hours away from the closest town with healthcare conditions adequate to treat severe cases of Covid-19.
Other regions with a high percentage of the population living more than four hours away to a town with specialized healthcare are the innermost areas of the North-East region, the northen part of the state of Minas Gerais, and the south of the states of Piauí and Maranhão.
The analysis of Icict/Fiocruz crossed figures of hospital admissions due to respiratory problems (including Covid-19) from the Ministry of Health’s Sivep-Gripe (influenza) database with population displacement and distances potentially covered by the population, considering the Regions of Influence of the Cities (IBGE, 2018) and the Health Regions (CIR) defined by the Secretaries of Health of each state.
The technical note also highlighted the quickness of the interiorization of Covid-19. For instance in just one week (between 9 and 16 May), in the municipalities with populations between 20 and 50 thousand inhabitants, six cities reported for the first time a fatal victim of Covid-19, every day. Among smaller towns, with population between 10 and 20 thousand people, in the same week, every day five cities joined the list of towns with deaths by Covid-19.
On average, in that same week, in towns with less than 50,000 inhabitants, every day 15 cities reported their first case of Covid-19. The first case of Covid-19 infection was registered in 227 municipalities with less than 10 thousand inhabitants; in 197 towns with 10 to 20,000 inhabitants; and in 112 with populations ranging from 20 to 50 thousand inhabitants. Up to May 16, 60% of Brazilian municipalities had registered cases of the disease, and 21% had deaths by the disease. In towns with more than 50 thousand inhabitants, 98% had cases and 58% had coronavirus-related deaths.
The technical note highlights the importance of integration and dialogue between towns, states and the federal government in Covid-19 containment policies, and shows the challenge represented by interiorization:
“One of the great problems for the Brazilian health network is geographical accessibility. The country has continental dimensions, and some of its more remote regions force their populations to cross huge distances in search of healthcare (...) Of course, not all towns in the country are expected to have an intensive care unit, but it is necessary to define reference and counter-reference services in healthcare, avoiding areas without services as well as long displacements, which may affect an individual’s health condition”, states the technical note.
The note also concludes that defining and using regions made up of sets of municipalities is the way to adopt restriction or relaxing measures for social isolation.