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

Lincoln Luís Silva,Guilherme Luiz Rodrigues Ramajo,Rosilene Fressatti Cardoso,Thiago Augusto Hernandes Rocha,Pedro Henrique Iora,Iago Amado Peres Gualda,Luciano De Andrade,Pedro Vasconcelos Maia Do Amaral,João Ricardo Nickenig Vissoci,Amanda De Carvalho Dutra,João Felipe Hermann Costa Scheidt,Catherine Ann Staton

doi:10.3389/fpubh.2021.740284

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.

Highlights

In December 2019, the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was identified as the causative agent of coronavirus 2019 (COVID-19) [1]
The aim was to evaluate the Brazilian health system infrastructure based on the amount of health resources (ICU and hospital beds, health professionals, and the accessibility to intensive care units (ICU) beds) to verify the Brazilian preparedness for the COVID-19 pandemic
To reduce local and regional inequality, Brazil was divided into 438 health regions to correct these distortions among the States in order to optimize the distribution of resources and efficiency in the health care network [14]

Summary

Introduction

In December 2019, the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was identified as the causative agent of coronavirus 2019 (COVID-19) [1]. Brazil, where the virus reached much later than other countries, is one of the most affected countries with 19.1 million confirmed cases and 533,000 deaths reported so far [2]. This case burden put the Brazilian health service at risk of total collapse [3]. Resource constraints, including a lack of intensive care, inequitable distribution of hospital beds, and inadequate numbers of ventilators, compromise the capacity of the health system to care for patients with COVID-19 [5]. 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

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Conclusion