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.
Highlights
The advance of the novel coronavirus, which has already claimed more than one million lives globally, has hit the Indigenous populations of the Brazilian Amazon head-on
In terms of health care infrastructure, we considered the sum of Basic Healthcare Units (BHU) facilities administrated by SESAI4 per Indigenous population according to each DSEI
6RAISG is a consortium of civil society organizations from the Amazon countries that produces and disseminates statistical data and geospatial socioenvironmental information. 7CAR is the acronym for Cadastro Ambiental Rural, the mandatory register for every rural property to be recognized by the federal government. 8To calculate deforestation, we considered the whole area for each Indigenous Land and excluded rivers, lakes, and other types of landscape features that did not match the naturally occurring vegetation
Summary
The advance of the novel coronavirus, which has already claimed more than one million lives globally, has hit the Indigenous populations of the Brazilian Amazon head-on. The history of Indigenous Peoples in Brazil, regardless of ethnicity, is marked by a series of epidemics caused by exogenous diseases, which have left a death trail in their wake, from the beginning of the colonization period until the current days [2]. This process results from a deep and cruel history of subjugation and marginalization of Indigenous Peoples [3, 4], which they actively fight against since . Indigenous children and women present higher levels of malnutrition and anemia, among other morbidities [6], when compared to the Brazilian population as a whole [7, 8], as a direct effect of the inequalities expressed by health disparity [4, 9]
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