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Economic and regional disparities are related to mortality and testing, CT scans and X-ray access among children and adolescents hospitalized for Covid-19. Photo: Piron Guillaume / Unsplash

In Brazil’s poorest municipalities, children admitted to hospital for Covid-19 were about four times more likely to die than municipal residents with the highest per capita GDP. Among adolescents, the risk was almost double. Inequality also recurred between regions of the country: in the northeast, infant mortality was 2.5 times higher than in the southeast. Here are some of the findings from a study conducted in the Federal University of Santa Catarina’s (UFSC) postgraduate program in public health.

Conducted by researchers Caroline FabrinDuring his undergraduate degree, and supervised by professors and epidemiologists Alexandra BoeingThe work reveals how socio-economic inequality has affected hospital care and the mortality of children and adolescents hospitalized for covid-19 in Brazil between March 2020 and December 2021. It used data from more than 22,000 people between the ages of 0 and 18. , Taken from the Influenza Epidemiological Surveillance Information System (Sivep-Gripe), which records hospitalizations and deaths from severe Acute Respiratory Syndrome (SARS) throughout the Brazilian region, and whose termination is mandatory for public health services and for the individual.

In addition to demonstrating how economic and regional disparities were associated with mortality rates for children and adolescents hospitalized for Covid-19, the study also found discrepancies between test and test performance. CT scans were twice as common in municipalities with the highest decile of GDP per capita as in poorer municipalities. They had about twice the frequency of children in the south than in the north of the country. Biological sample collection and X-rays for diagnosis were more frequent in high-income areas. The results were consistent during the two-wave analysis of the Covid-19.

According to municipal and macro-regional GDP decile, the table collects biological sample collection access, X-ray and CT scans, use of ventilation assistance, ICU admissions, and hospitalized infants and adolescents for Covid-19.

The results show how the disease affected the population disproportionately and contrasted between Brazilian territories and municipalities. The amount of specialized equipment and professionals in rich areas explains only part of the result. Caroline cites examples of other factors that affect the problem: “It is the accumulation of multiple factors that negatively affect the lives of residents, including social adversity, such as poor living and working conditions, low access to health services and high incidence of chronic diseases. Physical distance is ineffective, a work situation that makes remote work impossible. These conditions can increase exposure to the virus and result in the spread of a population that is generally more susceptible to chronic disease.

According to the researchers, the work sheds light on the syndrome of Kovid-19. A syndrome is a situation in which two or more diseases interact in such a way that they do more harm than good. A neologism that combines “synergy” and “epidemic”, the term was coined by anthropologist Meryl Singer in the 1990s. In an interview given to BBC News WorldSinger explains that “the effects of these interactions are also facilitated by social and environmental conditions that, in some ways, bring these two diseases closer together or make the population more vulnerable to their effects.”

This is the case with Covid-19. Its most negative consequences are measured by pre-existing inequality and its impact on society also extends to social injustice. “This feature of Covid as a syndicate is an interaction between pre-existing clinical conditions and social and economic factors, the whole thing that I relate to earlier, involving work conditions that do not allow remote work, crowd houses. It turns out that the epidemic in this population is in the context of a syndrome, “said Caroline.

All of these relationships that make certain groups more vulnerable must be taken into account by the state. “It is important to consider population characteristics when facing a crisis. So the population that is already disadvantaged should be given priority in times of crisis. And not what happened in the country in the face of the epidemic. Conflicts should be addressed according to the needs of each location, ”the researcher stressed.

The research could contribute to Covid-19’s new wave or even future epidemics or pandemic response plans, “so that we can focus on the needs of each location, so that we have a more integrated policy to respond. Not different, according to the power of each municipality or state, so that it is homogeneous and takes into account local needs, the need for each location to respond to the health crisis. In general, the health network is not well distributed, and this needs to be taken into account, “said Caroline.

Another contribution to this work was a clear view of the situation of children and adolescents during the Covid-19 epidemic. Caroline says the inspiration for the study stemmed from the perceptions of a small number of studies investigating the effects of the disease on these populations. “Since children’s data analysis is very small, there is a need to understand what is happening to children. There were many publications about Kovid among adults and adults, but children were a group about which a few publications were published,” he commented.

According to him, most of the articles found in the specialized literature tried to describe the clinical features of the disease, test results and risk factors related to previous congenital diseases, as well as the incidence and mortality rate. “Some have addressed the link between socioeconomic inequality of the pediatric population and the Covid-19 results. In addition, other studies on discrimination have only analyzed ethnic cross-sections. “

Caroline also noted that the results of her research emphasize the importance of planning health activities specifically aimed at children and adolescents, “because they suffer from covid side effects in addition to suffering from the disease.”

Camilla Raposo / Ezcom / UFSC Journalist

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