Costa de Assis Sanderson José, Lopes Johnnatas Mikael, Guedes Marcello Barbosa Otoni Gonçalves, Sanchis Geronimo José Bouzas, Araujo Diego Neves, Roncalli Angelo Giuseppe
Public Health Program, Universidade Federal do Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil.
Medicine Department, Universidade Federal do Vale do São Francisco, Bahia, Brazil.
PLoS One. 2021 May 13;16(5):e0250493. doi: 10.1371/journal.pone.0250493. eCollection 2021.
Brazil is witnessing a massive increase of corona virus disease (COVID-19). Its peculiar primary health care (PHC) system faces a burden due to the contagion occurring in the community environment. Then, the aim is to estimate the effect of the coverage of primary health care and social isolation on the evolution of confirmed cases and deaths by COVID-19, controlling sociodemographic, economic and health system aspects.
A time series design was designed with data on diagnosed cases of COVID-19 and their deaths as outcomes in the capital cities of the Northeast region of Brazil. Independent variables such as PHC coverage, hospital beds, social isolation, demographic density, Gini index and other indicators were analyzed. A Autoregressive Generalized Linear Model method was applied for model the relationship.
We identified an exponential growth of cases (y = 0.00250.71x; p-value<0,001). However, there is a high variability in the occurrence of outcomes. PHC coverage≥75% (χ2 = 9.27; p-value = 0.01) and social isolation rate (χ2 = 365.99; p-value<0.001) proved to be mitigating factors for the spread of COVID-19 and its deaths. Capitals with hospital beds ≥ 3.2 per thousand inhabitants had fewer deaths (χ2 = 9.02; p-value = 0.003), but this was influenced by PHC coverage (χ2 = 30,87; p-value<0.001).
PHC mitigates the occurrence of Covid-19 and its deaths in a region of social vulnerability in Brazil together with social isolation. However, it is not known until when the system will withstand the overload in view of the low adhesion to social isolation, the lack of support and appropriate direction from the government to its population.
巴西正在经历冠状病毒病（COVID-19）的大规模增长。其独特的初级卫生保健（PHC）系统因社区环境中发生的传染而面临负担。因此，目的是评估初级卫生保健覆盖范围和社会隔离对COVID-19确诊病例和死亡演变的影响，同时控制社会人口、经济和卫生系统方面的因素。
采用时间序列设计，以巴西东北部地区首府城市中COVID-19确诊病例及其死亡数据作为结果。分析了诸如初级卫生保健覆盖范围、医院病床、社会隔离、人口密度、基尼指数等自变量及其他指标。应用自回归广义线性模型方法对这种关系进行建模。
我们发现病例呈指数增长（y = 0.0025×0.71x；p值<0.001）。然而，结果的发生存在很大差异。初级卫生保健覆盖范围≥75%（χ2 = 9.27；p值 = 0.01）和社会隔离率（χ2 = 365.99；p值<0.001）被证明是COVID-19传播及其死亡的缓解因素。每千名居民拥有≥3.2张医院病床的首府城市死亡人数较少（χ2 = 9.02；p值 = 0.003），但这受到初级卫生保健覆盖范围的影响（χ2 = 30.87；p值<0.001）。
在巴西社会脆弱地区，初级卫生保健与社会隔离一起减轻了Covid-19的发生及其死亡。然而，鉴于对社会隔离的低依从性、政府对民众缺乏支持和适当指导，该系统能承受这种超负荷状态到何时尚不清楚。
