Coronavirus Advances Faster in Small Towns, Survey Finds | Coronavirus

According to the researchers, the advance of Covid-19 towards smaller cities reveals a worrying situation due to the lower availability and capacity of its health services.

“The impact of the spread of the disease in small municipalities is related to the flow of more people who need special care,” explains Mônica Magalhães, a geoprocessing specialist applied to health and the environment and a researcher at MoitoraCovid-19, a Foundation pandemic monitoring project. Oswaldo Cruz (Fiocruz).

According to her, the flow of people from smaller cities to larger cities in search of medical services has always existed, being mapped by studies such as the study of Regions of Influence of Cities (REGIC), of the Brazilian Institute of Geography and Statistics (IBGE ). )

“What is happening in this pandemic is that the volume of this flow has grown a lot,” he says.

“We already see many more people leaving small municipalities for larger ones, because the number of urgent cases is much higher than what we generally follow with health indicators, in general. In other words, the demand for health services is dramatically increasing. Inpatient and ICU services, which had been operating at the limit all year long in normal situations. ”

To carry out the survey, the researchers took into account the REGIC health regions and divided the Brazilian municipalities into “health care networks”.

“They are groups of cities that have a strong interaction with each other, considering patient care and medical services,” explains health geographer Raphael Saldanha, also a researcher at MonitoraCovid-19.

According to him, basically, the survey asked which municipalities or urban concentrations the population seeks when they have to leave the place where they live to seek medical attention.

“The published regions are now a first approximation and may undergo adjustments until the final research report is published,” he says. “Therefore, while the health regions of the Ministry of Health are dictated by federal entities, those of REGIC are closer than what is done in practice, by the population.”

These networks were classified as low, medium and high complexity, according to three parameters: number of doctors, ICU beds, ventilators and ventilators.

“For each of them, we look for a reference value”, explains Mônica Magalhães. “These values ​​can be given by the World Health Organization (WHO) or by the Ministry of Health. In this analysis, we use values ​​from more than one source.”

They then verified the regions that were above or below these reference values.

Taking all the health regions into account, 70% of them already have a case of contamination by the new coronavirus and 30% already have deaths. Another worrying fact is that half of the people where covid-19 is spreading have care resources below the recommended parameters for normal situations, which means that, in pandemic cases, they are even less prepared.

The researchers evaluated the temporal evolution of the presence of covid-19 cases by regions of medium and low complexity, in two specific periods, from March 27 to April 2 and from April 17 to 23.

In the total of 758, the number of people with cases of the disease increased from 20.8% to 71.5% of them (158 to 542).

In the 54 regions with up to 20 thousand inhabitants, the index went from 3.7% to 22.2% (from two to 12); in the 192 with a population between 20 and 50 thousand, the increase was from 7.3% to 48.4% (from 14 to 93); in 171 from 50 to 100 thousand inhabitants, the percentage increased from 15.8% to 68.4% (27 to 117), in 265 from 100 to 500 thousand inhabitants there was an increase from 34.1% to 92.1% (from 92 to 244), and in the 76 with more than 500 thousand residents, the increase was from 30.3% to 100% (from 23 to 76%).

In the technical note they published, the researchers note that “a large part of the coastal region and the north of the country already has more than 70% of the municipalities with cases of covid-19 in the last period of analysis. (… ) It is observed that few regions in the center of the country in the north of Minas Gerais and Mato Grosso, in Tocantins and Piauí have not yet presented cases of the disease in the last period analyzed. ”

The MonitoraCovid-19 group also surveyed regions where deaths have already occurred. According to them, the comparison between the two periods analyzed (from March 27 to April 2 and from April 17 to 23) shows the internalization of the occurrence of deaths from the disease in the country.

“With the exception of the interior of Bahia, the north of Mato Grosso, the south of Pará and the south of Brazil, the rest of the health regions already had deaths from Covid-19 in the first period analyzed,” they write in the note. technique.

“Already in the second period, there is a wide dispersion of regions with deaths, both in the regions that presented in the first period, and in the more interior areas of the country.”

As small municipalities experienced an increase in cases in the past two weeks, the researchers’ concern was regarding isolation recommendations that are applied differently at each location.

“It is not possible to think about this in isolation, because cities are not isolated,” says Magalhães. “They all have a very big connection to each other, mainly because of the flow of people.”

Therefore, according to her, when you think about opening or releasing the mobility of people in the municipalities, you should always pay attention to the environment. “Will these other cities be able to provide health services to all their inhabitants?” He asks.

“Does the population of this locality look for other urban centers to be served? To think about the isolation policies for the prevention of Covid-19, it is necessary to understand these networks created by the population’s own needs, because different factors make them People pass through these spaces, and these municipalities cannot always serve the inhabitants themselves. ”

From REGIC’s mobility data, it can be seen that people, like viruses, are not subject to territorial limits. Outside the capitals, it is common to leave the municipality in search of services.

“In the case of health, there may also be a demand from other states,” explains Magalhães. “A very typical example is in the São Francisco river basin, the division between Juazeiro (BA) and Petrolina (PE). These are neighboring cities where the population flow is very intense, but in different states.”

In this context, says the researcher, the MonitoraCovid-19 team seeks to show that isolation measures should be considered together, since it will not help a municipality or state to think about health policies separately.

“Cities need to organize to achieve moderation, which can be effective in reducing new cases of Covid-19 infection,” he recommends.