# Social factors are associated with disparities in epidemiological and operational indicators of COVID-19 surveillance in a region of the Brazilian Amazon

## TL;DR

This study finds that social factors contribute to disparities in how well different regions in the Brazilian Amazon track and respond to COVID-19.

## Contribution

The study identifies specific health mesoregions in Pará with poor surveillance performance linked to social vulnerability and geographic isolation.

## Key findings

- The Lower Amazon, Southwest Pará, and Southeast Pará had the highest incidence and mortality rates of COVID-19.
- Health mesoregions like Lower Amazon and Metropolitan Region of Belém showed the highest lethality rates.
- Most mesoregions failed to meet targets for timely notification, sample collection, and test recording.

## Abstract

COVID-19 has caused substantial impacts on health, the economy, education, and quality of life worldwide, and pandemic control measures are directly associated with the quality of the pandemic response, which is essential for developing more assertive interventions for health promotion, treatment, and control of COVID-19.

To evaluate epidemiological and operational indicators of COVID-19 surveillance in hospitalized patients in the state of Pará in 2021 by health mesoregion.

A cross-sectional, analytical, and ecological epidemiological study. Data were obtained from the Epidemiological Surveillance of Severe Acute Respiratory Syndrome through the Influenza Epidemiological Surveillance System (SIVEP-Gripe).

A total of 18,007 severe acute respiratory syndrome surveillance reports were included. In terms of incidence, there was a significant difference in the Lower Amazon, Southwest Pará, and Southeast Pará (p < 0.001). In terms of lethality, the highest rates were in the Lower Amazon and Metropolitan Region of Belém (p < 0.001). In terms of mortality, significance was observed in the Lower Amazon, the Metropolitan Region of Belém, and Southwest Pará (p < 0.001). For timely notification (80%), sample collection (80%), completion of the collection date (100%), recording of the molecular test date (100%), and Intensive Care Unit (ICU) admission (100%), none of the mesoregions reached the target. The criterion of confirmation, evolution, and date of evolution did not reach the target (100%) in any mesoregion. For timely case closure (80%), five mesoregions reached the goal: Lower Amazon, Marajó, Metropolitan Region of Belém, Northeast Pará, and Southeast Pará.

Differences were observed between health mesoregions in both epidemiological and operational indicators. The most affected mesoregions were the Lower Amazon, Southwest Pará, and Southeast Pará, which have high social vulnerability and are farther from the metropolitan area of Belém, where health services with better hospital and laboratory structures are concentrated.