Drawing a parallel with the current situation, Cardoso warns that the health conditions of indigenous populations in rural areas across the country have not changed, and that they are highly susceptible to SARS-CoV-2. As a result, the researcher says, the new virus could cause similar or worse damage. \u201cWe still don’t know if the pandemic will behave like influenza, affecting mainly children, who have risk factors related to malnutrition and exposure to pollution, or if it will follow the pattern seen in European countries, more severely affecting the elderly, or if both groups will be fatally affected,\u201d says the epidemiologist.<\/p>\n
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Sanitation expert Douglas Rodrigues, head of the Health and Environment Unit of the Department of Preventive Medicine at the Federal University of S\u00e3o Paulo\u2019s School of Medicine (EPM-UNIFESP), says that due to the epidemiological profile of the native populations, they are one of the at-risk groups in the current pandemic, alongside the immunocompromised, the elderly, and people with chronic diseases. \u201cIndigenous peoples are vulnerable due to multiple factors, with a high prevalence of infectious diseases and chronic illnesses, such as diabetes and hypertension, as well as high rates of obesity and malnutrition,\u201d warns Rodrigues.<\/p>\n
Evidence of these vulnerabilities was identified at least a decade ago by the first National Survey on Health and Nutrition of Indigenous Peoples, carried out between 2008 and 2009 by FIOCRUZ. Published in the journal Cadernos de Sa\u00fade P\u00fablica <\/em>in 2019, the article \u201cIniquidades \u00e9tnico-raciais nas hospitaliza\u00e7\u00f5es por causas evit\u00e1veis em menores de cinco anos no Brasil (2009\u20132014)\u201d (\u201cEthnic and racial inequalities in hospital admissions due to avoidable causes in Brazilian children aged under five\u201d) showed that the hospitalization rate for primary care\u2013sensitive conditions in indigenous children was five times greater than observed among white children. Compared to other races and ethnicities, indigenous people face more unfavorable conditions, with higher hospitalization rates for pneumonia and diarrhea, in addition to other infectious and parasitic diseases, in all regions of the country. In the North and Midwest, the adjusted hospitalization rates for primary care\u2013sensitive conditions in indigenous children were 5 and 18 times the corresponding rates in white children, respectively.<\/p>\n Another contributing factor is the environmental problems in many territories, which make it impossible for some communities to remain isolated from cities with confirmed cases of the disease. \u201cForty percent of the country’s indigenous population lives in regions where nature has been devastated. As a result, hunting, fishing, and food gathering have become impractical. The indigenous people are now dependent on cities,\u201d says Rodrigues, from UNIFESP. According to him, although villages like Parque do Xingu in the Brazilian Midwest also consume industrialized goods, the indigenous peoples there are better able to isolate themselves because of the preserved environment. \u201cDifferent health policies are needed to combat coronavirus among these peoples. Communities that subsist on hunting, fishing, and gathering must remain isolated. Others that depend on nearby cities for their food need to receive supplies, so that they don\u2019t need to travel in and out of their territories,\u201d he proposes.<\/p>\n Anthropologist Gersem dos Santos Luciano, from the Department of Indigenous Education at the Federal University of Amazonas (UFAM), recalls that historically, epidemics have been responsible for severely reducing indigenous populations in Brazil. \u201cThe flu alone decimated entire villages,\u201d he says. One flu outbreak, for example, left the Kaingang people, who lived in the state of S\u00e3o Paulo, on the verge of extinction after they first made contact with outsiders between 1912 and 1913, according to ISA data. Luciano, who is of Baniwa heritage and was born in the village of Yaquirana, in the Upper Negro River region of the Amazon, explains that one of the contributing factors is that indigenous people often live in community houses. \u201cIn the case of the Xapono or the Yanomami, for example, just one dwelling, called a maloca toototobi, <\/em>is home to as many as 300 people. Since the SARS-CoV-2 virus has a higher transmission rate than the common flu, it can potentially be more dangerous in these environments,\u201d he notes.<\/p>\n Edgar Kanayk\u00f5 Xakriab\u00e1 \u2013 Ethnophotography | Anthropology<\/span><\/a> In April, leaders of the Xakriab\u00e1 banned nonindigenous people from entering the reserveEdgar Kanayk\u00f5 Xakriab\u00e1 \u2013 Ethnophotography | Anthropology<\/span><\/p><\/div>\n The National Healthcare Policy for Indigenous Peoples celebrated its 20th<\/sup> year in 2019. It is implemented by the Ministry of Health\u2019s Special Department for Indigenous Health, attending 800,000 individuals from over 34 special indigenous health districts. In 2018, Ana Lucia Pontes, a researcher from the Department of Endemics at the FIOCRUZ National School of Public Health, began studying the trajectory of indigenous participation in the formulation of the current indigenous health policy. According to her, the process began with the first National Conference on Indigenous Health Protection in 1986, where discussions focused on how national policies could respond to the health needs of indigenous peoples within the scope of Brazilian health reform, while contemplating their ways of life and perspectives. The talks took an opposing position to the approach of the military dictatorship (1964\u20131985), which promoted the construction of hydroelectric dams and roads in indigenous reserves, and led to numerous fatal epidemics. The Perimetral Norte highway, for example, was built in 1974 and 1975 and crosses the states of Amazonas, Par\u00e1, Amap\u00e1, and Roraima\u2014during construction, infectious diseases killed 22% of the population in four villages, according to the ISA. Two years later, a measles epidemic killed half the population in four other indigenous communities.<\/p>\n \u201cThe 1988 Federal Constitution recognizes the rights of indigenous peoples, and this understanding paved the way for a specific health policy to be created based on the particular elements of their territories, social systems, ways of life, and traditional knowledge,\u201d she says. According to Pontes, before the 1990s, national health policies for the indigenous population were implemented without considering the way they live, instead arguing that they should be assimilated and integrated into national healthcare standards.<\/p>\n Dialogue on traditional knowledge is one of the central axes of the Xingu Project, an EPM-UNIFESP program that has been operating in the health district of Parque Ind\u00edgena do Xingu since 1965. Sanitation expert Sofia Mendon\u00e7a, head of the program, explains that since the 1980s, indigenous leaders have been involved in designing the local health system. An article published in the journal Cadernos de Sa\u00fade P\u00fablica<\/em> in 2019 shows that training indigenous health agents and indigenous nursing assistants was crucial to the development of preventive campaigns and early diagnoses, resulting in better strategies to combat respiratory diseases and diarrhea, for example.<\/p>\n Despite the improvements, Mendon\u00e7a notes that one of the obstacles in the fight against COVID-19 is the primary care offered in villages and its connections with state and municipal health departments. \u201cIndigenous health districts are not always included in state and municipal contingency plans,\u201d highlights Pontes, from FIOCRUZ. She also notes that most cities near indigenous reserves in the Amazon do not have hospitals with Intensive Care Units (ICUs), meaning people need to travel to Manaus for treatment in serious cases. As of April 17, the Amazonas state capital had recorded roughly 1,000 of the state\u2019s 1,200 COVID-19 cases, although it only has 500 ICU beds, according to 2018 data from the Brazilian Medical Council (CFM). On April 13, a month after the first case in the state was confirmed, the healthcare system in Manaus collapsed. \u201cThe COVID-19 pandemic will test the indigenous health system at all levels,\u201d predicts Mendon\u00e7a, from the Xingu Project. \u201cMany indigenous peoples, for example, use tobacco for rituals and festivities. They have also already suffered from several episodes of the flu and other infections. If the disease severely affects older people, who have a great deal of knowledge on traditional prayer and healing practices, it can lead to a major population decline and social disorganization,\u201d he emphasizes.<\/p>\n With 40,000 inhabitants, S\u00e3o Gabriel da Cachoeira has the largest indigenous population in Brazil. Luciano, from UFAM, who has relatives living in the area, explains that it is seen as a reference for other indigenous communities. When the pandemic began to worsen in Brazil in early March, villages in the region banned outsiders from entering, while river and road traffic was drastically reduced. \u201cThe indigenous community has really mobilized itself,\u201d he states. They have encouraged leaders to advise villagers to stay within the reserve and have taught indigenous people to recognize the symptoms of the disease and how to self-isolate when contamination is suspected. Indigenous organizations and the ISA have also translated and adapted educational material and prevention campaigns for the different cultural and linguistic contexts. “Due to their collective way of living, we can\u2019t ask people to isolate themselves in their homes, but we are advising them to remain in their reserves,” says Luciano. Another important aspect is hygiene procedures. Since not all villages have access to potable water, one of the key guidelines is not to reuse water.<\/p>\n SESAI has about 1,500 basic health centers that serve Brazil\u2019s indigenous population. Some of them cover multiple reserves. Sofia Mendon\u00e7a, from UNIFESP, believes that these centers need to be restructured, with suspected COVID-19 cases treated in separate locations to reduce the risk of contamination. “Removing miners, land grabbers, extractors, and loggers from prohibited areas is another fundamental measure, since these illegal activities represent major potential for disease transmission,” argues the doctor. According to data from the Report on Violence against Indigenous Peoples in Brazil, published by the Indigenous Missionary Council (CIMI), 21 indigenous reserves inhabited by isolated groups are currently invaded. According to CIMI, there are 114 isolated indigenous peoples recorded in Brazil\u201428 are confirmed by the National Indigenous Foundation (FUNAI).<\/p>\n In partnership with the Federal University of Minas Gerais (UFMG), ISA produced a COVID-19 vulnerability indicator for indigenous reserves. The aim is to assess the risks to indigenous populations in each region of the country, according to criteria such as age, access to hospital beds, prevalence of respiratory diseases, and number of cases per municipality. Moreira explains that among nonindigenous populations, this type of analysis considers criteria such as the Human Development Index (HDI) and inequality and poverty indices. However, for indigenous people, other issues are more appropriate, such as deforestation rates and the presence of outsiders in the territory. These criteria were used to identify the 10 regions most vulnerable to the pandemic. The indigenous reserves facing the highest risk are Barragem and Jaragu\u00e1 in S\u00e3o Paulo State and Yanomami, in Roraima. Those in S\u00e3o Paulo State are vulnerable due the older average age and significant marginalization, which has led to greater social isolation, while the Yanomami have a high rate of respiratory disease, even with widespread vaccination, and low access to hospitals with ICUs. \u201cMany indigenous communities are already isolated, or they have now closed their borders or moved deeper into the forest. Indigenous peoples are articulating their historical experience of other catastrophic epidemics to try to deal with the current threat,\u201d concludes Moreira, from ISA.<\/p>\n Hugo Ferreira de S\u00e1 \/ Fulni-\u00d4 Cinema Collective<\/span><\/a> Child from the fulni-\u00f4 indigenous village in \u00c1guas Belas, Pernambuco, holds a drawing inspired by the coronavirusHugo Ferreira de S\u00e1 \/ Fulni-\u00d4 Cinema Collective<\/span><\/p><\/div><\/p>\n The Brazilian Institute of Geography and Statistics (IBGE) brought forward the publication of data on indigenous peoples and quilombola communities to support the development of COVID-19 policies for these populations. The information is part of the territorial database for the next Census, which has been postponed until 2021, and also includes data from the 2010 Census. According to the data published by the IBGE:<\/p>\n \u2022 The current 7,103 indigenous locations are distributed across 827 municipalities; 632 of them in officially demarcated reserves SOURCE <\/strong>Geography and Statistics Database on Indigenous and Quilombola Communities\/IBGE\/2019 Scientific articles<\/strong>![\"\"](\"https:\/\/revistapesquisa.fapesp.br\/wp-content\/uploads\/2020\/11\/047_-pandemia-e-indigenas_291-1.jpg\")
![\"\"](\"https:\/\/revistapesquisa.fapesp.br\/wp-content\/uploads\/2020\/11\/048_-pandemia-e-indigenas_291-1.jpg\")
\n\u2022 The North has the largest number: 4,504 in total, followed by the Northeast (1,211), and the Midwest (713)
\n\u2022 The largest number of officially demarcated reserves is also found in the North: 305 in total. There are 148 in Amazonas, 73 in Mato Grosso, and 54 in Par\u00e1
\n\u2022 The state of Amazonas is home to the majority of the country’s indigenous locations (2,602), followed by Roraima (587), and Par\u00e1 (546)<\/p>\n
\n<\/div>\n
\nCARDOSO, A. M. et al<\/em>. Investigation of an outbreak of acute respiratory disease in an indigenous village in Brazil: Contribution of Influenza A(H1N1) pdm09 and human respiratory syncytial viruses<\/a>. PLOS ONE<\/strong>. pp. 1\u201315. July 2019.
\nFARIAS, Y. M. et al<\/em>. Iniquidades \u00e9tnico-raciais nas hospitaliza\u00e7\u00f5es por causas evit\u00e1veis em menores de cinco anos no Brasil, 2009\u20132014<\/a>. Cadernos de Sa\u00fade P\u00fablica<\/strong>. No. 35, sup. 3. pp. 1\u201314. 2019.
\nMENDON\u00c7A, S. B. M. et al.<\/em> Modelo de aten\u00e7\u00e3o \u00e0 sa\u00fade ind\u00edgena: O caso do DSEI Xingu<\/a>. Cadernos de Sa\u00fade P\u00fablica<\/strong>. No. 35, sup. 3. 2019.
\nOLIVEIRA, U. et al<\/em>. Modelagem da vulnerabilidade dos povos indi\u0301genas no Brasil \u00e0 Covid-19<\/a>. Instituto Socioambiental<\/strong>. Online.<\/p>\n","protected":false},"excerpt":{"rendered":"Chronic health problems and poor connections with public authorities make combating the SARS-CoV-2 virus a challenge for indigenous peoples","protected":false},"author":601,"featured_media":364396,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[156],"tags":[260,256],"coauthors":[1600],"class_list":["post-363847","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cover","tag-public-health","tag-public-policies","position_at_home-sumario","keywords-coronavirus-en","keywords-covid-19-en","keywords-sars-cov-2-en"],"acf":[],"_links":{"self":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/363847","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/users\/601"}],"replies":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/comments?post=363847"}],"version-history":[{"count":5,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/363847\/revisions"}],"predecessor-version":[{"id":378536,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/posts\/363847\/revisions\/378536"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media\/364396"}],"wp:attachment":[{"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/media?parent=363847"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/categories?post=363847"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/tags?post=363847"},{"taxonomy":"author","embeddable":true,"href":"https:\/\/revistapesquisa.fapesp.br\/en\/wp-json\/wp\/v2\/coauthors?post=363847"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}