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ASIAN JOURNAL OF
SCIENCE AND TECHNOLOGY

Asian Journal of Science and Technology

ISSN: 0976-3376 Vol. 13, Issue, 03, pp.12046-12051, March, 2022

RESEARCH ARTICLE
EPIDEMIOLOGICAL PROFILE AND GEOGRAPHICAL DISTRIBUTION OF COVID-19: AN
EPIDEMIOLOGIC STUDY IN THE AMAZON XINGU REGION, BRAZIL
*Rodrigo Januário Jacomel, Felipe Azevedo Alberto Nascimento, Lucas Mendes Carvalho, Sérgio
Beltrão Lima, Aline Andrade de Sousa, Denis Vieira Gomes Ferreira, Amanda Caroline Duarte
Ferreira, Ilano Oliveira da Silva, Maria da Conceição Nascimento Pinheiro and
Ademir Ferreira da Silva Júnior
Universidade Federal do Pará. Campus Universitário de Altamira. Adress: Rua Coronel José Porfírio, nº 2515,
Campus II, Bairro: São Sebastião. CEP 68372-040 – Altamira, Pará, Brazil

ARTICLE INFO ABSTRACT

Article History: COVID-19 emerged in December / 2019 in China and became a global crisis that requires strategies
Received 05th December, 2021 such as social isolation, increased testing and vaccination. In a descriptive, cross-sectional, and
Received in revised form quantitative epidemiological study, based on secondary data, collected by the public database of the
28th January, 2022 Tenth Regional Health Department of the State of Pará, 11.693 diagnosed cases of infection by the
Accepted 17th February, 2022 SARS-CoV-2 virus were analyzed between April and September, 2020, in a region in the Brazilian
Published online 19th March, 2022 Amazon. It was found that 396 people needed hospitalization and 260 died. Among the infected group,
women had a 5.8% higher prevalence compared to the number of men. In addition, individuals aged 30
Key words: to 39 years made up most of the sick population with COVID-19. It was observed that all municipalities
Coronavirus infection; COVID-19 in the region faced, in the analyzed period, a calamitous epidemic situation, with a high rate of viral
Pandemic; Demography; Social transmission, a significant number of deaths and little capacity to cope with the health crisis. Another
Epidemiology; Residence Characteristics; peculiar point concerns the way of life of urban, traditional, and riverside communities in the Amazon,
COVID-19 testing; Symptom which relate in different ways, impacting the spread of COVID-19. Thus, these analyzes demand a
Assessment. closer look at COVID-19 in the region, to avoid an even more pernicious outcome for the ongoing
crisis.

Citation: Rodrigo Januário Jacomel, Felipe Azevedo Alberto Nascimento, Lucas Mendes Carvalho, Sérgio Beltrão Lima et al. 2021. “Epidemiological
profile and geographical distribution of COVID-19: an epidemiologic study in the Amazon Xingu Region, Brazil..”, Asian Journal of Science and
Technology, 11, (03), 12046-12051.

Copyright © 2021, Rodrigo Januário Jacomel et al. This is an open access article distributed under the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

INTRODUCTION Within five to six days after the symptom’s onset, the virus
reaches its peak viral load and severe cases progress to acute
respiratory distress syndrome (Huang et al., 2020). The
The first cases of the Coronavirus disease 2019 (COVID-19)
clinical manifestations of COVID-19 in 80% of cases are
were identified in December 2019, more precisely, in a group
classified as mild, generally characterized by fever, dry cough,
of patients admitted with a diagnosis of pneumonia of
and tiredness. In more severe cases, equivalent to 5%, there is
unknown etiology to hospitals in the city of Wuhan, China
progressive dyspnea, pulmonary bleeding, severe lymphopenia
(Wang et al., 2020). Initially, the outbreak caused by severe
and renal failure (Li et al., 2020; Chan et al., 2020). The
acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was
severe phases, associated with diseases of the lower respiratory
restricted to the province of Hubei in China but it spread
tract, are frequently observed in individuals with risk factors,
rapidly to several countries, causing a global pandemic in
such as: heart disease, pneumatics, and other chronic
March 2020 (Batista et al., 2020). The coronavirus is
conditions such as diabetes, obesity and asthma (Chan et al.,
transmitted mainly through respiratory droplets. For the
2020). Laboratory diagnosis occurs through the Reverse-
infection, the average incubation period is approximately four
Transcriptase Polymerase Chain Reaction (RT-PCR) test,
to five days before the symptom’s onset, 97.5% of these
referring to the polymerase chain reaction with reverse
patients have clinical signs with an average duration of 11.5
transcription, remaining a reference standard for the definitive
days (Guan et al., 2020; Li et al., 2020).
diagnosis of COVID-19 infection, with positive radiological
*Corresponding Author: Rodrigo Januário Jacomel,
finding (Guan et al., 2020; Li et al., 2020). Considering this
Universidade Federal do Pará. Campus Universitário de Altamira. scenario, the world population faces a crisis, which has
Adress: Rua Coronel José Porfírio, nº 2515, Campus II, Bairro: São plagued diverse peoples and ethnicities on all continents
Sebastião. CEP 68372-040 – Altamira, Pará, Brazil. (Batista et al., 2020; Caetano et al., 2020; Pan et al., 2020).
12047 Rodrigo Januário Jacomel et al. Epidemiological profile and geographical distribution of covid-19:
an epidemiologic study in the amazon xingu region, Brazil

As a result, governments and institutions around the world are in the Transamazônica and Middle Xingu region is necessary
urged to make decisions and set strategies to reduce the taking into account the socioeconomic and cultural
impacts arising from this new disease that causes a high peculiarities of the area. The region has several social and
number of hospitalizations in Intensive Care Units (ICU) and structural deficiencies linked to unique impacts on coping with
high mortality (Chan et al., 2020). Thus, among the strategies SARS-CoV-2, such as the under sizing of hospital beds and
adopted are included social distancing, field hospitals, restricted access to water treatment. In addition, one of the
increased number of tests, etc. It is notable that just as most striking characteristics of the region is the existence of
important as epidemiological screenings, the adaptation of traditional and riverside communities with their specific forms
protocols and provision of support for populations inserted in of social organization, based on kinship, proximity (physical
specific contexts to contain the increase in cases and the and mental) and community and reciprocal relationships,
mortality rate are needed (Caetano et al., 2020). Based on this which can directly impact the propagation of COVID-19
context, it is essential to compose prevention, monitoring and (Sousa & Ferreira et al., 2021). Considering these features, the
care protocols for different populations within different location is unique in the Brazilian territory and the specific
territories that suffer the effects of this disease in different analysis of the distribution of the cases of COVID-19 becomes
ways. As stated by Pan, et al (2020) cultural, behavioral, and essential. This context motivated the execution of the research
socioeconomic differences between ethnic groups can that enabled the description of the epidemiological profile and
influence viral spread and, consequently, the basic number of geographic distribution of the first cases of the disease in the
reproduction (R0) in a specific area. According to the authors, Xingu region - Pará - Brazil.
health behaviors and conditions are different in communities
of black, Asian, and other minority ethnic groups, such as MATERIALS AND METHODS
indigenous peoples compared to white individuals. This may
be related to a higher prevalence of certain infectious This study is the result of an epidemiological, descriptive, and
respiratory diseases, such as tuberculosis. Differences in local cross-sectional research, with a quantitative approach, carried
culture can also influence society's responses to government out through the survey of secondary data referring to the cases
measures, which can be seen in the different blockade actions of COVID-19 in the Xingu region in Pará State, Northern
between countries in Asia and countries in Europe and North Brazil (Brasil, 2021). Data from the disease notification
America (Pan et al., 2020). records, referring to the period between the 18th and 38th
Epidemiological Week in the year 2020 were used. Data
In the west of Pará state in Northern Brazil, the Xingu region, collection was carried out between September 23, 2020 and
comprises nine municipalities along the Transamazonian September 30, 2020. The variables used for the study were:
Highway (BR-230). The region has an estimated population of age group, distribution by gender (sex), diagnostic method,
more than 370,000 inhabitants, with Altamira (in the need for hospitalization, existence of relevant
geographical coordinates 3°12'04" South latitude, and comorbidities/risk factor, municipality of residence and
52°12'49" West longitude of Greenwich) the most populous lethality. Only cases confirmed by RT-PCR, rapid test and/or
city, with approximately 116,000 people. The other eight clinical diagnosis were included in the analysis. For the
municipalities are: Anapú, Medicilândia, Vitória do Xingu, purposes of epidemiological analysis, cases that did not have
Placas, Senador José Porfírio, Porto de Moz, Pacajá and age and sex data were not included in the analysis. The
Uruará (municipalities between the geographic coordinates 3° collected data were processed using MS Excel software and
45'05" South latitude, 54°24'06" West longitude Greenwich; analyzed using descriptive statistics. Thematic maps were
1°40'44" South latitude, 52° 16'04 West longitude of developed from the formatted spreadsheets to represent the
Greenwich; 3°50'53" South latitude, 50°35'44" West longitude cases of COVID-19 in the Xingu region. In the production of
Greenwich) all varying from 10,000 and 50,000 inhabitants the maps, the Geographic Information System from the
(IBGE, 2020). The Belo Monte Hydroelectric Plant, the database of the Brazilian Institute of Geography and Statistics
second largest in Brazil and the largest entirely Brazilian, had was used, as a spatial reference SIRGAS 2000 (EPSG: 4674)
a considerable impact on this portion of the Xingu Region. The was used, through the free software QGIS 3.10.1, which is the
plant was built between 2010 and 2017, as part of the federal main tool for spatial study. Since this study was carried out
government’s Growth Acceleration Program, the project cost with secondary data, accessed from a bank with anonymized
was over R$ 30 billion and caused a transformation in the sensitive information, in the public domain, it was not
social and population profile in all municipalities. The growth necessary to submit it to a Human Research Ethics Committee.
in the circulation of people, capital and goods in the region has
boosted trade and brought countless investments. But to the RESULTS
same extent, the region experienced an increase in
socioeconomic problems such as violence, the exacerbation of The survey found 11,693 confirmed cases of COVID-19, 396
agrarian conflicts, the relocation of traditional populations, (3.39%) hospitalizations and 260 (2.22%) deaths, from April
prostitution, and the swelling of educational and health 24 to September 11, 2020, in the Xingu region. When
services, which, although mitigated, are still felt in the region analyzing the total number of COVID-19 cases, by sex, it was
(Amazonia-Real, 2021). In this context, as the COVID-19 observed that 6,188 (52.9%) were distributed among females
pandemic expands to environments with less robust health and 5,505 (47.1%) among males, with no significant
systems in the most diverse populations, it will be increasingly predominant incidence between the sexes and affecting,
important to ensure that health systems include diverse and mainly, the age group between 30 to 39 years (Table 1).
marginalized communities, like traditional, indigenous, Regarding the diagnostic methods for COVID-19 performed in
riverside and resettled communities (Batista et al., 2020; the Xingu region, the rapid tests were the most performed
Caetano et al., 2020; Pan et al., 2020; Sousa et al., 2021). An diagnostic method (87.65%), followed by the clinical-
understanding of the regional distribution of COVID-19 cases epidemiological diagnosis (7.99%) (Table 2). As for the
12048 Asian Journal of Science and Technology, Vol. 13, Issue, 03, pp.12046-12051, March, 2022

clinical analysis of patients with comorbidities, which involve DISCUSSION

a higher risk when presented with COVID-19, the study
showed that 456 (3.90%) patients had heart disease and 310 Considering the 11.693 confirmed cases of COVID-19 in the
(2.65%) diabetes. Among the cardiopathic patients, 161 period, the incidence rate of the disease was 330.36 per 10,000
(9.51%) are residents of the municipality of Medicilândia. inhabitants. The city of Vitória do Xingu had the highest rate
Considering the patients with diabetes, 127 (3.16%) live in the in the region (617.84), followed by the cities of Medicilândia
city of Altamira (Table 3). The research investigated the main (529.48) and Senador José Porfírio (491.29). One of the
symptoms presented by patients diagnosed with COVID-19, reasons that may explain the great incidence of COVID-19 in
such as: fever, sore throat, dyspnea, myalgia, headache, the municipality of Vitória da Xingu, is its characteristic of a
anosmia, ageusia and cough. Fever was the most reported port region, connecting other municipalities with the
symptom among patients confirmed with COVID-19 in the transamazon road, in addition to being a transit area to the
analyzed period. Amazon River. Port areas have historically been the epicenters
of disease transmission in pandemic times, as occurred in the
This condition reached 7,868 people. Furthermore, 7,066 early twentieth century in the capital of Pernambuco state,
people reported having cough. As for geographical when the British ship S. S Demerara docked in the port with
distribution, confirmed cases occurred in a variable manner in suspected cases of Spanish Flu. This episode is cited as the
the Xingu region, with the highest number in Altamira (4,019 first record of the disease in Brazil (Bertolli, 2003). It was also
cases), followed by Medicilândia (1,693 cases) and Uruará observed that 52.9% of the cases of COVID-19 in the Xingu
(1,083 cases) (Figure 1). Regarding the incidence of COVID- region affected female patients. This data is like the studies by
19, in the Xingu region, the study showed a confirmed cases Richardsom, et al (2020). Furthermore, one of the reasons that
rate of 330.36/10,000 inhabitants. The survey revealed that the may explain the lower number of case reports among men is
city of Vitória do Xingu had the highest rate in the region the historical and cultural tendency for women to be the ones
(617.84), followed by the cities of Medicilândia (529.48) and who most seek health services, thus enabling the diagnosis of
Senador José Porfírio (491.29). As for the geographical several diseases (Bertolli, 2003). The research revealed that
distribution of the number of deaths, there was variation the rapid test was the most used diagnostic method for the
between the municipalities, with the highest lethality measured detection of COVID-19 in the Xingu region (87.65%),
in Altamira (116 cases), followed by Porto de Moz (26 cases), followed by the clinical-epidemiological diagnosis (7.99%).
Anapú (21 cases) and Vitória do Xingu (21 cases) (Figure 1).
The gold standard for the diagnosis of the COVID-19 is the
RT-PCR exam, with molecular analysis, but at the time of the
reported cases, the offer of this resource was still scarce and
expensive. Rapid tests appear as an alternative and
complementary methodology for the diagnosis of the disease.
However, they can mask real serology results, implying
underreporting of the disease and loss of the virus replication
window (Escalera-Antezana et al., 2020). The analysis of the
clinical profile of the patients, shows that 456 (3.90%) had
heart disease and 310 (2.65%) diabetes. Among the cardiac
patients, 161 (9.51%) are residents of the municipality of
Medicilândia. In the diabetics group, 127 (3.16%) live in the
city of Altamira. One of the reasons for heart diseases to be at
the top of the comorbidities associated with COVID-19, is
because these diseases already have a chronic inflammatory
process, which can be aggravated by viral infection, such as
that of the SARS-CoV-2 virus. In addition, one of the phases
of virus’ action is the inhibition of the Angiotensin-Converting
Enzyme 2, ECA-2, which would deregulate the Renin-
Angiotensin-Aldosterone system, causing local and systemic
tissue damage (Bonow et al., 2020). Patients who have pre-
existing medical disorders deserve special attention, once the
virus’ attack can maximize the effects of conditions already
Figure 1. Spatial distribution of the total number of COVID-19 existed, increasing the possibility of death. There is also a
cases and incidence per 10,000 inhabitants in municipalities of the direct influence between age and especially previous risk
Xingu Region in Pará State, Northern Brazil in the period factors with the development of severe forms of COVID-19
between the 18th and the 38th epidemiological weeks of 2020 (Borges et al., 2013). The study also evaluated the main
symptoms presented by patients diagnosed with COVID-19 in
As for the distribution of hospitalizations and hospitalizations the Xingu region. It was found that fever was the most
in the Intensive Care Unit (ICU), 396 (3.39%) patients reported symptom (65.7%), followed by cough. These
required hospitalization of which 130 (1.11%) in the ICU. The numbers are inferior to that registered in other studies. The
statistical validation tests of the results were performed using study conducted by Huang, et al (2020) with 41 patients in
the Chi-squared test. The study revealed significant differences Wuhan, China registered fever in 98% of the patients
for patients who were not hospitalized and survived, and this analyzed. Following the same trend, the study by Wang, et al
group was approximately 58 times larger than that composed (2020) also in Wuhan, China based on the analysis of 69
of hospitalized patients who died (11,232/195) (p <0.001). patients registered fever in 87% of them.
12049 Rodrigo Januário Jacomel et al. Epidemiological profile and geographical distribution of covid-19:
an epidemiologic study in the amazon xingu region, Brazil

Table 1. Distribution of COVID-19 cases in the region classified by age and gender. Data extracted from the Notifications of
Diseases of the Secretariat of Public Health of Pará13

Cohort Female Gender Male

<1 51 (0,44%) 54 (0,46%)
1 to 5 92 (0,79%) 82 (0,71%)
6 to 19 577 (4,97%) 491 (4,23%)
20 to 29 1295 (11,15%) 951 (8,19%)
30 to 39 1544 (13,30%) 1359 (11,70%)
40 to 49 1156 (9,96%) 1059 (9,12%)
50 to 59 738 (6,36%) 702 (6,05%)
60 to 69 400 (3,44%) 403 (3,47%)
70 to 79 188 (1,62%) 242 (2,08%)
80 to 89 89 (0,77%) 97 (0,84%)
90 or more 14 (0,12%) 27 (0,23%)

Table 2. Distribution of diagnostic methods used during the research period. Data extracted from the Notifications of Diseases
of the Secretariat of Public Health of Pará13

Municipality Laboratory Test % Rapid Test % Clinical % % of diagnostic methods in Xingu Region
Altamira 271 6.74 3743 93.13 5 0.12 34.37
Anapu 12 1.33 888 98.67 0 0 7.07
Brasil Novo 62 8.73 510 71.83 138 19.44 6.07
Medicilândia 19 1.12 1121 66.21 553 32.66 14.48
Pacajá 60 7.03 787 92.15 7 0.82 7.3
Porto de Moz 50 5.4 873 94.28 3 0.32 7.92
Senador José Porfírio 6 1.06 556 98.58 2 0.35 4.82
Uruará 16 1.48 880 81.26 187 17.27 9.26
Vitória do Xingu 14 1.48 891 94.39 39 4.13 8.07
Total 510 4.36 10249 87.65 934 7.99 100

Table 3. Distribution of patients with comorbidities and stratification of patients with Covid-19 that had fever, sore throat,
dyspnea, myalgia, headache, anosmia, ageusia or cough. Data extracted from the Notifications of Diseases of the Secretariat of
Public Health of Pará13

Altamira Anapú Brasil Medicilândia Pacajá Porto de Senador Uruará Vitória do Total
Novo Moz José Xingu
Porfírio
Comorbid Heart Diseases 120 8 12 161 (9,51%) 20 62 (6,69%) 13 (2,30%) 47 13 (1,38%) 456
(2,99%) (0,89%) (1,69%) (2,34%) (4,34%) (3,90%)
Pneumopathy 53 2 1 0 (0%) 0 (0%) 1 (0,11%) 2 (0,36%) 2 1 (0,11%) 62
(1,32%) (0,22%) (0,14%) (1,18%) (0,53%)
Immunocompromised 106 0 (0%) 1 2 2 2 (0,22%) 1 (0,18%) 0 (0%) 0 (0%) 114
(2,64%) (0,14%) (0,12%) (0,23%) (0,97%)
Diabetic 127 7 10 73 21 25 (2,70%) 8 (1,42%) 29 10 (1,06%) 310
(3,16%) (0,78%) (1,41%) (4,31%) (2,46%) (2,68%) (2,65%)
Renal 13 0 (0%) 2 5 2 3 (0,32%) 1 (0,18%) 0 (0%) 0 (0%) 26
(0,32%) (0,28%) (0,30%) (0,23%) (0,22%)
Neuropathy 2 (0,05%) 0 (0%) 1 0 (0%) 0 (0%) 0 (0%) 0 (0%) 1 0 (0%) 4 (0,03%)
(0,14%) (0,09%)
Asthma 8 (0,20%) 1 2 5 3 4 (0,43%) 1 (0,18%) 4 0 (0%) 28
(0,11%) (0,28%) (0,30%) (0,35%) (0,37%) (0,24%)
Obesity 11 0 (0%) 2 3 0 (0%) 2 0 (0%) 0 2 21
(0,27%) (0,28%) (0,18%) (0,22%) (0%) (0,21%) (0,18%)
Symptoms Fever 2437 634 351 1275 645 689 379 771 687 7868
Sore throat 1597 433 263 1004 366 510 298 664 402 5537
Myalgia 813 42 247 928 160 306 38 552 238 3324
Cough 2144 604 351 1197 509 588 375 728 570 7066
Coryza 145 27 36 203 29 16 20 382 31 889

In 12 patients analyzed in Bolivia, fever was observed in 75% critical infections, require ventilatory support and oxygen
of patients (Escalera-Antezana et al., 2020). According to therapy, differentiating it from other common respiratory
Silva et al (2020), in symptomatic patients, there are clinical infections. Regarding the distribution of hospitalizations and
manifestations such as fever, cough, dyspnea, myalgia and ICU admissions of patients diagnosed with COVID-19 in the
fatigue, which can be accompanied by respiratory secretion, Xingu region, 396 (3.39%) were hospitalized and 130 (1.11%)
headache, hemoptysis and diarrhea. Thus, this symptom is patients required admission to the Intensive Care Unit (ICU).
often pointed out as being like that of infections by other This result can be corroborated by the WHO data, which
viruses such as Novovirus and Influenza (Lai et al., 2020). reveal that 80% of patients will have mild symptoms and will
According to the meta-analysis carried out by Li et al (2020), not require hospitalization. The other 20% will be hospitalized,
the most common symptoms presented by patients with of which 20%, 3 out of 4 will need oxygen therapy and 25%
COVID-19 are fever and dry cough. It is noteworthy that will need care in the ICU (WHO, 2020). The study found that
symptoms such as high fever, dry cough and dyspnea, in the number of hospitalizations in the Xingu region was lower
addition to the greater recurrence of evolution to severe and than expected, compared to other regions in the world.
12050 Asian Journal of Science and Technology, Vol. 13, Issue, 03, pp.12046-12051, March, 2022

This can be explained by the undersized health services and precarious basic sanitation, poor conditions of transport and
the shortage of ICU beds in the Brazilian Amazon. In a group housing, conflicts in the countryside and incipient Human
of five states, with the lowest offer of ICU beds per 10,000 Development Index (HDI). Widespread poverty and financial
inhabitants, 3 of them are states in the Legal Amazon difficulties in the municipality are elements capable of making
(Noronha et al., 2020). It can be inferred that, if the it difficult to face the pandemic and the response capacity of
availability of hospitals beds in the Xingu region was greater the local health system, significantly increasing the mortality
or minimally adequate, certainly more hospitalizations could rate related to COVID-19 (Cardoso & Cardoso, 2020). When
have occurred. In fact, Pará is one of the federative units most assessing the fatality rate in the Xingu region, defined as the
strongly marked by a undersized health assistance, which proportion of deaths by COVID-19 in relation to the total
directly impacts the number of hospitalizations (Sousa et al., number of patients, by sex and age group, there is a higher
2021). With an inefficient service infrastructure, there is a high lethality for males, aged 70 to 79 years. The analysis of data
probability of health system collapse due to the need for referring to mortality by gender allows us to ascertain that,
hospitalization. It is also necessary to consider a historical despite the greater number of people infected with SARS-
shortage of health professionals in the North of Brazil, marked CoV-2 in the region being women, the group of men have died
by the lowest index of doctors per thousand inhabitants in the the most. Innumerable reasons are associated with higher
country, registering 1.05, in this case. On the other hand, the mortality among men, for example, the production of
Southeast and South regions have 2.44 and 2.27 doctors per estrogens in women and immunological factors related to the
thousand inhabitants, respectively. At the beginning of 2020, X chromosome, which, once doubled in the female gender, is
just over 19 thousand of these professionals were working in supposed to have several advantages for immunity (Horst et
the North of the country. In the city of São Paulo, for example, al., 2016). On the other hand, testosterone, a predominantly
there are more than 30 thousand doctors working. Thus, it is male hormone, appears to have an immunosuppressive effect,
possible to note that the lack of supplies and professionals can making men more susceptible to infections and contagious
be one of the causes for high mortality among hospitalized events (Holdstock et al., 1982). In addition to these factors,
patients in the region. The survey showed that 195 of the 396 women are less affected by viral infections because they have
hospitalized patients died, which represents almost 50% of the a greater production and circulation of antibodies, adding to
sample. Added to this is the fact that the North has the lowest the fact of a higher level of synthesis of inflammatory
number of respirators per 100 thousand inhabitants in Brazil. biomarkers (Bernardi et al., 2020). Analyzing the age, it is
There are only 3500 units for a population of almost 16 million possible to observe that the highest mortality among women
inhabitants (Daspett et al., 2020). aged 60 to 69 years and among men aged 70 to 79 years
follows the national and world rate, since adults are the most
In addition, the middle Xingu region is characterized by its infected, however, the elderly are the ones who most die
large territorial extension and the ICU beds are centralized in (Shahid et al., 2020). Studies show a lethality of almost 15%
the municipalities' headquarters. Thus, there is a difficult in people over 80 years old, who contracted COVID-19. In the
logistics of displacement of the population to obtain a bed. The age group from 70 to 79 years old, this index is 8% and, from
average distance that a resident need to travel to receive care in 60 to 69 years old, it is 8.8%. These rates are 3.82 times higher
an ICU bed in the Xingu region of Pará is between 240 and than the general average (Hammerschimdt & Santana, 2020).
500 kilometers. All difficulties in access and the scarcity of Thus, in general, between the 18th and 38th Epidemiological
human resources and infrastructure in the region directly Week of 2020, 11.693 cases of COVID-19 were confirmed in
impact the use of an ICU bed by the health system user the Xingu region. The highest incidence occurred among
(Noronha et al., 2020). The geographical distribution of cases females (52.9%). In addition, there were 396 (3.39%)
varied in each municipality in the Xingu region, with the hospitalizations and 260 (2.22%) deaths. The delay in the
highest number in Altamira (4,019 cases), followed by performance of public management and the socioeconomic
Medicilândia (1,693 cases) and Uruará (1,083 cases). difficulties of the region, which makes it harder for the
Chronologically, until July 2020, the North region of Brazil population to adhere to preventive measures, may explain the
registered more than 400 thousand confirmed cases of SARS- explosion of cases. According to Córdoba & Aiello et al
CoV-2 infection and, in parallel, the Xingu region, considering (2016), with the difficulty in maintaining social distance, less
all nine municipalities, totaled at least 6,000 cases of the access to health and basic sanitation, job shortages and falling
disease at the time24. It is also observed, analyzing the state income, it is observed that COVID-19 disproportionately
context, that other regions of Pará such as Baixo Amazonas reaches the most vulnerable and poor regions, like the Amazon
and Carajás presented a sudden increase in cases, possibly Xingu. Considering the particularities of the region, such as
related to the high migratory flow related to mining, in the the significant population of traditional communities,
case of Parauapebas, and with port regions, in the case of indigenous and riverside residents, it is necessary to take a
Santarém (Sousa & Júnior, 2020). The research also evaluated closer look at the development of COVID-19 in the region,
the geographical distribution of deaths, where the highest opting for a massive health education campaign and
number was observed in Altamira (116 cases), followed by improvements in the health assistance, to avoid an even more
Porto de Moz (26 cases), Anapú (21 cases) and Vitória do pernicious outcome to the current crisis.
Xingu (21 cases). It was already expected that Altamira would
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an epidemiologic study in the amazon xingu region, Brazil

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