COVID-19: District level vulnerability assessment in India.

OBJECTIVES: COVID-19 Pandemic has brought a threatening challenge to the world and as well as for Indian society and economy. In India, it has become a public health disaster and its' intensity increasing continuously. For the disaster risk reduction, and capacity building against the COVID-19 pandemic understanding of the relationship between socio-environmental conditions with the pandemic is very necessary. The objective of the present work is to construct a socio-environmental vulnerability index of the potential risk of community spread of COVID-19 using socio-economic and environmental variables. METHODOLOGY: In this, cross-sectional study principal component analyses have been used to drive SoEVI. 4 uncorrelated sub-index has been extracted from 16 sub-indicators which reflects 59% of the variance. Aggregation of 4 Sub-Index has been done to obtain the final vulnerability Index. RESULTS: Results show that there is spatial variability in vulnerability based on environmental and socio-economic conditions. Districts of north and central India found more vulnerable then south India. Statistical significance has been tested using regression analysis, positive relation has been found between vulnerability index and confirmed and active cases. CONCLUSION: The vulnerability index has highlighted environmentaly and socioeconomicallybackward districts. These areas will suffer more critical problems against COVID-19 pandemic for their socio-environmental problem.

Utilization of Telemedicine among Medicare beneficiaries undergoing Hepatopancreatic Surgery during the COVID-19 Pandemic.

INTRODUCTION: Telemedicine may serve as an important avenue to address disparities in access to cancer care. We sought to define factors associated with telemedicine use among Medicare beneficiaries who underwent hepatopancreatic (HP) surgery, as well as characterize trends in telemedicine usage relative to community vulnerability based on the enactment of the Medicare telemedicine coverage waiver. METHODS: Patients who underwent HP surgery between 2013-2020 were identified from the Medicare Standard Analytic Files (SAF). Telemedicine utilization was assessed pre- versus post- implementation of the Medicare telemedicine coverage waiver; the county-level social vulnerability index (SVI) was obtained from the Center for Disease Control. Interrupted time series analysis with negative binomial and multivariable logistic regression methods were used to assess changes in telemedicine utilization after the implementation of the Medicare telemedicine coverage waiver relative to SVI. RESULTS: Pre-waiver telemedicine visits were scarce among 16,690 patients (0.2%, n = 28), while post-waiver telemedicine adoption was substantial among 3,301 patients (45.8%, n = 1,388). Post-waiver, the median patient age was 70 years (IQR, 66-74) with the majority of patients being age 65-69 (n = 994, 32.8%); 1,599 (52.8%) were female. Most patients self-identified as White (n = 2641, 87.1%), while a minority of patients self-identified as Black (n = 190, 6.3%), Asian (n = 18, 0.6%), Hispanic (n = 35, 1.2%), or Other/unknown (n = 147, 4.9%). On multivariable regression analysis, patients who lived in highly vulnerable counties (referent Low SVI; moderate SVI: OR 1.09, 95% CI 0.86-1.39, p = 0.449; high SVI: OR 0.72, 95% CI 0.55-0.94, p = 0.001) and individuals with advancing age (referent 18-64; 65-69, OR 0.68, 95%CI 0.54-0.86; 70-74, OR 0.56, 95%CI 0.44-0.71; 75-79, OR 0.57, 95%CI 0.44-0.75; 80-84, OR 0.43, 95%CI 0.30-0.61; 85 + , OR 0.25, 95%CI 0.13-0.49) had lower odds of utilizing telemedicine. In contrast, Black patients (referent White; OR 2.26, 95% CI 1.65-3.10) and patients with a higher CCI score > 2 (referent ≤ 2; OR 1.49, 95% CI 1.28-1.71) were more likely to use telemedicine (all p < 0.001). CONCLUSIONS: Medicare beneficiaries residing in counties with extreme vulnerability, as well as elderly individuals, were markedly less likely to use telemedicine services related to HP surgical episodes of care. The lower utilization of telemedicine in areas of high social vulnerability was attributable to concomitant lower rates of internet access in these areas.

Preparing for the next outbreak: A review of indices measuring outbreak preparedness, vulnerability, and resilience.

The COVID-19 pandemic has highlighted the need for relevant metrics describing the resources and community attributes that affect the impact of communicable disease outbreaks. Such tools can help inform policy, assess change, and identify gaps to potentially reduce the negative outcomes of future outbreaks. The present review was designed to identify available indices to assess communicable disease outbreak preparedness, vulnerability, or resilience, including articles describing an index or scale developed to address disasters or emergencies which could be applied to addressing a future outbreak. This review assesses the landscape of indices available, with a particular focus on tools assessing local-level attributes. This systematic review yielded 59 unique indices applicable to assessing communicable disease outbreaks through the lens of preparedness, vulnerability, or resilience. However, despite the large number of tools identified, only 3 of these indices assessed factors at the local level and were generalizable to different types of outbreaks. Given the influence of local resources and community attributes on a wide range of communicable disease outcomes, there is a need for local-level tools that can be applied broadly to various types of outbreaks. Such tools should assess both current and long-term changes in outbreak preparedness with the intent to identify gaps, inform local-level decision makers, public policy, and future response to current and novel outbreaks.

Psychological Distress and Negative Emotions in Post-COVID Infection: A Comparative Study of the COVID and NO-COVID Young Patients.

According to the literature, mental health assumed urgent relevance, and several scholars are debating on the enduring of the neurological and psychiatric symptoms in post COVID patients. Our study aimed to investigate the emotional dimensions in young population to the COVID exposition: primary endpoint was to detect the psychological distress up to 3 months in post-COVID-19. A comparative study was conducted among young adults in Italy. We also assessed dysphoria, depression, anxiety, stress symptoms, pessimism, and positive personality traits. The participants were 140 Italian young aged 18-30 years (mean = 22.1, SD ± 2.65; 65.0% female). The sample was distinguished in two groups: COVID and NO-COVID groups. The results revealed that young who have been exposed to COVID-19 infection evidenced emotional vulnerability by higher psychological distress (depression, anxiety, stress), dysphoria signs (irritability, discontent, interpersonal resentment, and feelings of renunciation/surrender) then No COVID-19 infection young. Furthermore, COVID patients showed higher negative emotions about the expected life, uncertain for future, and loss of motivation (characterized no desires) than NO-COVID infection. In conclusion, the vulnerability of young exposed to COVID infection even in mild severity should be considered as emerging unmet need of mental health recovering: urgent health policy actions to boost the psychological, biological and social strategic pillar for young generation.

Vulnerabilities in Mental Health due to Covid-19 Pandemic: The Response of the Italian Physicians.

COVID-19 pandemic has exacerbated the pre-existing vulnerabilities and inequalities in societies. In this paper we analyse the categories that have suffered more than others from the pandemic and the restrictions on social life in terms of mental health. We rely on the Serendipity project based on a survey administered between November 2021 and February 2022 to a sample of Italian physicians (n = 1281). The survey aimed to assess the perception of general practitioners, paediatricians, geriatricians, and mental health specialists (psychiatrists, neurologists, child neuropsychiatrists), about changes in the mental health of the population as an effect of the COVID-19 pandemic and the lockdown. The strategies implemented by the doctors interviewed in terms of the intensity of the prevention, emergence, and treatment of mental health interventions, and their association with physicians' characteristics and their opinions on patient vulnerability have been illustrated by means of a multiple correspondence analysis. An overall result of the survey is the consensus of doctors on the worsening of mental health in general population, especially among their patients, due to the pandemic and on the onset of new discomforts. The most exposed individuals to the risk of onset or worsening of mental disorders include women, young people, and patients with psychiatric comorbidity. The paper also illustrates the interventions put in place by the physicians and deemed necessary from a public heath response perspective, that include providing psychoeducation to the general population, improving telehealth services, and increasing financial and human resources for community-based care.

Using the social vulnerability index to assess COVID-19 vaccine uptake in Louisiana.

Using data from the Louisiana Department of Public Health, we explored the spatial relationships between the Social Vulnerability Index (SVI) and COVID-19-related vaccination and mortality rates. Publicly available COVID-19 vaccination and mortality data accrued from December 2020 to October 2021 was downloaded from the Louisiana Department of Health website and merged with the SVI data; geospatial analysis was then performed to identify the spatial association between the SVI and vaccine uptake and mortality rate. Bivariate Moran's I analysis revealed significant clustering of high SVI ranking with low COVID-19 vaccination rates (1.00, p < 0.001) and high smoothed mortality rates (0.61, p < 0.001). Regression revealed that for each 10% increase in SVI ranking, COVID-19 vaccination rates decreased by 3.02-fold (95% CI = 3.73-2.30), and mortality rates increased by a factor of 1.19 (95% CI = 0.99-1.43). SVI values are spatially linked and significantly associated with Louisiana's COVID-19-related vaccination and mortality rates. We also found that vaccination uptake was higher in whites than in blacks. These findings can help identify regions with low vaccination rates and high mortality, enabling the necessary steps to increase vaccination rates in disadvantaged neighborhoods.

The Characteristics of the Financially Vulnerable Groups Impacted by COVID-19 and Other Factors

Businesses have been exposed to various challenges during the global pandemic. Unfortunately, the financially vulnerable groups in society are disproportionately affected by such a difficult time. Therefore, it is important for businesses to recognise this when creating new business models for sustainable corporate management. This paper attempts to (1) identify the factors that affect individual financial vulnerability, (2) develop survey items to assess financial vulnerability and its factors and (3) provide the characteristics of financially vulnerable groups by presenting a complete set of descriptive statistics. The results can help to create more inclusive business models that are better equipped to address the challenges ahead. A questionnaire-based survey was conducted with collaboration with an NGO that provides a financial counselling service in Hong Kong. In total, 338 valid responses were collected and the data were used to characterise financially vulnerable groups in terms of (1) change in financial conditions due to COVID-19;(2) exposure to digitised financial services and related push marketing;(3) financial management ability;(4) changes in four financial behaviours and (5) financial vulnerability as measured according to the debt/service ratio. Results show that the respondents have a median debt/service ratio of 0.513, which represents an unsustainable level of debt. Around 1/4 of surveyed respondents reported that their debt/service ratio was 1 or even higher, indicating obvious difficulties in meeting financial obligations. A total of 36.7% of the respondents reported worsening financial conditions since the outbreak of COVID-19. The results presented provide a solid empirical set of data that will help future research work to examine and/or develop a heuristic financial vulnerability model that incorporates the key factors leading to it. Businesses can refer to them when creating new business models that are sustainable, able to meet corporate social responsibility goals and can achieve several targets/goals of the United Nations' Sustainable Development Goals.

The Immediate Impacts of COVID-19 on Low-Income Households: Evidence from Malaysia

This study unravelled the economic impacts of the coronavirus disease 2019 (COVID-19) on low-income households. The asymmetric economic impacts of the pandemic that are biased towards the poor, young, and women have been well established. However, micro evidence on the poor is limited, thus demanding detailed understanding to design an effective targeted assistance. In this study, data were gathered from face-to-face interviews using a sampling frame provided by the Department of Statistics Malaysia (DOSM). Online data collection was dismissed to ensure all low-income households had the same chance to participate, as some might have no online access. Logistic regressions were estimated to identify the characteristics of households that suffered job loss and income reduction. The findings revealed that one in ten households experienced job loss during the pandemic, while one third survived with lower income. The extent of income reduction was rather severe, as the pandemic had reduced income generation by more than half among the affected households. The regression outcomes showed that the higher-income households among the low-income households had higher chances of experiencing income reduction. A similar scenario was noted for less-educated households. Notably, the adverse impacts were not biased toward female-headed households, as is widely perceived. There was no evidence that economic sectors explained job losses, but households involved in the agriculture, domestic, and transportation sectors had higher chances of suffering from income reduction. These results suggest that monetary government assistance should not rely on general indicators, such as female-headed households and below-poverty-line income (PLI). Instead, a more effective measure is to look at other characteristics, such as employment type, education level, and job sectors.

Pandemic vulnerability knowledge visualisation for strategic decision-making: A COVID-19 index for government response in Australia

Purpose: First, the key vulnerability factors from the literature are identified. Second, using the vulnerability factors as indicators, a composite index is developed. Last, from the index values, a set of vulnerability knowledge maps, showing the vulnerability hotspots, are prepared. Design/methodology/approach: This study aims to develop a pandemic vulnerability knowledge visualisation index to support the strategic decision-making efforts of authorities. Findings: Ten indicators are identified as vulnerability factors that could significantly impact the virus spread risks. Verifying the identified hotspots against the recorded infected cases and deaths has evidenced the usefulness of the index. Determining and visualising the high-vulnerability locations and communities could help in informed strategic decision-making and responses of the authorities to the pandemic. Originality/value: The study demonstrates that the developed pandemic vulnerability knowledge visualisation index is particularly appropriate in the context of Australia. Nonetheless, by replicating the methodologic steps of the study, customised versions can be developed for other country contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

The immediate and long-term consequences of the Covid-19 pandemic on education in Portugal: An empirical exploration

The purpose of this article is to analyze how the Covid-19 pandemic contributed to the increase in the number of people in situations of vulnerability and, consequently, to the increase of social and economic inequalities that, historically, have thriven in Brazil. Therefore, it starts with an analytical reconstruction of the concepts of necropolitics and democratic legitimacy, proposed by Achille Mbembe and Pierre Rosanvallon, respectively. Thus, it seeks to show, preliminarily, how public policies and government management during the crisis contributed to the worsening of the post-pandemic chaotic scenario, with the resulting ratification and, even, resurgence of the invisibility of vulnerable groups, through the implementation of increasingly indifferent policies and, in some cases, refractory to the desires and needs of these groups, which will be considered mainly from the perspective of Achille Mbembe's necropolitics. Then, within the scope of this analysis, the forms of legitimacy (impartiality, proximity and reflexivity). Through this sophisticated conception of the democratic experience, viewed as irreducible to its electoral dimension (delegation democracy), an attempt will be made to explain the extent to which the increased vulnerability of various social groups in the context of the pandemic can be considered as an expression of greater democratic deficit in Brazil. © 2023: Author(s).

Social insecurity and varieties of family resilience strategies during the COVID-19 pandemic

PurposeThis study is aimed at developing an understanding of the consequences of the pandemic on families' socioeconomic resilience, and the strategies adopted by the families in overcoming social vulnerabilities amid uncertainty.Design/methodology/approachThe materials for this study consist of semi-structured interviews with 21 families spread across the South Sumatra Province, Indonesia. Families in the study represent four different income levels, namely very high, high, middle and low, and who also work in the informal sector. Each family has at least 1 or more members who fall into the vulnerable category (children, the elderly, people with disabilities unemployed or having potential economic vulnerability).FindingsTwo main findings are outlined. Regardless of their socioeconomic status, many of the families analyzed adopted similar strategies to remain resilient. Among the strategies are classifying the urgency of purchasing consumer goods based on financial capacity rather than needs, leveraging digital economic opportunities as alternative sources of income, utilizing more extensive informal networks and going into debt. Another interesting finding shows that the pandemic, to some extent, has saved poor families from social insecurity. This is supported by evidence showing that social distancing measures during the pandemic have reduced the intensity of sociocultural activities, which require invited community members to contribute financially. The reduction of sociocultural activities in the community has provided more potential savings for the poor.Research limitations/implicationsIn this study, informants who provided information about their family conditions represent a major segment of the workforce and tend to be technologically savvy and younger, due to the use of Zoom as a platform for conducting interviews. Therefore, there may be a bias in the results. Another limitation is that since the interviewees were recommended by our social network in the fields, there is a risk of a distorted selection of participants.Originality/valueThis study offers insights that are critical in helping to analyze family patterns in developing countries in mitigating the risks and uncertainties caused by COVID-19. In addition, the literature on social policy and development could benefit from further research on COVID-19 as an alternative driver to identify mechanisms that could bring about change that would result in "security.” Critical questions and limitations of this study are presented at the end of the paper to be responded to as future research agenda.

Learning to combat social isolation in senior living communities during COVID-19 and beyond

Social isolation has been a growing concern since the onset of the COVID-19 pandemic, disproportionately impacting older adults. Social isolation can impact the physical, mental, and emotional health of older adults. The purpose of this study was to examine coping strategies of older adults living in senior living communities, as well as the supportive efforts of the team members working in such communities, to determine best practices for combating social isolation for older adults. This qualitative study was guided by the research question: How do older adults perceive loneliness, social isolation, and social connectedness living in senior living communities? Guided by the theoretical frameworks of socioemotional selectivity theory (SST) and strength and vulnerability integration model (SAVI), this study explored how diminished time horizons impact the prioritization of social connections. This qualitative study collected data through semi-structured interviews from older adults living in senior living communities in the United States. Several themes emerged from the data including Parameters of Social Connection, Dining Room as a Hub of Socialization, Time Horizon Awareness and Compensation, Strategies of Connection, and Loss of Spouse. Several implications for best practices are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Coping Strategies and Livelihood Sustainability for Rural Women in the Face of COVID-19: The Case of Mutoko District, Zimbabwe

This paper examines the coping mechanisms, levels of livelihood sustainability and diversification for rural farmers in Mutoko district, an area in Mashonaland East province, about 148 km from Harare. Despite the rural farmers being well known for being the best fruit and vegetable suppliers to Harare (tomatoes and mangoes), the farmers appear to remain subsistence, living from hand to mouth because of the nature of their farming practices. The normal operations of the farmers were interrupted by the COVID-19 movement restrictions effected by the Zimbabwean Government from March 2020, since their main livelihoods depend on daily or weekly trips to Harare's Mbare Musika to sell fresh fruits and vegetables. The study interviewed 10 women purposively selected, and an additional 20 respondents who participated in 5 focus groups comprising of 4 people each. The respondents indicated that they had challenges during COVID-19 movement restrictions in 2020 and 2021, and these included loss of revenue, reduction in production, lack of storage and preservation strategies for their agricultural produce and inability to provide family needs like online lessons for school children among other things. The paper recommends that processing plants be installed in the district and rural industrialisation be intensified to enable other sources of income, besides agricultural activities. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Did virtual consultations during Covid-19 improve diabetes transition clinic attendance compared to face to face clinic attendance

We have an established transition clinic for the patients with diabetes aged 16 to 19. Our Transition clinic covers a vast area including deprived areas such as Ellesmereport. We do have 3 monthly follow up in addition to the home visits by paedatric diabetes specialist nurses. The team involves paediatric consultants, pdsn and dietcician from adult and paedatrics departments. Virtual consultation were the main mode of consultations during covid. We used Accu Rx, Attendanywhere and telephone consultations. We compared the clinic attendance pre and post covid. We compared clinic attendance for 9 months from March 2019 to December 2019 which were pre Covid to March 2020 to December 2020 during Covid. We had 150 appointments in 2019 and 112 appointments in 2020. The DNAs were 21 during covid with virtual consultations and 28 pre Covid with face to face appointments. The DNA rates were 18.6% in 2019 as face to face review and 18.75% during covid as virtual consultations. Surprisingly, the DNA rates did not improve when the clinics were virtual as we expected. In Conclusion, the virtual consultations did not improve the attendance in this vulnerable age group. Due to vulnerability of this age group, we felt that the face to face consultations were more appropriate. All of our appointments for the diabetes transition clinics are face to face in person due to above findings.

Introduction

Two hundred seventy-four million people-one in thirty people on the planet-are in humanitarian need as of September 2022.1 More than one hundred million of these individuals are displaced, usually as a result of crisis: conflict, political upheaval, economic meltdown, or climate shocks.2 In a humanitarian crisis, health is the most urgent and paramount need. But today the system for preventing and addressing humanitarian crisis is failing, and with it, the health needs of millions of vulnerable people are under threat. From treating childhood acute malnutrition to delivering COVID-19 vaccines to ensuring access to sexual, reproductive, maternal, and newborn health, health care in humanitarian contexts requires a dramatic rethink amid growing challenges to access and service delivery.

Refugee women in Africa, COVID-19 and multisystem violence: when it rains it pours

The first wave of the COVID-19 pandemic to hit Africa (February–September 2020) was not particularly virulent either in terms of cases detected or lethality. However, the presence of the virus and the subsequent restrictions exacerbated pre-existing inequalities based on ethnicity, class and gender. This paper analyses the impacts of the pandemic on refugee women, who are subject to "structural vulnerability” and "multisystemic violence” in Africa. After analysing the ten African countries with the largest refugee populations, the different forms and levels of these impacts are systematised, along with the consequences and implications for refugee women in the long term, highlighting the need for strategies to be adopted towards this group at various levels © 2023, Revista CIDOB d'Afers Internacionals.All Rights Reserved.

DEATH LANDSCAPES AND COVID-19 IN THE AMERICAS: NORMATIVE RESPONSES OF THE INTER-AMERICAN COMMISSION OF HUMAN RIGHTS TOWARDS VULNERABILITY-DEATH

The article engages with the death landscapes of the Americas' two largest democracies – Brazil and the United States – during the Covid-19 crisis, offering a conceptual tool entitled vulnerability-death binomial to consider the extent to which a politics of tragedy is a turning point in the ways institutional politics addresses vulnerability and death, emphasizing the work of the Inter-American Commission on Human Rights (IACHR). When analyzing the normative responses of IACHR, no articulation was found between vulnerability and death but, instead, a bifurcation of each. Although it reveals that there is not a normative interplay between vulnerability and death, the bifurcation does not mean a choice between binary paths. While the two democracies have raised institutional challenges, the IACHR deepened certain senses of vulnerability and a normative movement towards death: issues historically absent from the international basic structure and capable of challenging the international justice theory © 2023, Lua Nova.All Rights Reserved.

Towards a classification of vulnerability of small-scale fisheries

Vulnerability of small-scale fisheries (SSF) results from complex interactions amongst various threats and stressors, including biophysical risks, environmental variability, unstable political situations, and weak governance, to name a few. SSF vulnerability has become more evident, with increased severity, during the COVID-19 pandemic. Knowledge about what makes SSF vulnerable is limited, which impedes appropriate policy responses and intervention. As a first step to rectifying the situation, a classification approach is proposed to better describe and differentiate types of vulnerability to SSF and to guide data collection and dissemination about SSF vulnerability. The classification system is developed based on a narrative review of case studies worldwide, published in scientific journals in the past 20 years. The case studies cover SSF in diverse aquatic environments, including river, floodplain, reservoir, river delta, lake, atoll, estuaries, lagoon mangrove, coral reefs, seagrass ecosystem, islands, coastal and marine environment. Similar to the five pillars of sustainability, SSF vulnerability is associated with five main factors, i.e., biophysical, social, economic, technological, and governance. Knowledge about SSF vulnerability helps inform tailored management strategies and policies to reduce SSF marginalization and promote viability, aligning, therefore, with the goal of the Voluntary Guidelines for Securing Sustainable Small-Scale Fisheries.Copyright © 2022 Elsevier Ltd

‘Cocooning' in prison during COVID-19: Findings from recent research in Ireland

The advent of COVID-19 prompted the enforced isolation of elderly and vulnerable populations around the world, for their own safety. For people in prison, these restrictions risked compounding the isolation and harm they experienced. At the same time, the pandemic created barriers to prison oversight when it was most needed to ensure that the state upheld the rights and wellbeing of those in custody. This article reports findings from a unique collaboration in Ireland between the Office of the Inspector of Prisons – a national prison oversight body – and academic criminologists. Early in the pandemic, they cooperated to hear the voices of people ‘cocooning' – isolated because of their advanced age or a medical vulnerability – in Irish prisons by providing journals to this cohort, analysing the data, and encouraging the Irish Prison Service to change practices accordingly. The findings indicated that ‘cocooners' were initially ambivalent about these new restrictions, both experiencing them as a punishment akin to solitary confinement, and understanding the goal of protection. As time passed, however, participants reported a drastic impact on their mental and physical health, and implications for their (already limited) agency and relationships with others, experienced more or less severely depending on staff and management practices. The paper also discusses the implications for prison practices during and following the pandemic, understanding isolation in the penological context, and collaboration between prison oversight bodies and academics.

Vulnerability and Democracy: social vulnerability as a factor in increasing the democratic deficit in the context of the Covid-19 pandemic in Brazil

The purpose of this article is to analyze how the Covid-19 pandemic contributed to the increase in the number of people in situations of vulnerability and, consequently, to the increase of social and economic inequalities that, historically, have thriven in Brazil. Therefore, it starts with an analytical reconstruction of the concepts of necropolitics and democratic legitimacy, proposed by Achille Mbembe and Pierre Rosanvallon, respectively. Thus, it seeks to show, preliminarily, how public policies and government management during the crisis contributed to the worsening of the post-pandemic chaotic scenario, with the resulting ratification and, even, resurgence of the invisibility of vulnerable groups, through the implementation of increasingly indifferent policies and, in some cases, refractory to the desires and needs of these groups, which will be considered mainly from the perspective of Achille Mbembe's necropolitics. Then, within the scope of this analysis, the forms of legitimacy (impartiality, proximity and reflexivity). Through this sophisticated conception of the democratic experience, viewed as irreducible to its electoral dimension (delegation democracy), an attempt will be made to explain the extent to which the increased vulnerability of various social groups in the context of the pandemic can be considered as an expression of greater democratic deficit in Brazil. © 2023: Author(s).