The Covid-19 Protection Index (CPI) as a Way to Identify Vulnerabilities and Disparities Across Brazilian Territories

ABSTRACT

In Brazil, the Covid-19 pandemic spread across an extremely unequal and exclusory territory, disproportionately affecting the most vulnerable populations. In order to identify how living and habitability conditions and their overlap with gender, race, and class affect the impact of Covid-19 on certain social groups, the "Ação Covid-19” research group developed the Covid-19 Protection Index (CPI) as an alternative to the Human Development Index to measure inequalities in the context of the pandemic. Our aim was to examine specific territories (states, cities, and neighborhoods) and demonstrate how the spread of the SARS-CoV-2 virus could be associated with a socially exclusory model of territorial occupation, what regions and populations would be most severely affected, and who would suffer most if measures to mitigate the spread of the pandemic were not taken (potentially increasing these populations' vulnerability). The CPI uses data from the Brazilian Institute of Geographical and Statistical Research (IBGE) to build fourteen variables classified along three dimensions the urban surroundings of households (Urban Environment), the living standard inside households, and the human dimension. At all territorial scales, the CPI corresponded to actual Brazilian inequalities. The index was found to be negatively correlated to the number of cases and deaths at the beginning of the pandemic, giving us a good portrait of the pre-existing vulnerabilities to which populations are subject in Brazil. We also used the index as an input in a simulator developed by our research group to emulate the dynamics of the virus's spread in different neighborhoods within a city. As expected, we observed higher infection curves for low CPI territories and flatter curves for high CPI neighborhoods. Furthermore, even among lower CPI territories we found important discrepancies, as some communities were able to organize themselves to protect the community from the virus even in the absence of public intervention measures. The CPI was also juxtaposed to vaccination rates in Brazil, where we found that the vulnerabilities pointed out by the CPI were maintained, reflecting the national vaccination program's lack of prioritization of more vulnerable populations. The index was shown to be a good tool to identify vulnerable territories, and thus could be used to direct government action, pointing out those territories that should be prioritized not only in terms of the healthcare system but other interrelated matters, such as their environment, economy, demography, housing, and territorial infrastructure. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.