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Description
By early March 2020, COVID-19 had spread internationally and was declared a public health emergency by the World Health Organization (WHO). As of June 2020, the only strategies for disease control were the non-pharmaceutical interventions (NPIs), such as masking and social distancing resulting in the COVID-19 pandemic to accelerate and continue to be a threat to public health globally. Brazil has seen one of the worst outbreaks, with cases and fatalities increasing as the southern hemisphere moves into its winter months. In the state of São Paulo, there is the island of São Vicente, home to the cities of São Vicente and Santos. These two cities are nearly identical geographically and environmentally, however, from epidemiological week 1 to 30, the island of São Vicente has seen infection rates significantly above the state and national averages. With distinct social disparities, creating divisive challenges between the two cities, the dueling public health crisis has affected government action, access to health care and testing, and the ability of residents to abide by strict WHO recommendations for transmission control that indicates socio-economic factors are directly, and divergently influencing health outcomes across the island. This thesis followed the public health database reporting for the COVID-19 outbreak on the island of São Vicente, as Brazil was also experiencing one of the worst Dengue Fever outbreaks in recent history, while analyzing social media postings for each of the two cities, allowing for a comparative analysis on how social factors influence health outcomes. Labeled a “syndemic”, the two concurrent outbreaks, create added challenges to controlling distinct public health emergencies on a semi-isolated island of only 57.4 km2 . The difference between the socio- vi economic demographic profiles of Santos and São Vicente, directly impacts the financial and political capabilities of local governments to provide the proper resources and information for informed and proactive action against current and future public health crises. These same factors also illuminated drastic health inequities when assessing the social determinants of health that directly influenced each city’s inhabitants’, in correlation with the prevalent and extreme income inequality, access to information, diagnosis, treatment, and resources.
