Emergency Care Gap in Brazil: Geographical Accessibility as a Proxy of Response Capacity to Tackle COVID-19

Background: The new coronavirus disease (COVID-19) has claimed thousands of lives worldwide and disrupted the health system in many countries. As the national emergency care capacity is a crucial part of the COVID-19 response, we evaluated the Brazilian Health Care System response preparedness against the COVID-19 pandemic. Methods: A retrospective and ecological study was performed with data retrieved from the Brazilian Information Technology Department of the Public Health Care System. The numbers of intensive care (ICU) and hospital beds, general or intensivist physicians, nurses, nursing technicians, physiotherapists, and ventilators from each health region were extracted. Beds per health professionals and ventilators per population rates were assessed. A health service accessibility index was created using a two-step floating catchment area (2SFCA). A spatial analysis using Getis-Ord Gi^* was performed to identify areas lacking access to high-complexity centers (HCC). Results: As of February 2020, Brazil had 35,682 ICU beds, 426,388 hospital beds, and 65,411 ventilators. In addition, 17,240 new ICU beds were created in June 2020. The South and Southeast regions have the highest rates of professionals and infrastructure to attend patients with COVID-19 compared with the northern region. The north region has the lowest accessibility to ICUs. Conclusions: The Brazilian Health Care System is unevenly distributed across the country. The inequitable distribution of health facilities, equipment, and human resources led to inadequate preparedness to manage the COVID-19 pandemic. In addition, the ineffectiveness of public measures of the municipal and federal administrations aggravated the pandemic in Brazil.