ABSTRACT:

Objective:

To describe changes in socioeconomic and health conditions of Brazilians during the COVID-19 pandemic.

Methodology:

Cross-sectional study with data from a web-based behavioral survey carried out from April 24 to May 24, 2020, with 45,161 participants recruited by the chain sampling method. A descriptive analysis of the survey topics was performed: adherence to social restriction measures, diagnosis of the new coronavirus, work situation and income, difficulties in routine activities, presence of comorbidities, psychological issues, and access to health services. Prevalence and respective 95% confidence intervals were estimated.

Results:

Approximately 74% of Brazilians adhered to social restrictions. As for flu symptoms, 28.1% reported having at least one flu symptom, but only 5.9% underwent testing for COVID-19. Regarding the socioeconomic impact, 55.1% reported a decrease in family income, and 7.0% were left without any income; 25.8% of the people lost their jobs, with the group of informal workers being the most affected (50.6%). As for health conditions, 29.4% reported worsening of health status; 45%, having sleep problems; 40% frequently presented feelings of sadness, and 52.5%, of anxiety; 21.7% sought health care, and, among them, 13.9% did not get care.

Conclusion:

The findings show the importance of controlling the COVID-19 pandemic in Brazil, to mitigate the adverse effects on the socioeconomic and health conditions related to social restriction measures.

Keywords:
Pandemics; Coronavirus infections; Social isolation; Social change; Health evaluation; Brazil

INTRODUCTION

The occurrence of COVID-19 caused by a new strain of the coronavirus (Sars-CoV-2) was first reported in the city of Wuhan, in China, in December, 2019. On January 30, 2020, the World Health Organization (WHO) declared the COVID-19 outbreak as a public health international emergency, and, in less than three months, the disease had spread around the world, being declared as a pandemic on March 11, 2020¹1. Steffens I. A hundred days into the coronavirus disease (COVID-19) pandemic. Euro Surveill 2020; 25(14): pii=2000550. https://doi.org/10.2807/1560-7917.ES.2020.25.14.2000550
https://doi.org/https://doi.org/10.2807/... ^,22. World Health Organization. Emergency Committee. Statement on the second meeting of the International Health Regulations (2005) Emergency Committee regarding the outbreak of novel coronavirus (2019-nCoV). Genebra: World Health Organization; 2020.^,33. World Health Organization. Emergency Committee. WHO Director - General’s opening remarks at the media briefing on COVID-19 - 11 March 2020. Genebra: World Health Organization ; 2020..

In Brazil, the first confirmed case of COVID-19 was on February 26, 2020 and, in July, more than 2.5 million cases and 90 thousand deaths caused by Sars-CoV-2 had been confirmed. Three weeks after the first case was reported, all of the Brazilian states already presented at least one confirmed case of the disease⁴4. Fundação Oswaldo Cruz. MonitoraCOVID-19 [Internet]. Rio de Janeiro: Fundação Oswaldo Cruz; 2020 [acessado em 14 jul. 2020]. Disponível em: Disponível em: https://bigdata-covid19.icict.fiocruz.br/
https://bigdata-covid19.icict.fiocruz.br... .

Due to the absence of vaccines and efficient therapy for the treatment of COVID-19, a combination of public health measures has been recommended to mitigate the propagation of the virus, and to prevent the overload of health systems⁵5. Salathé M, Althaus CL, Neher R, Stringhini S, Hodcroft E, Fellay J, et al. COVID-19 epidemic in Switzerland: on the importance of testing, contact tracing and isolation. Swiss Med Wkly 2020; 150: w20225. https://doi.org/10.4414/smw.2020.20225
https://doi.org/https://doi.org/10.4414/... ^,66. Mascha EJ, Schober P, Schefold JC, Stueber F, Luedi MM. Staffing with disease-based epidemiologic indices may reduce shortage of intensive care unit staff during the COVID-19 pandemic. Anesth Analg 2020; 131(1): 24-30. https://doi.org/10.1213/ANE.0000000000004849
https://doi.org/https://doi.org/10.1213/... ^,77. Garcia-Alamino JM. Aspectos epidemiológicos, clínica y mecanismos de control de la pandemia por Sars-Cov-2: situación en España. Enferm Clin 2020. https://doi.org/10.1016/j.enfcli.2020.05.001
https://doi.org/https://doi.org/10.1016/... .

With the declaration of the pandemic and the fast growth in the number of cases and deaths in Brazil, public health measures in the field of control and prevention had to be established by governments, such as the closing of borders, restriction of on-site classes, prohibition of the functioning of commercial establishments, such as stores and restaurants, besides social distancing and suspension of public meetings and events⁸8. Aquino EML, Silveira IH, Pescarini JM, Aquino R, Souza-Filho JA, Rocha AS, et al. Social distancing measures to control the COVID-19 pandemic: potential impacts and challenges in Brazil. Ciên Saúde Colet 2020; 25(Supl. 1): 2423-46. https://doi.org/10.1590/1413-81232020256.1.10502020
https://doi.org/https://doi.org/10.1590/... .

Despite the unquestionable importance of the social restriction initiatives to contain the propagation of the disease, there are major consequences in society, with direct effects on the families’ work and income, besides implications on the physical and mental health of individuals. Besides, the uncertainty about the disease, the separation of beloved ones and the changes in daily activities also bring out relevant psychological issues⁹9. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet 2020; 395(10227): 912-20. https://doi.org/10.1016/S0140-6736(20)30460-8
https://doi.org/https://doi.org/10.1016/... ^,1010. Lima CT, Carvalho PMM, Lima IAAS, Nunes JVAO, Saraiva JS, Souza RI, et al. The emotional impact of Coronavirus 2019-nCoV (new Coronavirus disease). Psychiatry Res 2020; 287: 112915. https://doi.org/10.1016/j.psychres.2020.112915
https://doi.org/https://doi.org/10.1016/... .

This study aimed at describing the adherence to social restriction measures and changes in the work and income in routine activities, besides assessing the psychological issues of Brazilians during the COVID-19 pandemic.

METHODS

This study was based on data from the study ConVid - Pesquisa de Comportamentos (Behavioral Research), carried out from April 24 to May 24, 2020, with a web-based behavioral survey. The study was elaborated by Fundação Oswaldo Cruz (FIOCRUZ), in partnership with Universidade Federal de Minas Gerais (UFMG) and Universidade Estadual de Campinas (UNICAMP), and approved by the Research Ethics Committee of Escola Politécnica de Saúde Joaquim Venâncio (Report n. 3.980.277) for its national application.

The survey was elaborated in the Research Electronic Data Capture (RedCap) platform. All of the collected data were anonymous, with no possibility to identify the participants, and the survey was filled out by each individual using a cell phone, a computer or a tablet with access to the internet.

The survey approached several aspects, and the questions were related to sociodemographic aspects, infection by the new coronavirus, adherence to social restriction measures, health status, access to health services during the pandemic, psychological issues and lifestyle before and during the pandemic¹¹11. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. ConVid - Pesquisa de Comportamentos [Internet]. 2020 [acessado em 16 jul. 2020]. Disponível em: https://doi.org/10.7303/syn22250673.1
https://doi.org/https://doi.org/10.7303/... .

The study participants were recruited by the chain sampling method. First, we selected a group of researchers from different States to begin the chain of dissemination. Each one sent a research link to at least 20 people in their social networks, according to stratification by gender, age group and schooling, thus forming the second wave of the chain. Then, all individuals who received the link, regardless of the source, had the opportunity to answer the survey and share the link with other people in their social networks. More details about the research can be found in the official website of the study ConVid - Pesquisa de Comportamentos (https://convid.fiocruz.br/).

The study database was calibrated using the information from the National Household Sample Survey (PNAD), 2019, per Federation Unit, sex, age, race/ethnicity, and schooling, to obtain a sample whose distribution is similar to the Brazilian population. Before the beginning of the analyses, the data were assessed regarding the presence of duplicities (3.6%) and missing data (4.3%), and both were excluded from the database. The total sample was comprised of 45,161valid surveys.

This study aimed at analyzing part of the themes investigated in ConVid - Pesquisa de Comportamentos (Behavioral Research). Prevalence rates (%) were estimated with the respective 95% confidence intervals (95%CI), for each one of the following variables: adherence to social restriction measures, report of flu symptoms, testing and infection by the new coronavirus, work and family income status, difficulties to perform activities of daily life, presence of risk comorbidities to aggravate COVID-19, health status, access to health services, and psychological issues of the individuals during the pandemic.

To assess the adherence to social restriction measures, the following question was used: during the new coronavirus pandemic, how often did you (or do you still) restrict contact with people? The options were: I did nothing and continued with my normal lifestyle; I tried to be careful and stay away from people, reducing contact and not visiting the elderly, but I kept working and going out; I stayed home, only going to the supermarket and the drugstore; I strictly stayed at home, and only left in case of health needs.

Regarding the presence of flu symptoms, the following question was considered: after the pandemic arrived in Brazil, did you present any flu symptoms?. And the answers were yes and no. The testing and test results were assessed by the following questions: did you take the test to know if you were infected?; and was the test positive?; with the following categories of analysis: did not take the test; took the test, with positive result; took the test, with negative result; took the test, but have not seen the results yet.

Besides these questions, the following question was include, with “yes” and “no” answers: did any relative, close friend or work colleague have a severe case of the disease caused by the new coronavirus, or die?

In the work status analysis before and during the pandemic, we used the following questions: before the beginning of the new coronavirus pandemic, what was your main work status? (server, or worked with a contract and registration; worked without a registration; was self-employed); how did the pandemic affect your occupation/job? (I did not work before and continued this way; I continued to work or started working during the pandemic; I lost my job/ I did not work); during the pandemic, how much did you work? (less than usual; the same as before; more than usual); and, during the pandemic, how difficult was it for you to perform your work activities? (not difficult at all/a little; moderately; intensively).

For the classes of household average income, we asked the following questions: before the beginning of the new coronavirus pandemic, what was the total income of the household?; and how many residents are there in your household? The mean per capita household income was calculated with the following categories, considering minimum wage (MW): up to ½ MW; ½ to 1 MW; one to two MW; two to four MW; four or more MW.

Besides, it was possible to assess the effect of the pandemic on the income of the families with the following question: how did the pandemic affect your family income?, with the alternatives: it remained the same/increased; it decreased a little; it decreased a lot; there was no income.

The intensity of household work was assessed by the following question: did the pandemic affect/change the amount and type of your household work? The answers were: it decreased/remained the same; it increased; it increased a lot.

To evaluate the effects of the pandemic on health status, the following question was considered: Do you think the pandemic caused changes in your health status? And the answers could be: it remained the same/improved; it got worse.

The presence of risk comorbidities for the aggravation of cases of COVID-19 was based on the report of previous diagnosis of noncommunicable chronic diseases (NCDs), such as diabetes, hypertension, asthma/emphysema/chronic respiratory disease or another lung condition, heart disease or cancer, according to the clinical management protocol of COVID-19 from the Ministry of Health¹²12. Brasil. Ministério da Saúde. Secretaria de Atenção Especializada à Saúde. Departamento de Atenção Hospitalar, Domiciliar e de Urgência. Protocolo de manejo clínico da COVID-19 na Atenção Especializada [Internet]. Brasília: Ministério da Saúde; 2020 [acessado em 16 jul. 2020]. 48 p. Disponível em: Disponível em: http://bvsms.saude.gov.br/bvs/publicacoes/manejo_clinico_covid-19_atencao_especializada.pdf
http://bvsms.saude.gov.br/bvs/publicacoe... .

The search and access to health services during the pandemic were analyzed using the questions: during the new coronavirus pandemic, did you look for health care with a physician, dentist or another health professional? (yes; no); what was the main reason for you to look for health care? (suspicion of COVID-19 or respiratory infection; continuing a treatment or therapy; dental problem; mental health issue; disease or another health problem); were you able to get care? (yes; no); during the pandemic, did you have any of these difficulties related to health care? (yes; no).

Regarding the psychological issues, the quality of sleep was assessed through the question: did the pandemic affect the quality of your sleep? (no/my sleeping problems decreased; I started having sleeping problems/my existing sleeping problems became worse). The frequency of loneliness, sadness or depression, anxiety or nervousness, respectively, was measured by the following questions: during the pandemic, how often did you feel isolated from family members or close friends? (never/a few times; many times/always); during the pandemic, how often did you feel sad or depressed? (never/a few times; many times/always); during the pandemic, how often did you feel anxious or nervous? (never/a few times; many times/always).

RESULTS

Table 1 presents the results that are directly related to COVID-19. Concerning the adherence to social restriction measures, 74.3% of the individuals adhered to the measures, leaving their houses only for essential activities, such as the need for health care, drugstores and supermarkets. As to the presence of any flu symptom after the pandemic began, 28.1% reported having had symptoms, and, of these, only 5.9% had taken the test to know if they were infected by the new coronavirus. Among the tested participants, 22.5% (95%CI 14.5 - 33.1) tested positive for the new coronavirus. It was also observed that 17% of the individuals had a relative or close friend with a severe case of the disease, or who died due to COVID-19.

The results of Table 2, about work status, show that 28.9% did not work before the pandemic and continued without working, whereas 50.5% continued to work or began a new job during the pandemic; however, 20.6% lost their jobs or did not work.

Among the individuals who were working in the analyzed period, 29.4% worked more than usual during the pandemic. The performance of household tasks also changed with the pandemic, and 61.7% of the population reported increase in the amount of such activities (Table 2).

Regarding family income, by comparing it with that of the period before the pandemic, 55.1% reported decreased income, and 7% remained without any income at all. The impact on the families’ income can be equally observed in the data presented in Figure 1. In the evaluation of family income considering MW, among those with the lowest income (up to ½ MW per capita), 11.1% remained without any income, and 63.5% reported decreased income. In the superior category (four or more MW per capita), the percentage rates were 4.3% and 38.4%, respectively, with a gradient per income level: the higher the family income, the lower the reduction of income (Figure 1).

Besides, by comparing the proportion of people who lost their jobs after the pandemic, according to household per capita income (Figure 2), it was observed that informal workers (self-employed) in the lowest income classes were the most affected ones. In total, among those who worked before the pandemic, 25.8% could not work, whereas among informal workers this percentage was 50.6%. In the poorest income class, these percentage rates were 31.5 and 61%, respectively, and in the richest class, 18.1 and 35.6%.

As to the effects of the pandemic on health status, 29.4% of the individuals reported their health became worse during the pandemic. The presence of comorbidities associated with the aggravation of cases of COVID-19 was observed in 33.9% of the participants. About health care, 21.7% searched for medical or dental care. Among those who did, 16.5% needed care due to symptoms related to COVID-19; 25.5%, to continue an ongoing treatment or therapy; 19.6%, due to dental problems; 3.4%, mental health issues; and 35.1%, due to disease or another health problem. About care, 38.3% reported having had some sort of difficulty to be medically assisted (Table 3).

Regarding the psychological issues, 44% began having trouble sleeping, or reported worse quality of sleep after the pandemic. More than half (56.8%) reported feeling isolated from relatives and friends; 40% felt sad or depressed; and 52.5% often felt anxious or nervous during the COVID-19 pandemic (Table 3).

DISCUSSION

The study ConVid - Pesquisa de Comportamentos (Behavioral Research) aimed at describing the changes in the lives of adult Brazilians, in different aspects, during the COVID-19 pandemic. About the adherence to social restriction measures, it was possible to observe that approximately 75% of the participants did it, restricting contact with other people and only going out for essential activities. These findings corroborate the results from other national and international analyses, which show good adherence of the measures from a large portion of the population¹³13. Barros AJD, Victora CG, Menezes AMB, Horta BL, Hartwig F, Victora G, et al. Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study. Rev Saúde Pública 2020; 54: 75. https://doi.org/10.11606/s1518-8787.2020054002810
https://doi.org/https://doi.org/10.11606... ^,1414. Webster RK, Brooks SK, Smith LE, Woodland L, Wessely S, Rubin GJ. How to improve adherence with quarantine: rapid review of the evidence. Public Health 2020; 182: 163-9. https://doi.org/10.1016/j.puhe.2020.03.007
https://doi.org/https://doi.org/10.1016/... ; the impact of social restriction on the reduction of transmission rates of the new coronavirus was visible⁴4. Fundação Oswaldo Cruz. MonitoraCOVID-19 [Internet]. Rio de Janeiro: Fundação Oswaldo Cruz; 2020 [acessado em 14 jul. 2020]. Disponível em: Disponível em: https://bigdata-covid19.icict.fiocruz.br/
https://bigdata-covid19.icict.fiocruz.br... ^,1515. Qiu Y, Chen X, Shi W. Impacts of social and economic factors on the transmission of coronavirus disease 2019 (COVID-19) in China. J Popul Econ 2020; 33: 1127-72. https://doi.org/10.1007/s00148-020-00778-2
https://doi.org/https://doi.org/10.1007/... ^,1616. Shen M, Peng Z, Guo Y, Rong L, Li Y, Xiao Y, et al. Assessing the Effects of Metropolitan-Wide Quarantine on the Spread of COVID-19 in Public Space and Households. Int J Infect Dis 2020; 96: 503-5. https://doi.org/10.1016/j.ijid.2020.05.019
https://doi.org/https://doi.org/10.1016/... ^,1717. Tang B, Xia F, Tang S, Bragazzi NL, Li Q, Sun X, et al. The effectiveness of quarantine and isolation determine the trend of the COVID-19 epidemics in the final phase of the current outbreak in China. Int J Infect Dis 2020; 95: 288-293. https://doi.org/10.1016/j.ijid.2020.03.018
https://doi.org/https://doi.org/10.1016/... .

The presentation of flu symptoms during the pandemic was reported by more than one fourth of individuals aged 18 years or more who answered the survey; however, among them, the proportion of people who were tested to know if they were infected by the new coronavirus was only 5.9%. This low testing percentage, especially in the beginning of the pandemic, was also observed in other countries¹⁸18. Li R, Pei S, Chen B, Song Y, Zhang T, Yang W, et al. Substantial undocumented infection facilitates the rapid dissemination of novel coronavirus (SARS-CoV-2). Science 2020; 368(6490): 489-93. https://doi.org/10.1126/science.abb3221
https://doi.org/https://doi.org/10.1126/... . In Brazil, this can be explained by the lack of tests and the management protocol of patients, which suggests mandatory testing only for severe cases, with symptoms that are suggestive of severe acute respiratory syndrome.

The COVID-19 pandemic brought several challenges to public health, and showed the vulnerabilities of the health system to face emergencies¹1. Steffens I. A hundred days into the coronavirus disease (COVID-19) pandemic. Euro Surveill 2020; 25(14): pii=2000550. https://doi.org/10.2807/1560-7917.ES.2020.25.14.2000550
https://doi.org/https://doi.org/10.2807/... ^,1919. Reis RF, Quintela BM, Campos JO, Gomes JM, Rocha BM, Lobosco M, et al. Characterization of the COVID-19 pandemic and the impact of uncertainties, mitigation strategies, and underreporting of cases in South Korea, Italy, and Brazil. Chaos Solitons Fractals 2020; 136: 109888. https://doi.org/10.1016/j.chaos.2020.109888
https://doi.org/https://doi.org/10.1016/... . In this context, the availability of opportune information is a recurring challenge for decision makers²⁰20. Barreto ML, Barros AJD, Carvalho MS, Codeço CT, Hallal PRC, Medronho RA, et al. O que é urgente e necessário para subsidiar as políticas de enfrentamento da pandemia de COVID-19 no Brasil? Rev Bras Epidemiol 2020; 23: e200032. https://doi.org/10.1590/1980-549720200032
https://doi.org/https://doi.org/10.1590/... ^,2121. Prado MFD, Antunes BBP, Bastos LDSL, Peres IT, Silva AABD, Dantas LF, et al. Analysis of COVID-19 under-reporting in Brazil. Rev Bras Ter Intensiva 2020; 32(2): 224-8. https://doi.org/10.5935/0103-507x.20200030
https://doi.org/https://doi.org/10.5935/... ^,2222. Hallal PC, Horta BL, Barros AJD, Dellagostin OA, Hartwig FP, Pellanda LC, et al. Trends in the prevalence of COVID-19 infection in Rio Grande do Sul, Brazil: repeated serological surveys. Ciên Saúde Colet 2020; 25(Supl. 1): 2395-401. https://doi.org/10.1590/1413-81232020256.1.09632020
https://doi.org/https://doi.org/10.1590/... . In Brazil, the low diagnostic capacity had major implications on the notification of cases, which caused not only the underestimation of the prevalence in the population, but also the overestimation of lethality rates²³23. Silveira MF, Barros AJD, Horta BL, Pellandra LC, Victora GD, Dellagostin OA, et al. Population-based surveys of antibodies against SARS-CoV-2 in Southern Brazil. Nat Med 2020; 26: 1196-9. https://doi.org/10.1038/s41591-020-0992-3
https://doi.org/https://doi.org/10.1038/... . Besides, the fact that people with more severe symptoms presented higher chances of being tested compromised the analysis of the disease status and the monitoring of tendencies²⁴24. Lau H, Khosrawipour T, Kocbach P, Ichii H, Bania J, Khosrawipour V. Evaluating the massive underreporting and undertesting of COVID-19 cases in multiple global epicenters. Pulmonology 2020; 1-6. https://doi.org/10.1016/j.pulmoe.2020.05.015
https://doi.org/https://doi.org/10.1016/... .

Testing all suspected cases is one of the WHO recommendations to face COVID-19, since it enables to track the contacts and control the propagation of the disease²⁵25. World Health Organization. Considerations in adjusting public health and social measures in the context of COVID-19 - Interim guidance - 16 April 2020. Genebra: World Health Organization ; 2020.. However, in May 2020, when the study was performed, there was still lack of diagnostic tests for the disease. Despite the investments to produce these tests and the amplification of reference centers, increasing the capacity of processing samples, the distribution of diagnostic kits and the availability of free tests were still deficient, and the prices charged to take the test in the private sector were, and still are, high.

In this analysis, among the individuals who presented with flu symptoms after the pandemic started and took the diagnostic test, the percentage of positive results for COVID-19 was 1.3%. A study carried out in Rio de Janeiro with blood donors who did not have symptoms or previous known history of COVID-19 estimated a 4% prevalence²⁶26. Amorim Filho L, Szwarcwald CL, Mateos SOG, Ponce de Leon ACM, Medronho RA, Veloso VG, et al. Seroprevalence of anti-SARS-CoV-2 among blood donors in Rio de Janeiro, Brazil. Rev Saúde Pública 2020; 54: 69. http://doi.org/10.11606/s1518-8787.2020054002643
https://doi.org/http://doi.org/10.11606/... . The first stage of Epicovid19, a study performed in Rio Grande do Sul, estimated a 4.8% prevalence rate, which considerably increased in the other stages of application. In the beginning of the pandemic, nine out of ten cases were not notified²³23. Silveira MF, Barros AJD, Horta BL, Pellandra LC, Victora GD, Dellagostin OA, et al. Population-based surveys of antibodies against SARS-CoV-2 in Southern Brazil. Nat Med 2020; 26: 1196-9. https://doi.org/10.1038/s41591-020-0992-3
https://doi.org/https://doi.org/10.1038/... .

The positive effects of social restriction measures could be observed in the reduction tendency of daily growth rates in the number of accumulated cases in Brazil, from the first week of March to the last week of May, 2020²⁷27. Szwarcwald CL, Souza Júnior PRB, Malta DC, Barros MBA, Magalhães MAFM, Xavier DR, et al. Adesão às medidas de restrição social e efeitos sobre a disseminação covid-19 no Brasil. Epidemiol Serv Saúde 2020. No prelo.. These measures were essential to contain the dissemination of the disease and prevent the overload of the health system.

However, despite the importance of these measure, in this study it was possible to observe the adverse effects in work status and family income of individuals. Confinement in the household, as well as the closing of non-essential enterprises, led to dismissals and bankruptcy of establishments. Besides, due to changes in labor legislation²⁸28. Brasil. Lei nº 13.467, de 13 de julho de 2017. Altera a Consolidação das Leis do Trabalho (CLT), aprovada pelo Decreto-Lei nº 5.452, de 1º de maio de 1943, e as Leis nº 6.019, de 3 de janeiro de 1974, 8.036, de 11 de maio de 1990, e 8.212, de 24 de julho de 1991, a fim de adequar a legislação às novas relações de trabalho [Internet]. 2017 [acessado em 7 ago. 2020]. Disponível em: Disponível em: http://www.planalto.gov.br/ccivil_03/_ato2015-2018/2017/lei/l13467.htm
http://www.planalto.gov.br/ccivil_03/_at... , the proportion of informal and self-employed workers - who were the most affected by social restriction measures - considerably increased. Considering that the reduction of income affected mostly families with precarious life conditions, it is possible to say that the pandemic has aggravated social inequalities.

The performance of work activities has also changed; one fourth of the workers started to work remotely. Therefore, work began to occupy and share room with other daily and household activities, and the time dedicated to resting has not always been sufficient for physical and mental rehabilitation²⁹29. Losekann RGCB, Mourão HC. Desafios do teletrabalho na pandemia covid-19: quando o home vira office. Cad Adm 2020; 28: 71-5. https://doi.org/10.4025/cadadm.v28i0.53637
https://doi.org/https://doi.org/10.4025/... .

Even though it is essential for the containment of the pandemic, social distancing brought relevant psychic disorders related to the feeling of loneliness and isolation from family and friends, changes in socioeconomic context, lack of control over one’s own life and fear of getting sick³⁰30. Moretti SA, Guedes-Neta ML, Batista EC. Nossas Vidas em Meio à Pandemia da COVID - 19: Incertezas e Medos Sociais. Rev Enfermagem e Saúde Coletiva 2020; 4(2): 32-41.^,3131. Lima SO, Silva MA, Santos MLD, Moura AMM, Sales LGD, Menezes LHS, et al. Impactos no comportamento e na saúde mental de grupos vulneráveis em época de enfrentamento da infecção COVID-19: revisão narrativa. Rev Eletrônica Acervo Saúde 2020; (46): e4006. https://doi.org/10.25248/reas.e4006.2020
https://doi.org/https://doi.org/10.25248... . In Brazil, we observed large proportions of individuals who often felt isolated, sad or depressed, anxious or nervous, as well as people who reported having trouble sleeping. Among the ones who presented with previous diagnosis of depression, these effects were more intense³²32. Barros MBA, Lima MG, Malta DC, Szwarcwald CL, Azevedo RCS, Romero D, et al. Relato de tristeza/depressão, nervosismo/ansiedade e problemas de sono na população adulta brasileira durante a pandemia de COVID-19. Epidemol Serv Saúde 2020; 29(4): e2020427. http://doi.org/10.1590/s1679-49742020000400018
https://doi.org/http://doi.org/10.1590/s... . Such results are in accordance with findings from international studies, which assessed the mental health of individuals during the pandemic³²32. Barros MBA, Lima MG, Malta DC, Szwarcwald CL, Azevedo RCS, Romero D, et al. Relato de tristeza/depressão, nervosismo/ansiedade e problemas de sono na população adulta brasileira durante a pandemia de COVID-19. Epidemol Serv Saúde 2020; 29(4): e2020427. http://doi.org/10.1590/s1679-49742020000400018
https://doi.org/http://doi.org/10.1590/s... ^,3333. Huang Y, Zhao N. Generalized anxiety disorder, depressive symptoms and sleep quality during COVID-19 outbreak in China: a web-based cross-sectional survey. Psychiatry Res 2020; 288: 112954. https://doi.org/10.1016/j.psychres.2020.112954
https://doi.org/https://doi.org/10.1016/... ^,3434. Guo Y, Cheng C, Zeng Y, Li Y, Zhu M, Yang W, et al. Mental health disorders and associated risk factors in quarantined adults during the COVID-19 outbreak in China: a cross-sectional study. J Med Internet Res 2020; 22(8): e20328. https://doi.org/10.2196/20328
https://doi.org/https://doi.org/10.2196/... ^,3535. Rossi R, Socci V, Talevi D, Mensi S, Niolu C, Pacitti F, et al. COVID-19 Pandemic and Lockdown Measures Impact on Mental Health Among the General Population in Italy. Front Psychiatry 2020; 11: 790. https://doi.org/10.3389/fpsyt.2020.00790
https://doi.org/https://doi.org/10.3389/... ^,3636. Gallagher MW, Zvolensky MJ, Long LJ, Rogers AH, Garey L. The Impact of COVID-19 Experiences and Associated Stress on Anxiety, Depression, and Functional Impairment in American Adults. Cogn Ther Res 2020. https://doi.org/10.1007/s10608-020-10143-y
https://doi.org/https://doi.org/10.1007/... .

Regarding the self-evaluation of health, 29.4% reported worsened health status during the pandemic. Biological factors, such as the presence of COVID-19 symptoms and psychological issues, together with the context of socioeconomic losses, affected the health status of the Brazilian population³⁷37. Szwarcwald CL, Damacena GN, Barros MBA, Malta DC, Souza Júnior PRB, Azevedo LO, et al. Factors affecting the Brazilians’ self-rated health during the COVID-19 pandemic. Cad Saúde Pública 2020. No prelo..

The proportion of people at risk of aggravation of COVID-19 cases was estimated in 33.9% in this study, which is in agreement with the findings by Rezende et al., based on the data from the National Health Survey carried out in 2013, which was equally based on the presence of NCDs. The authors considered other criteria, including obesity, smoking and presence of renal problems, which increased the estimation to more than half of the Brazilian adult population at risk (54.4%)³⁸38. Rezende LFM, Thome B, Schveitzer MC, Souza-Júnior PRB, Szwarcwald CL. Adults at high-risk of severe coronavirus disease-2019 (COVID-19) in Brazil. Rev Saúde Pública 2020; 54: 50. https://doi.org/10.11606/s1518-8787.2020054002596
https://doi.org/https://doi.org/10.11606... .

Concerning the search for health care during the pandemic, most individuals in the study did not look for health services in the analyzed period. Among the individuals who reported a pre-existing NCD, 25.5% looked for care. The depletion of health services and the fear of being infected in health units led many people to cancel their appointments and to stop following-up their health problems³⁹39. Emanuel EJ, Persad G, Upshur R, Thome B, Parker M, Glickman A, et al. Fair allocation of scarce medical resources in the time of COVID-19. N Engl J Med 2020; 382: 2049-55. https://doi.org/10.1056/NEJMsb2005114
https://doi.org/https://doi.org/10.1056/... . Among those who sought care, 16.5% said the reason was the presence of symptoms related to COVID-19, and 38% mentioned difficulties to access the health service in the analyzed period.

In this study, some of the aspects investigated by ConVid - Pesquisa de Comportamentos were presented. The descriptive results of the study are available online, with free access for the population (https://convid.fiocruz.br/). The results were also publicized by the media, which allowed to guide the population to maintain healthy habits and look for telemedicine services to mitigate psychological disorders. Several articles showing changes in health conditions and lifestyle during the COVID-19 pandemic have been published or were approved for publication²⁷27. Szwarcwald CL, Souza Júnior PRB, Malta DC, Barros MBA, Magalhães MAFM, Xavier DR, et al. Adesão às medidas de restrição social e efeitos sobre a disseminação covid-19 no Brasil. Epidemiol Serv Saúde 2020. No prelo.^,3232. Barros MBA, Lima MG, Malta DC, Szwarcwald CL, Azevedo RCS, Romero D, et al. Relato de tristeza/depressão, nervosismo/ansiedade e problemas de sono na população adulta brasileira durante a pandemia de COVID-19. Epidemol Serv Saúde 2020; 29(4): e2020427. http://doi.org/10.1590/s1679-49742020000400018
https://doi.org/http://doi.org/10.1590/s... ^,3737. Szwarcwald CL, Damacena GN, Barros MBA, Malta DC, Souza Júnior PRB, Azevedo LO, et al. Factors affecting the Brazilians’ self-rated health during the COVID-19 pandemic. Cad Saúde Pública 2020. No prelo.^,4040. Malta DC, Szwarcwald CL, Barros MBA, Gomes CS, Machado IE, Souza Júnior PRB, et al. A pandemia da COVID-19 e as mudanças no estilo de vida dos brasileiros adultos: um estudo transversal, 2020. Epidemiol Serv Saúde 2020; 29(4): e2020407. https://doi.org/10.1590/S1679-49742020000400026
https://doi.org/https://doi.org/10.1590/... ^,4141. Werneck AO, Silva DR, Malta DC, Souza-Júnior PRB, Azevedo LO, Barros MBA, et al. Lifestyle behaviors changes during the COVID-19 pandemic quarantine among 6,881 Brazilian adults with depression and 35,143 without depression. Ciênc Saúde Colet 2020; 25(Supl. 2): 4151-6. http://doi.org/10.1590/1413-812320202510.2.27862020
https://doi.org/http://doi.org/10.1590/1... .

ConVid - Pesquisa de Comportamentos has some limitations referring to the chain sampling method using social media. Since this was a web-based survey, some population segments were underrepresented in the sample, such as people with low schooling, or with difficulties to handle cell phones and computers, or those without access to the internet, who had fewer chances of participating. Concerning the geographic distribution of the sample, the research reached all Federation Units and approximately 17,000 cities. For demographic variables (sex, age group and ethnicity), we obtained the necessary diversity to weigh the data, in order to obtain the representativeness of the Brazilian population. Despite the gap of people with low schooling, the large and comprehensive sample and the calibration of data using PNAD 2019 were essential for obtaining a sample distribution that was similar to the Brazilian population, and to generate the adequate estimations.

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