ABSTRACT

This study aimed to estimate the prevalence of adherence to social isolation and to inves- tigate associated factors during the Covid-19 pandemic among teachers in Minas Gerais, Brazil. This is a cross-sectional study carried out with a sample of 15,641 teachers. A digital form was applied for data collection. Descriptive analyses of the variables were conducted, which included adherence to social isolation, sociodemographic characteristics, occupational factors, and self-reported health conditions. The Poisson regression model with robust variance was used and Prevalence Ratios (PR) were estimated, with 95% confidence intervals. The prevalence of adherence to social isolation was estimated at 79.8%, and the associated factors were: female gender; 60 years old or older; living with a spouse; longer working hours; sleeping difficulty; feeling sad; and pathologies such as hypertension, diabetes mellitus, obesity, and respiratory diseases. There was a significant prevalence of adherence to social isolation measures among teachers, and that adherence is associated with sociodemographic characteristics, occupational factors, and health conditions of education professionals.

KEYWORDS
School teachers; Social isolation; Coronavirus infections; Covid-19; Epidemiology

Introduction

In December 2019, in the city of Wuhan, in China, a new variant of an already known virus, the coronavirus, called Sars-CoV-2, emerged. Because it is highly infectious, the virus quickly spread to other countries, and a public health emergency as declared by the World Health Organization (WHO). Due to the growth in the number of cases worldwide, the beginning of the Covid-19 pandemic was announced on March 11, 2020^{11 Almeida WS, Szwarcwald CL, Malta DC, et al. Changes in Brazilians’ socioeconomic and health conditions during the Covid-19 pandemic. Rev Bras Epidemiol. 2020 [acesso em 2020 dez 2]; 23:1-14. Disponível em: https://www.scielo.br/j/rbepid/a/w8HSZbzGgKCDFHmZ6w4gyQv/?format=pdf&lang=en
https://www.scielo.br/j/rbepid/a/w8HSZbz...} . The lack of effective treatment for the disease has led the Brazilian Ministry of Health to adopt prevention and spread control in the community as its the main strategy^{22 Bezerra CB, Saintrain MVL, Braga DRA, et al. Psychosocial impact of Covid-19 self-isolation on the Brazilian population: a preliminary cross-sectional analysis. Saúde Soc. 2020 [acesso em 2020 dez 2]; 29(4):1-10. Disponível em: https://www.scielo.br/j/sausoc/a/mMrwMQpYb3G8GyJ8zbRJPgv/?lang=en
https://www.scielo.br/j/sausoc/a/mMrwMQp...} .

Since the beginning of the pandemic, public health authorities in Brazil have recommended the adoption of measures to prevent the spread of the virus, such as social distancing, isolation of confirmed cases of the disease, washing hands, and wearing masks^{33 Güner HR, Hasanoğlu I, Aktaş F. Covid-19: Prevention and control measures in community. Turk J Med Sci. 2020 [acesso em 2020 dez 2]; 50(1):571-577. Disponível em: https://journals.tubitak.gov.tr/medical/abstract.htm?id=27233
https://journals.tubitak.gov.tr/medical/...} . However, the main strategy to reduce the number of Covid-19 cases and deaths was the total or partial closure of places that gathered a large number of people, such as schools, stores that provided non-essential services, borders, and the cancellation of public events^{11 Almeida WS, Szwarcwald CL, Malta DC, et al. Changes in Brazilians’ socioeconomic and health conditions during the Covid-19 pandemic. Rev Bras Epidemiol. 2020 [acesso em 2020 dez 2]; 23:1-14. Disponível em: https://www.scielo.br/j/rbepid/a/w8HSZbzGgKCDFHmZ6w4gyQv/?format=pdf&lang=en
https://www.scielo.br/j/rbepid/a/w8HSZbz...} . These procedures proved to be effective in reducing the overload in Intensive Care Units (ICU) according to a study carried out in the city of São Paulo, which showed an estimated increase of approximately 130% in the capacity of these units during the first month of the pandemic if there were no adherence to these restriction measures^{44 Aquino EML, Silveira IH, Pescarini JM, et al. Social distancing measures to control the Covid-19 pandemic: potential impacts and challenges in Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2020 dez 2]; 25(supl1):2423-2446. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32520287/
https://pubmed.ncbi.nlm.nih.gov/32520287...} .

Despite the importance of the control measures adopted, a large part of the population has undergone profound changes in their daily routine, mainly related to work. Education was deeply affected, and remote work began to be used through platforms to continue remote learning^{55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.}. Teachers in public schools had to reorganize their schedule to continue teaching classes synchronously and asynchronously; and, thus, there was an increase in working hours, bringing important consequences to the health of these workers, such as anxiety, stress and depression^{66 Souza KR, Santos GB, Rodrigues AMS, et al. Trabalho remoto, saúde docente e greve virtual em cenário de pandemia. Trab Educ Saúde. 2021 [acesso em 2020 dez 2]; 19:1-14. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1139807
https://pesquisa.bvsalud.org/portal/reso...} .

Although it is one of the most effective measures to combat the spread of the pandemic, social distancing, or social isolation, can have direct and indirect social and health consequences. Social isolation has caused changes in the pattern of coexistence in work environments and in the family context, arousing feelings of loneliness, fear and anxiety, amid the fear caused by the high rate of viral transmission, the invisibility and morbidity and mortality of Covid-19. Thus, it is necessary to understand the society’s health needs. Scientific evidence on the epidemiological impact of the Covid-19 pandemic on different population levels is necessary - such as basic education teachers - so that appropriate public policies can be formulated and implemented to manage the issue in each context^{22 Bezerra CB, Saintrain MVL, Braga DRA, et al. Psychosocial impact of Covid-19 self-isolation on the Brazilian population: a preliminary cross-sectional analysis. Saúde Soc. 2020 [acesso em 2020 dez 2]; 29(4):1-10. Disponível em: https://www.scielo.br/j/sausoc/a/mMrwMQpYb3G8GyJ8zbRJPgv/?lang=en
https://www.scielo.br/j/sausoc/a/mMrwMQp... ,66 Souza KR, Santos GB, Rodrigues AMS, et al. Trabalho remoto, saúde docente e greve virtual em cenário de pandemia. Trab Educ Saúde. 2021 [acesso em 2020 dez 2]; 19:1-14. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/biblio-1139807
https://pesquisa.bvsalud.org/portal/reso...} .

This study, therefore, was aimed at estimating the prevalence of adherence to social isolation and at verifying the associated factors, during the Covid-19 pandemic, among public school teachers in the state of Minas Gerais (MG) - Brazil.

Material and methods

Data from the research entitled ‘Condições de saúde e trabalho entre professores da rede estadual de ensino do estado de Minas Gerais na pandemia da Covid-19’ (Health and work conditions among teachers at state public schools in the state of Minas Gerais in the Covid-19 pandemic) were used. This is an epidemiological, cross-sectional and analytical study carried out with primary school teachers at state public schools in the state of MG, Brazil. In 2020, this population consisted of about 90 thousand teachers distributed in 3,500 state schools.

Data collection

For data collection, a digital form (Google Forms) was made available to participants after prior authorization from the State Department of Education of the State of Minas Gerais (SEE-MG) and partnership with it. The link to the form was sent to the institutional email of all primary teachers at state public schools, provided by the Regional Education Superintendencies of MG. SEE-MG recommended and encouraged the participation of the teachers in the research, and an invitation was published on its official homepage and social media. Data were collected between August 20 and September 11, 2020, with guaranteed anonymity of the participants, who took, on average, 25 minutes to answer the questionnaire. The inclusion criteria adopted were: working at least in one state school in MG and being an in-service teacher in 2020.

Prior to data collection, a pilot study was carried out with 20 teachers from 5 cities in the state to test and adjust the instrument for data collection.

Study variables

Adherence to social isolation during the pandemic was considered a dependent variable of the study. This variable was evaluated by the question ‘During the new coronavirus pandemic, how would you classify your adherence to social isolation?’, with the following response options: 1) ‘I stayed strictly at home, leaving only for health care needs and/or shopping at supermarkets and pharmacy’; 2) ‘I tried to be careful, stay away from people, not visit the elderly, but I kept working and going out’; 3) ‘I didn’t adhere to it, I lived a normal life’. Adherence to social isolation was considered when the teacher answered option 1. Options 2 and 3 were grouped and considered as non-adherence to social isolation. This procedure followed previous studies^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw... ,88 Szwarcwald CL, Souza Júnior PRB, Malta DC, et al. Adherence to physical contact restriction measures and the spread of Covid-19 in Brazil. Epidemiol Serv Saúde. 2020 [acesso em 2020 dez 2]; 29(5):1-11. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33175010/
https://pubmed.ncbi.nlm.nih.gov/33175010...} .

The independent variables investigated in this study were distributed into three groups: sociodemographic characteristics, occupational factors and self-reported health conditions. In the group of sociodemographic characteristics, the following were addressed: age group (21 to 40 years old, 41 to 60 years old, over 60 years old); sex; family income (one to two minimum wages, three to five minimum wages and above five minimum wages); marital status (living or not with the spouse); education (master’s/doctoral, specialization degrees, undergraduate degree); and number of children (none, one to two, three or more). Occupational factors were: type of contract with the school (state employee/effective and hired/designated); teaching experience (1 to 10 years, 11 to 20 years, more than 20 years); and weekly working hours (2 to 10 hours, 11 to 39 hours and 40 hours or more). Self-reported health conditions were: episodes of sadness during the pandemic (no, yes); sleeping difficulty during the pandemic (no, yes); episode of anxiety or depression during the pandemic (no, yes); systemic arterial hypertension (no, yes); diabetes mellitus (no, yes); obesity (no, yes); and respiratory diseases (no, yes).

Information regarding the location of the school was also collected: school region (urban or rural) and regional area (Centro, Mata, Norte, Sul and Vale do Aço).

Data analysis

The data obtained were transferred to the Statistical Package for the Social Sciences (SPSS) software, version 20.0 for Windows^®, and analyzed. The variables were described by absolute and relative frequencies. Using the chi-square test, bivariate analyses were conducted to assess the association between the dependent and independent variables. The variables that presented a descriptive level <0.20 were selected for the multiple model. In the multiple analysis, the Poisson regression model was used, with robust variance^{99 Fávero LP. Análise de dados. Rio de Janeiro: Elsevier; 2015.,1010 Kleinbaum DG, Kupper LL, Muller KE, et al. Applied regression analysis and multivariable methods. [Local desconhecido]: Alexander Kugushev Book; 1998.}. At this stage, a significance level of 0.05 and the Deviance test were adopted to assess the model’s goodness-of-fit^{99 Fávero LP. Análise de dados. Rio de Janeiro: Elsevier; 2015.,1010 Kleinbaum DG, Kupper LL, Muller KE, et al. Applied regression analysis and multivariable methods. [Local desconhecido]: Alexander Kugushev Book; 1998.}. The magnitude of the associations was estimated using the crude and adjusted Prevalence Ratios (PR), with their respective 95% confidence intervals.

Ethical considerations

This research was approved by the Research Ethics Committee of the State University of Montes Claros (Unimontes), with Opinion No. 4,200,389. All participants received a copy of the Free and Informed Consent Term and answered ‘yes’ to the question regarding their agreement to participate in the research.

Results

A total of 16,210 forms were received, of which 569 were excluded from the study (114 did not accept to participate in the study and 455 answered ‘no’ to the question ‘Do you have a position as a primary teacher at a state school in the state of Minas Gerais?’). After such exclusions, 15,641 forms were considered valid and were included in the study.

A total of 15,641 teachers from about 800 municipalities in Minas participated in the study, of which 13.3% worked in schools located in rural areas, more than half of the teachers were over 40 years old, and the female sex was predominant (81.9%) in the sample. Table 1 shows the distributions of participants according to sociodemographic characteristics and occupational factors. About 90% of the teachers have reported feeling sad; and 58.1% have had sleeping difficulties during the pandemic. Table 2 describes the distributions of the other health conditions of the teachers.

The prevalence of adherence to social isolation in the general sample was equivalent to 79.8%. It was slightly higher among teachers who worked in schools in the urban area (graph 1). In the regional areas, the following results of adherence to this practice were detected: Centro (81.7%), Mata (81.4%), Norte (78.4%), Sul (77.5%), Triângulo (77 .4%), and Vale do Aço (81.7%).

The following variables were associated with adherence to social isolation in the bivariate analysis and were selected for the multiple model (p-value < 0.20): age group, sex, marital status, number of children, teaching experience in years, workload, episode of sadness, sleeping difficulties, systemic arterial hypertension, diabetes mellitus, obesity and respiratory diseases (tables 1 and 2).

Table 3 shows the results of the multiple analysis. Adherence to social isolation was more prevalent among participants over the age of 60, women, who lived with a spouse, who worked more than 10 hours/week, who felt sadness and had sleeping difficulty during the pandemic, who had comorbidities (systemic arterial hypertension, diabetes mellitus, obesity and respiratory diseases). The Deviance test showed that the model presented goodness-of-fit regarding the observed data (χ^{22 Bezerra CB, Saintrain MVL, Braga DRA, et al. Psychosocial impact of Covid-19 self-isolation on the Brazilian population: a preliminary cross-sectional analysis. Saúde Soc. 2020 [acesso em 2020 dez 2]; 29(4):1-10. Disponível em: https://www.scielo.br/j/sausoc/a/mMrwMQpYb3G8GyJ8zbRJPgv/?lang=en
https://www.scielo.br/j/sausoc/a/mMrwMQp...} =5511.0; p-value=0.353).

Discussion

This study gathered epidemiological evidence on adherence to social isolation and associated factors among primary teachers at state public schools in the state of MG. There was an expressive prevalence of the outcome, its distribution in regional teaching areas, in addition to the association with the following factors: age group equal to or greater than 60 years old, female, living with a spouse, longer working hours, feeling sad, sleeping difficulties, systemic arterial hypertension, diabetes mellitus, obesity and respiratory diseases.

The definition of social isolation or distancing varies between studies and different epidemic moments, which makes it difficult to compare among countries and among groups or individuals within the same country^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} . Different results are identified in the international scenario. A telephone survey conducted in Hong Kong - China showed high prevalence of adults who avoided crowded places (from 61% in January to 85% in March 2020)^{1212 Cowling BJ, Ali ST, Ng TWY, et al. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health. 2020 [acesso em 2020 dez 2]; 5(5):279-88. Disponível em: https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30090-6/fulltext
https://www.thelancet.com/journals/lanpu...} . In Japan, only 30% of the participants always avoided crowded places and 12.6% never avoided them^{1313 Machida M, Nakamura I, Saito R, et al. Changes in implementation of personal protective measures by ordinary Japanese citizens: A longitudinal study from the early phase to the community transmission phase of the Covid-19 outbreak. Int J Infect Dis. 2020 [acesso em 2020 dez 2]; 96:371-5. Disponível em: https://www.ijidonline.com/article/S1201-9712(20)30346-5/fulltext
https://www.ijidonline.com/article/S1201...} . In the United States (USA), an internet survey revealed that only 4% of the adults had left home in the previous three days^{1414 Alsan M, Stantcheva S, Yang D, et al. Disparities in Coronavirus 2019 Reported Incidence, Knowledge, and Behavior Among US Adults. JAMA Netw Open. 2020 [acesso em 2020 dez 2]; 3(6):1-11. Disponível em: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2767261
https://jamanetwork.com/journals/jamanet...} .

In Brazil, the prevalence detected was closer to what was found in this study. In a survey with primary teachers in the South region, only 6% reported not being practicing social distancing^{55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.}. In the general population, the national literature presents the following findings on the prevalence of social isolation: 89.9% in a survey conducted in 24 states of the 5 regions of the country^{22 Bezerra CB, Saintrain MVL, Braga DRA, et al. Psychosocial impact of Covid-19 self-isolation on the Brazilian population: a preliminary cross-sectional analysis. Saúde Soc. 2020 [acesso em 2020 dez 2]; 29(4):1-10. Disponível em: https://www.scielo.br/j/sausoc/a/mMrwMQpYb3G8GyJ8zbRJPgv/?lang=en
https://www.scielo.br/j/sausoc/a/mMrwMQp...} ; 91% among adults participating in the telephone survey called Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico’, Vigitel)^{1515 Brasil. Ministério da Saúde, Secretaria de Vigilância em Saúde. Boletim Epidemiológico 11. Situação epidemiológica da Covid-19: doença pelo coronavírus 2020. Semana epidemiológica 49. 2020. [acesso em 2020 dez 2]. Disponível em: https://www.gov.br/saude/pt-br/centrais-de-conteudo/publicacoes/boletins/boletins-epidemiologicos/covid-19/2020/boletim_epidemiologico_covid_40-1.pdf
https://www.gov.br/saude/pt-br/centrais-...} ; in the study conducted in 9 cities in the state of Rio Grande do Sul, 65% of respondents adhered to social isolation^{1616 Barros AJD, Victora CG, Menezes AMB, et al. Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study. Rev Saúde Pública. 2020 [acesso em 2020 dez 2]; 54:1-14. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32725098/
https://pubmed.ncbi.nlm.nih.gov/32725098...} . In a national sample representative of the population at the age of 50 or over, a prevalence of 33% was observed (considering social isolation as not having left home in the previous seven days) or 94% when defining social isolation as not having left home or having gone out only to perform essential activities^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} . Also nationwide, in remote health surveys, 75% of the adults stayed at home and, of these, 15% strictly maintained social distancing^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw...} ; 74.2% reported intense adherence to social restraint measures^{88 Szwarcwald CL, Souza Júnior PRB, Malta DC, et al. Adherence to physical contact restriction measures and the spread of Covid-19 in Brazil. Epidemiol Serv Saúde. 2020 [acesso em 2020 dez 2]; 29(5):1-11. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33175010/
https://pubmed.ncbi.nlm.nih.gov/33175010...} . In the state of Pernambuco, at the beginning of the pandemic, 32% of those surveyed were in total isolation, 57% in partial isolation and 11% were not isolated^{1717 Bezerra ACV, Silva CEM, Soares FRG. Percepção sobre o isolamento social no contexto da pandemia de covid-19 no estado de Pernambuco, Brasil. Hygeia. 2020 [acesso em 2020 dez 2]; 143-152. Disponível em: https://seer.ufu.br/index.php/hygeia/article/view/54397
https://seer.ufu.br/index.php/hygeia/art...} .

In view of these findings, it is worth mentioning that social distancing measures contribute to reducing the spread of Covid-19 infection, with a significant impact on reducing mortality^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw...} , as observed in the international<sup>1818 Shen M, Peng Z, Guo 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 [acesso em 2020 dez 2]; 96:503-505. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32416146/
https://pubmed.ncbi.nlm.nih.gov/32416146...

19 Tang B, Xia F, Tang S, 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 [acesso em 2020 dez 2]; 95:288-293. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32171948/
https://pubmed.ncbi.nlm.nih.gov/32171948... -2020 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 [acesso em 2020 dez 2]; 33(4):1127-1172. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32395017/
https://pubmed.ncbi.nlm.nih.gov/32395017...</sup> and national literature^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw... ,88 Szwarcwald CL, Souza Júnior PRB, Malta DC, et al. Adherence to physical contact restriction measures and the spread of Covid-19 in Brazil. Epidemiol Serv Saúde. 2020 [acesso em 2020 dez 2]; 29(5):1-11. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33175010/
https://pubmed.ncbi.nlm.nih.gov/33175010... ,1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} . However, in the national epidemiological and political scenario, the control of the Covid-19 epidemic takes place in a context of political disputes. Although the country has established general guidelines early to deal with the problem, it has been the target of conflicting narratives, with denial or reduction of its severity by the main authorities. The implementation of control and prevention measures is often insufficient. There is an environment of uncertainty that can affect the population’s perception of the importance of adhering to prevention measures^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} .

Such a situation may explain the slight variation in the prevalence of adherence to social isolation among the investigated educational areas, which also differed according to the urban or rural location of the school. Furthermore, the state of MG has a diversity of social, economic, and cultural characteristics, an extensive territorial dimension, and marked socioeconomic inequalities between its regions^{2121 Magalhães SCM, Santos FO, Lima SC, et al. Situação epidemiológica da transmissão da covid-19 no norte de Minas Gerais, Brasil. Hygeia. 2020 [acesso em 2020 dez 2]; 80-87. Disponível em: https://seer.ufu.br/index.php/hygeia/article/view/54711
https://seer.ufu.br/index.php/hygeia/art...} . Regional studies are relevant because they elucidate the strengths and weaknesses of the regions, so that priority areas are defined, and public health interventions can be developed with greater effectiveness in the fight against the pandemic<sup>2121 Magalhães SCM, Santos FO, Lima SC, et al. Situação epidemiológica da transmissão da covid-19 no norte de Minas Gerais, Brasil. Hygeia. 2020 [acesso em 2020 dez 2]; 80-87. Disponível em: https://seer.ufu.br/index.php/hygeia/article/view/54711
https://seer.ufu.br/index.php/hygeia/art...

22 Matsumoto PSS, Tenório Crepaldi M, Avanzi Júnior PS, et al. Mapeamento de covid-19 e isolamento social: ferramentas de monitoramento e vigilância em saúde pública. Hygeia. 2020 [acesso em 2020 dez 2]; 298-311. Disponível em: https://seer.ufu.br/index.php/hygeia/article/view/54553
https://seer.ufu.br/index.php/hygeia/art... -2323 Ferreira RV, Carvalho DM, Souza ALP, et al. Covid-19 na região de saúde Triângulo Sul, MG: uma perspectiva cartográfica. Hygeia. 2020 [acesso em 2020 dez 2]; 49-59. Disponível em: https://seer.ufu.br/index.php/hygeia/article/view/54379
https://seer.ufu.br/index.php/hygeia/art...</sup> .

Regarding the factors associated with adherence to social isolation, similarly to the present study, other investigations also revealed greater adherence among elderly people^{55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.,88 Szwarcwald CL, Souza Júnior PRB, Malta DC, et al. Adherence to physical contact restriction measures and the spread of Covid-19 in Brazil. Epidemiol Serv Saúde. 2020 [acesso em 2020 dez 2]; 29(5):1-11. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33175010/
https://pubmed.ncbi.nlm.nih.gov/33175010... ,1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062... ,1616 Barros AJD, Victora CG, Menezes AMB, et al. Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study. Rev Saúde Pública. 2020 [acesso em 2020 dez 2]; 54:1-14. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32725098/
https://pubmed.ncbi.nlm.nih.gov/32725098...} and women^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw... ,88 Szwarcwald CL, Souza Júnior PRB, Malta DC, et al. Adherence to physical contact restriction measures and the spread of Covid-19 in Brazil. Epidemiol Serv Saúde. 2020 [acesso em 2020 dez 2]; 29(5):1-11. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33175010/
https://pubmed.ncbi.nlm.nih.gov/33175010... ,1616 Barros AJD, Victora CG, Menezes AMB, et al. Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study. Rev Saúde Pública. 2020 [acesso em 2020 dez 2]; 54:1-14. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32725098/
https://pubmed.ncbi.nlm.nih.gov/32725098... ,2424 Pereira-Ávila FMV, Lam SC, Góes FGB, et al. Factors associated with the use and reuse of face masks among Brazilian individuals during the Covid-19 pandemic. Rev Latino-Am Enfermagem. 2020 [acesso em 2020 dez 2]; 28:1-8. Disponível em: https://www.scielo.br/j/rlae/a/brr8RNdssv3TQRqzpmpYvhf/?lang=en&format=pdf
https://www.scielo.br/j/rlae/a/brr8RNdss... ,2525 Huang Y, Wu Q, Wang P, et al. Measures Undertaken in China to Avoid Covid-19 Infection: internet-based, cross-sectional survey Study. J Med Internet Res. 2020 [acesso em 2020 dez 2]; 22(5):1-12. Disponível em: https://www.jmir.org/2020/5/e18718/
https://www.jmir.org/2020/5/e18718/...} . The older age group has probably increased social distancing. However, younger people tend to have greater social mobility and, therefore, high exposure to the Covid-19^{55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.} virus, which increases transmission to the elderly^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} . In turn, women have shown greater adherence to protective measures, making up a portion of the population with good acceptance of official recommendations related to healthcare^{2525 Huang Y, Wu Q, Wang P, et al. Measures Undertaken in China to Avoid Covid-19 Infection: internet-based, cross-sectional survey Study. J Med Internet Res. 2020 [acesso em 2020 dez 2]; 22(5):1-12. Disponível em: https://www.jmir.org/2020/5/e18718/
https://www.jmir.org/2020/5/e18718/...} .

Another factor associated with the assessed outcome was the weekly workload of 11 to 39 hours or 40 or more hours. Social isolation measures promoted the acceleration of changes in work routines through the computerization of processes and procedures, implying an increase in the provision of online services, especially in the field of education^{44 Aquino EML, Silveira IH, Pescarini JM, et al. Social distancing measures to control the Covid-19 pandemic: potential impacts and challenges in Brazil. Ciênc. Saúde Colet. 2020 [acesso em 2020 dez 2]; 25(supl1):2423-2446. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32520287/
https://pubmed.ncbi.nlm.nih.gov/32520287... ,55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.}. This had repercussions for the teachers who continued to work from home, in a process of transition from face-to-face teaching to a digital model of education, which is not a simple change easily absorbed by society^{55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.}. In addition, the low remuneration of the category can be a factor that provides a greater workload, with the teacher accumulating positions and tasks. Teaching is a complex work that affects the health of the professional, as it is carried out in the midst of tensions and different responsibilities^{2626 Vieira MRM, Magalhães TA, Silva RRV, et al. Hipertensão Arterial e trabalho entre docentes da educação básica da rede pública de ensino. Ciênc. Saúde Colet. 2020 [acesso em 2020 dez 2]; 25(8):3047-61. Disponível em: https://www.cienciaesaudecoletiva.com.br/artigos/hipertensao-arterial-e-trabalho-entre-docentes-da-educacao-basica-da-rede-publica-de-ensino/16985?id=16985
https://www.cienciaesaudecoletiva.com.br...} .

The impact of the current pandemic on mental health has been reported in the literature<sup>22 Bezerra CB, Saintrain MVL, Braga DRA, et al. Psychosocial impact of Covid-19 self-isolation on the Brazilian population: a preliminary cross-sectional analysis. Saúde Soc. 2020 [acesso em 2020 dez 2]; 29(4):1-10. Disponível em: https://www.scielo.br/j/sausoc/a/mMrwMQpYb3G8GyJ8zbRJPgv/?lang=en
https://www.scielo.br/j/sausoc/a/mMrwMQp... ,55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.,77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw... ,1717 Bezerra ACV, Silva CEM, Soares FRG. Percepção sobre o isolamento social no contexto da pandemia de covid-19 no estado de Pernambuco, Brasil. Hygeia. 2020 [acesso em 2020 dez 2]; 143-152. Disponível em: https://seer.ufu.br/index.php/hygeia/article/view/54397
https://seer.ufu.br/index.php/hygeia/art... ,2727 Santos KMR, Galvão MHR, Gomes SM, et al. Depression and anxiety in nursing professionals during the covid-19 pandemic. Esc Anna Nery. 2021 [acesso em 2020 dez 2]; 25(esp):1-15. Disponível em: https://www.scielo.br/j/ean/a/DfmDPNnHcwnVymcDsHDc6hp/?lang=en&format=pdf
https://www.scielo.br/j/ean/a/DfmDPNnHcw...

28 Liu N, Zhang F, Wei C, et al. Prevalence and predictors of PTSS during Covid-19 outbreak in China hardest-hit areas: gender differences matter. Psychiatry Res. 2020 [acesso em 2020 dez 2]; 287:1-7. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32240896/
https://pubmed.ncbi.nlm.nih.gov/32240896... -2929 Chatzittofis A, Karanikola M, Michailidou K, et al. Impact of the Covid-19 Pandemic on the Mental Health of Healthcare Workers. Int J Environ Res Public Health. 2021 [acesso em 2020 dez 2]; 18(4):2-8. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33546513/
https://pubmed.ncbi.nlm.nih.gov/33546513...</sup> . This is a reality that converges with what was observed in this study, in which episodes of sadness and sleeping difficulties were associated with social distancing, similarly to other studies^{22 Bezerra CB, Saintrain MVL, Braga DRA, et al. Psychosocial impact of Covid-19 self-isolation on the Brazilian population: a preliminary cross-sectional analysis. Saúde Soc. 2020 [acesso em 2020 dez 2]; 29(4):1-10. Disponível em: https://www.scielo.br/j/sausoc/a/mMrwMQpYb3G8GyJ8zbRJPgv/?lang=en
https://www.scielo.br/j/sausoc/a/mMrwMQp... ,77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw...} . When considering the sociable nature of individuals, isolation is an aspect that can trigger mental suffering^{2727 Santos KMR, Galvão MHR, Gomes SM, et al. Depression and anxiety in nursing professionals during the covid-19 pandemic. Esc Anna Nery. 2021 [acesso em 2020 dez 2]; 25(esp):1-15. Disponível em: https://www.scielo.br/j/ean/a/DfmDPNnHcwnVymcDsHDc6hp/?lang=en&format=pdf
https://www.scielo.br/j/ean/a/DfmDPNnHcw...} . With socioeconomic repercussions and restrictions on human mobility, mental health problems have increased significantly since the outbreak of the pandemic. This is because people tend to feel anxious and insecure in an environment of change and constant pressure^{55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.,2929 Chatzittofis A, Karanikola M, Michailidou K, et al. Impact of the Covid-19 Pandemic on the Mental Health of Healthcare Workers. Int J Environ Res Public Health. 2021 [acesso em 2020 dez 2]; 18(4):2-8. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33546513/
https://pubmed.ncbi.nlm.nih.gov/33546513...} , given the duration of social confinement, the fear of contamination, and the need for economic support^{2828 Liu N, Zhang F, Wei C, et al. Prevalence and predictors of PTSS during Covid-19 outbreak in China hardest-hit areas: gender differences matter. Psychiatry Res. 2020 [acesso em 2020 dez 2]; 287:1-7. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32240896/
https://pubmed.ncbi.nlm.nih.gov/32240896...} .

In teaching, specifically in primary education, there are high demands that can make the teacher vulnerable to physical and mental health problems^{2626 Vieira MRM, Magalhães TA, Silva RRV, et al. Hipertensão Arterial e trabalho entre docentes da educação básica da rede pública de ensino. Ciênc. Saúde Colet. 2020 [acesso em 2020 dez 2]; 25(8):3047-61. Disponível em: https://www.cienciaesaudecoletiva.com.br/artigos/hipertensao-arterial-e-trabalho-entre-docentes-da-educacao-basica-da-rede-publica-de-ensino/16985?id=16985
https://www.cienciaesaudecoletiva.com.br...} . Thus, it is necessary to ensure that these professionals receive appropriate assistance, with strategies to promote mental health and psychosocial care in the short, medium, and long-term^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw... ,2626 Vieira MRM, Magalhães TA, Silva RRV, et al. Hipertensão Arterial e trabalho entre docentes da educação básica da rede pública de ensino. Ciênc. Saúde Colet. 2020 [acesso em 2020 dez 2]; 25(8):3047-61. Disponível em: https://www.cienciaesaudecoletiva.com.br/artigos/hipertensao-arterial-e-trabalho-entre-docentes-da-educacao-basica-da-rede-publica-de-ensino/16985?id=16985
https://www.cienciaesaudecoletiva.com.br...} .

In the present study, there was an association of the outcome variable with systemic arterial hypertension, diabetes mellitus, obesity, and respiratory diseases. This is a finding consistent with the pandemic situation experienced, in which people with such pathologies fall into risk groups that must be extra cautious. It also reflects a global and national epidemiological reality, marked by a high occurrence of Chronic Non-Communicable Diseases (NCDs), which are the main cause of death worldwide^{3030 Costa SM, Lima CA, Nobre ALCSD, et al. Hypertension bearers with high risk/big risk of cardiovascular diseases and socioeconomic and health indicators. Rev Assoc Med Bras. 2018 [acesso em 2020 dez 2]; 64(7):601-10. Disponível em: https://www.semanticscholar.org/paper/Hypertension-bearers-with-high-risk%2Fbig-risk-of-and-Costa-Lima/6211a114d50c5258bbf1fe086aed367708b53499
https://www.semanticscholar.org/paper/Hy...} .

Symptoms associated with coronavirus infection are reported to be more severe in older people and among those with preexisting chronic diseases^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} . There is a relationship of such diseases with higher rates of hospitalizations caused by Covid-19^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} , ICU admissions^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062... ,3131 Laires PA, Dias S, Gama A, et al. The association between chronic disease and serious Covid-19 outcomes and its influence on risk perception: survey study and database analysis. JMIR Public Health Surveill. 2021 [acesso em 2020 dez 2]; 7(1):1-12. Disponível em: https://publichealth.jmir.org/2021/1/e22794/
https://publichealth.jmir.org/2021/1/e22...} , evolution to death^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} , in addition to a worse prognosis of hospitalized patients and mortality<sup>3131 Laires PA, Dias S, Gama A, et al. The association between chronic disease and serious Covid-19 outcomes and its influence on risk perception: survey study and database analysis. JMIR Public Health Surveill. 2021 [acesso em 2020 dez 2]; 7(1):1-12. Disponível em: https://publichealth.jmir.org/2021/1/e22794/
https://publichealth.jmir.org/2021/1/e22...

32 Zhong B-L, Luo W, Li H-M, et al. Knowledge, attitudes, and practices towards Covid-19 among Chinese residents during the rapid rise period of the Covid-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci. 2020 [acesso em 2020 dez 2]; 16(10):1745-1752. Disponível em: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7098034/
https://www.ncbi.nlm.nih.gov/pmc/article...

33 Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on Covid-19 in China. Clin Res Cardiol. 2020 [acesso em 2020 dez 2]; 109(5):531-538. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32161990/
https://pubmed.ncbi.nlm.nih.gov/32161990... -3434 Wang B, Li R, Lu Z, et al. Does comorbidity increase the risk of patients with Covid-19: evidence from meta-analysis. Aging. 2020 [acesso em 2020 dez 2]; 12(7):6049-57. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32267833/
https://pubmed.ncbi.nlm.nih.gov/32267833...</sup> . Thus, it is necessary to prioritize health promotion strategies during and after the pandemic^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw... ,3131 Laires PA, Dias S, Gama A, et al. The association between chronic disease and serious Covid-19 outcomes and its influence on risk perception: survey study and database analysis. JMIR Public Health Surveill. 2021 [acesso em 2020 dez 2]; 7(1):1-12. Disponível em: https://publichealth.jmir.org/2021/1/e22794/
https://publichealth.jmir.org/2021/1/e22...} , especially giving special support to teachers with NCDs^{2626 Vieira MRM, Magalhães TA, Silva RRV, et al. Hipertensão Arterial e trabalho entre docentes da educação básica da rede pública de ensino. Ciênc. Saúde Colet. 2020 [acesso em 2020 dez 2]; 25(8):3047-61. Disponível em: https://www.cienciaesaudecoletiva.com.br/artigos/hipertensao-arterial-e-trabalho-entre-docentes-da-educacao-basica-da-rede-publica-de-ensino/16985?id=16985
https://www.cienciaesaudecoletiva.com.br...} .

Finally, as the sample investigated here is an important population group, it is clear that the Covid-19 pandemic has implications for daily life. It is crucial that different government bodies and civil society entities ensure health care, safety, and resources necessary to reduce the speed of spread of the disease and mitigate its results in people’s health^{55 Cruz RM, Rocha RER, Andreoni S, et al. Retorno ao trabalho? Indicadores de saúde mental em professores durante a pandemia da Covid-19. Rev Poly. 2020 [acesso em 2020 dez 2]; 31(1):325-344. Disponível em: revistas.ufg.br/sv/article/view/66964.,2424 Pereira-Ávila FMV, Lam SC, Góes FGB, et al. Factors associated with the use and reuse of face masks among Brazilian individuals during the Covid-19 pandemic. Rev Latino-Am Enfermagem. 2020 [acesso em 2020 dez 2]; 28:1-8. Disponível em: https://www.scielo.br/j/rlae/a/brr8RNdssv3TQRqzpmpYvhf/?lang=en&format=pdf
https://www.scielo.br/j/rlae/a/brr8RNdss... ,3535 Tan W, Hao F, McIntyre RS, et al. Is returning to work during the Covid-19 pandemic stressful? A study on immediate mental health status and psychoneuroimmunity prevention measures of chinese workforce. Brain Behav Immun. 2020 [acesso em 2020 dez 2]; 87:84-92. Disponível em: https://www.sciencedirect.com/science/article/pii/S0889159120306036
https://www.sciencedirect.com/science/ar... ,3636 Endo PT, Silva I, Lima L, et al. #StayHome: Monitoring and benchmarking social isolation trends in Caruaru and the Região Metropolitana do Recife during the Covid-19 pandemic. Rev Soc Bras Med Trop. 2020 [acesso em 2020 dez 2]; 53:1-4. Disponível em: https://www.scienceopen.com/document?vid=a1f41d53-523a-407b-aa5f-1f1763e1057f
https://www.scienceopen.com/document?vid...} . Given the epidemiological circumstances of the country, clear and timely information should be provided, so that the community perceives the risks inherent to the epidemic and increases its adherence to social distancing^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062... ,3636 Endo PT, Silva I, Lima L, et al. #StayHome: Monitoring and benchmarking social isolation trends in Caruaru and the Região Metropolitana do Recife during the Covid-19 pandemic. Rev Soc Bras Med Trop. 2020 [acesso em 2020 dez 2]; 53:1-4. Disponível em: https://www.scienceopen.com/document?vid=a1f41d53-523a-407b-aa5f-1f1763e1057f
https://www.scienceopen.com/document?vid...} .

This study has limitations and advantages. Information on social isolation was based on self-report and may be prone to memory bias or social desirability, in which the respondent may feel embarrassed to reveal low adherence to recommended practices, which may overestimate the prevalence of the event^{1616 Barros AJD, Victora CG, Menezes AMB, et al. Social distancing patterns in nine municipalities of Rio Grande do Sul, Brazil: the Epicovid19/RS study. Rev Saúde Pública. 2020 [acesso em 2020 dez 2]; 54:1-14. Disponível em: https://pubmed.ncbi.nlm.nih.gov/32725098/
https://pubmed.ncbi.nlm.nih.gov/32725098...} . In a cross-sectional design, it is difficult to examine social distancing patterns because of the rapid evolution of the pandemic, so inferences based on the results are restricted to the period in which the information was collected. The observed associations do not allow us to confirm a causal relationship. Thus, longitudinal investigations are suggested, which will allow us to assess how the factors studied behave throughout the evolution of the epidemic^{1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} .

However, a robust sample was investigated, with participants residing in different municipalities located in all regions of a state. Online health surveys are promising; and, ethically, the method of data collection adopted is more plausible in the context of the pandemic, especially due to the possibility of obtaining information without the inherent risk of face-to-face interviews^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw... ,1111 Lima-Costa MF, Mambrini JVM, Andrade FB, et al. Social distancing, use of face masks and hand washing among participants in the Brazilian Longitudinal Study of Aging: The Elsi-Covid-19 initiative. Cad. Saúde Pública. 2020 [acesso em 2020 dez 2]; 36(supl3):1-13. Disponível em: https://pubmed.ncbi.nlm.nih.gov/33053062/
https://pubmed.ncbi.nlm.nih.gov/33053062...} . This type of survey has a low operational cost and allow tracking knowledge, behaviors, lifestyles, and perceptions in contexts of the rapid rise of infectious diseases^{77 Malta DC, Gomes CS, Szwarcwald CL, et al. Distanciamento social, sentimento de tristeza e estilos de vida da população brasileira durante a pandemia de Covid-19. Saúde debate. 2020 [acesso em 2020 dez 2]; 44(4):177-90. Disponível em: https://www.scielo.br/j/sdeb/a/8YsdKcVzwf3yYVZqWMnbnXs/?format=pdf&lang=pt
https://www.scielo.br/j/sdeb/a/8YsdKcVzw...} .

Conclusions

In this study, a significant prevalence of adherence to social distancing was evidenced among public school teachers in the state of MG. The distribution of this adherence varied among the regional areas of basic education and was higher among teachers in the urban area. The outcome in the research was more prevalent among participants ate the age of 60 or over, female, living with a spouse, longer working hour per week, feeling sad, having sleeping difficulties, systemic arterial hypertension, diabetes mellitus, obesity, and respiratory diseases.

References

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