Construction and application of a human vulnerability index for climate change in the Brazilian context: the experience of the state of Espírito Santo, Brazil

Climate change poses a serious threat to the human population, causing impacts in different sectors. Understanding the factors that may increase human’s vulnerability to climate change allows to identify critical points and to direct immediate actions to reduce vulnerability. Thus, this study developed and applied an index of vulnerability to climate change for the microregions of the state of Espírito Santo, Brazil, encompassing the key elements of vulnerability – Exposure, Sensitivity and Adaptive Capacity. Climatic anomalies of precipitation and temperature were also used for estimate future climate changes. Construction of the indicators was based on the assignment of scores indicating levels of vulnerability for each group of municipalities (clustering); subsequent arithmetic mean and standardization of the values were applied to generate indices from 0 and 1. The Northwestern microregion presented high vulnerability due to its sociodemographic, economic and environmental characteristics. In addition, the entire state may be affected by changes in future climate, mainly by the increase of average temperatures. The Northern region may have a considerable increase in the number of consecutive dry days. These results are expected to contribute to guide actions of adaptation to the climate change and to increase the resilience of the territory from the identification of existing vulnerabilities.A mudança do clima representa séria ameaça para a população humana, causando impactos em diferentes setores. Conhecer os fatores que elevam a vulnerabilidade do ser humano à mudança do clima permite identificar pontos críticos e direcionar ações imediatas para reduzi-la. Assim, este estudo desenvolveu e aplicou um índice de vulnerabilidade à mudança do clima para as microrregiões do Espírito Santo, abarcando os elementos fundamentais da vulnerabilidade – exposição, sensibilidade e capacidade adaptativa. Anomalias climáticas de precipitação e temperatura também foram usadas para estimar as alterações para o futuro. A construção dos indicadores se baseou na atribuição de notas indicativas de vulnerabilidade para cada grupo de municípios (clustering), com posterior média aritmética e padronização dos valores para gerar índices variando entre 0 e 1. Verificou-se que a microrregião Noroeste apresenta vulnerabilidade extremamente elevada, em virtude de características, sociodemográficas, econômicas e ambientais. Todo o estado poderá ser afetado por alterações do clima futuro, principalmente pelo aumento de temperaturas médias. O norte do estado poderá ter aumento no número de dias secos consecutivos. Espera-se que esses resultados contribuam para orientar ações de adaptação à mudança do clima e aumentar a resiliência do território a partir da identificação das vulnerabilidades existentes

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Analyzing Spatial Patterns of Health Vulnerability to Drought in the Brazilian Semiarid Region

Health determinants might play an important role in shaping the impacts related to long-term disasters such as droughts. Understanding their distribution in populated dry regions may help to map vulnerabilities and set coping strategies for current and future threats to human health. The aim of the study was to identify the most vulnerable municipalities of the Brazilian semiarid region when it comes to the relationship between drought, health, and their determinants using a multidimensional index. From a place-based framework, epidemiological, socio-economic, rural, and health infrastructure data were obtained for 1135 municipalities in the Brazilian semiarid region. An exploratory factor analysis was used to reduce 32 variables to four independent factors and compute a Health Vulnerability Index. The health vulnerability was modulated by social determinants, rural characteristics, and access to water in this semiarid region. There was a clear distinction between municipalities with the highest human welfare and economic development and those municipalities with the worst living conditions and health status. Spatial patterns showed a cluster of the most vulnerable municipalities in the western, eastern, and northeastern portions of the semiarid region. The spatial visualization of the associated vulnerabilities supports decision making on health promotion policies that should focus on reducing social inequality. In addition, policymakers are presented with a simple tool to identify populations or areas with the worst socioeconomic and health conditions, which can facilitate the targeting of actions and resources on a more equitable basis. Further, the results contribute to the understanding of social determinants that may be related to medium- and long-term health outcomes in the region

Construção e aplicação de um índice de vulnerabilidade humana à mudança do clima para o contexto brasileiro: a experiência do estado do Espírito Santo1

Resumo A mudança do clima representa séria ameaça para a população humana, causando impactos em diferentes setores. Conhecer os fatores que elevam a vulnerabilidade do ser humano à mudança do clima permite identificar pontos críticos e direcionar ações imediatas para reduzi-la. Assim, este estudo desenvolveu e aplicou um índice de vulnerabilidade à mudança do clima para as microrregiões do Espírito Santo, abarcando os elementos fundamentais da vulnerabilidade - exposição, sensibilidade e capacidade adaptativa. Anomalias climáticas de precipitação e temperatura também foram usadas para estimar as alterações para o futuro. A construção dos indicadores se baseou na atribuição de notas indicativas de vulnerabilidade para cada grupo de municípios (clustering), com posterior média aritmética e padronização dos valores para gerar índices variando entre 0 e 1. Verificou-se que a microrregião Noroeste apresenta vulnerabilidade extremamente elevada, em virtude de características, sociodemográficas, econômicas e ambientais. Todo o estado poderá ser afetado por alterações do clima futuro, principalmente pelo aumento de temperaturas médias. O norte do estado poderá ter aumento no número de dias secos consecutivos. Espera-se que esses resultados contribuam para orientar ações de adaptação à mudança do clima e aumentar a resiliência do território a partir da identificação das vulnerabilidades existentes

Mapping human vulnerability to climate change in the Brazilian Amazon: The construction of a municipal vulnerability index

<div><p>Vulnerability, understood as the propensity to be adversely affected, has attained importance in the context of climate change by helping to understand what makes populations and territories predisposed to its impacts. Conditions of vulnerability may vary depending on the characteristics of each territory studied—social, environmental, infrastructural, public policies, among others. Thus, the present study aimed to evaluate what makes the municipalities of the state of Amazonas, Brazil, vulnerable to climate change in the context of the largest tropical forest in the world, and which regions of the State are the most susceptible. A Municipal Vulnerability Index was developed, which was used to associate current socio-environmental characteristics of municipalities with climate change scenarios in order to identify those that may be most affected by climate change. The results showed that poor adaptive capacity and poverty had the most influence on current vulnerability of the municipalities of Amazonas with the most vulnerable areas being the southern, northern, and eastern regions of the state. When current vulnerability was related to future climate change projections, the most vulnerable areas were the northern, northeastern, extreme southern, and southwestern regions. From a socio-environmental and climatic point of view, these regions should be a priority for public policy efforts to reduce their vulnerability and prepare them to cope with the adverse aspects of climate change.</p></div

Conceptual framework showing the relationships among vulnerability components.

<p>The circle represents a municipality in which the conditions of exposure, sensitivity and adaptive capacity determine the vulnerability profile of the population. The boxes exemplify some of the conditions considered critical for each vulnerability component; the green box is related to exposure, the yellow box to sensitivity and the orange box to adaptive capacity. Climate risk is represented by future climate change. (Adapted from Allen Consulting Group, 2005).</p

Values of the sub-indices that compose the current Vulnerability Index (VInd) of the microregions of Amazonas.

<p>Distribution of average values of exposure, sensitivity, and adaptive capacity indices for each microregion of the state of Amazonas.</p

Distribution of the current Vulnerability Index, Climate Scenario Index, and Municipal Vulnerability Index.

<p>(A) Values of the indices referring to the most vulnerable municipalities and the Amazonas state capital, Manaus, Brazil, according to MVI. (B) Distribution of the indices, in average values, for the microregions of the state of Amazonas, Brazil.</p

Methodological scheme.

<p>Organization of the indices chosen to generate the Municipal Vulnerability Index considering a pessimistic emission scenario (RCP8.5).</p

Diagram illustrating the steps of calculating all indicators and indices.

<p>Steps 1 and 2 comprise transforming the raw variables into indicators. Step 1 is representing the assignment of scores and Step 2 is illustrating the procedures of arithmetic mean and standardization to generate the indicators ranging from 0 (least vulnerable) to 1 (most vulnerable). Step 3 illustrates the aggregation of the indices to generate the final index, the Municipal Vulnerability Index.</p