Am. J. Trop. Med. Hyg., 103(2), 2020, pp. 609–612 doi:10.4269/ajtmh.20-0563 Copyright © 2020 by The American Society of Tropical Medicine and Hygiene Perspective Piece COVID-19 and Brazilian Indigenous Populations Graziela Almeida Cupertino, 1 Marli do Carmo Cupertino, 1,2 Andr ´ eia Patr´ ıcia Gomes, 2 Luciene Muniz Braga, 2 and Rodrigo Siqueira-Batista 1,2 * 1 School of Medicine, Faculdade Din ˆ amica do Vale do Piranga, Ponte Nova, Minas Gerais, Brazil; 2 Department of Medicine and Nursing, Universidade Federal de Viçosa, Viçosa, Minas Gerais, Brazil Abstract. The newly discovered SARS-CoV-2 is the cause of COVID-19, including severe respiratory symptoms with an important lethality rate and high dissemination capacity. Considering the indigenous people of Brazil, it is feared that COVID-19 will spread to these communities, causing another stage of decimation. Despite advances in indigenous health care in the country, there are still many challenges due to the social vulnerability of this population, whose lands continue to be illegally exploited. Based on these considerations, this article discusses challenges in caring for the indigenous population in the context of the COVID-19 pandemic in Brazil. INTRODUCTION The indigenous population that inhabited Brazil in 1500 was, according to estimates, around 3 million people strong, distributed throughout the national territory in more than a thousand different ethnic groups. Of these, 2 million occupied the Brazilian coast and the rest the interior. Seventy years after the discovery of Brazilian lands and contact with the in- digenous peoples by Europeans, this population was drasti- cally reduced, estimated at 1,200,000 Indians distributed in the country, 200,000 of them on the coast and one million in the interior. 1,2 For centuries, the indigenous ethnic groups continued to suffer from the decimation of their peoples and, in 1957, reached their lowest number of inhabitants in the country, about 70,000 (5,000 along the coast and 65,000 in the interior). Diseases, wars, persecutions, and socioeconomic ruptures were mainly responsible for this reduction. Various epidemics of infectious and parasitic diseases were most likely the greatest cause of the demographic decline of these peoples. 1,2 Among the many illnesses that have affected the indigenous Brazilians, from the arrival of the Portuguese to the present day, are helminthiasis, syphilis, gonorrhea, rickettsiosis, tu- berculosis, pneumonia, whooping cough, malaria, yellow fe- ver, smallpox, measles, chicken pox, and respiratory viruses. 1 Pandemic influenza, the Spanish flu, raged during 1918–1919 and was responsible for the deaths of 20 million people around the world. In Brazil, this disease was responsible for the ex- tinction of countless indigenous ethnic groups. All these epi- demics and their devastating consequences to the Indian population show the great vulnerability of these peoples to the introduction of new pathogens. 1 The year 2020 brings a new disease, COVID-19, with high dissemination potential, which has mobilized health authori- ties worldwide. Since its emergence in China in December 2019, it has rapidly spread throughout the world, and, by May 11, 2020, it had affected 215 countries, with more than 4 million confirmed cases and more than 350,000 deaths as of June 1, 2020. 3 As in other countries, once it was introduced in Brazil, COVID-19 claimed many victims and raised many questions for its control, especially when dealing with the most susceptible groups, such as Indians. Based on these con- siderations, we discuss challenges in caring for the indigenous population in the context of the COVID-19 pandemic in Brazil. SARS-COV-2 AND COVID-19: A NEW PANDEMIC IN BRAZIL Coronaviruses (CoVs) are the second leading cause of the common cold, behind rhinoviruses. 3,4 The CoVs mostly cause mild respiratory infections. However, the emergence of three new species of CoVs that infect humans has altered this re- ality, with serious outbreaks of SARS-CoV, Middle East respiratory syndrome, and now COVID-19, caused by SARS- CoV-2. The newly discovered SARS-CoV-2 is capable of causing severe respiratory symptoms, with an important lethality rate, although most infections are mild to moderate. Infection with this pathogen first appeared in December 2019 in Wuhan, Hubei Province, China. On January 30, 2020, the outbreak was declared a public health emergency of international im- portance by the WHO, and, on March 11, COVID-19 was characterized by the WHO as a pandemic. 3,5 In Brazil, the first case of COVID-19 was confirmed on February 26, 2020, but retrospective analyses have sug- gested that the first cases occurred in January. Considering the growing number of suspect cases and the country’s continental dimension, population density, disparities be- tween rural and urban areas, and great socioeconomic in- equality, the current scenario points to a multitude of vulnerabilities for this pandemic. Therefore, there is a need for broad and effective measures to contain the advance of COVID-19 throughout the country. 6,7 HEALTH OF INDIGENOUS PEOPLE IN BRAZIL The Special Secretariat of Indigenous Health (SESAI) of the Ministry of Health, created in 2010, reports the existence of 416 distinct indigenous ethnic groups currently in Brazil. 6 According to the National Indian Foundation (FUNAI), the latest census conducted by the Brazilian Institute of Geogra- phy and Statistics shows an indigenous population of 817,963 * Address correspondence to Rodrigo Siqueira-Batista, Department of Medicine and Nursing, Laboratory of Epidemiological and Computational Methods in Health, Universidade Federal de Viçosa, Avenida Peter Henri Rolfs, S/N – Campus Universit ´ ario, Viçosa 36570- 900, Brazil. E-mail: rsiqueirabatista@yahoo.com.br 609