Coping with COVID-19 in an international border region: health and economy*

Objective: to analyze how the social isolation measures and closed borders affected the health and economy in an international border region. Method: descriptive cross-sectional study conducted in the western region of Paraná, Brazil, using an electronic form created using Google® forms. A sample of 2,510 people was addressed. Descriptive analysis and the Chi-square test were performed, with a level of significance established at 5%. This public opinion survey, addressing unidentified participants, is in accordance with Resolutions 466/2012 and 510/2016. Results: the participants were 41.5 years old on average, most were women and worked in the education sector; 41.9% reported that the closing of borders/commercial businesses negatively influenced income; 17.7% reported the possibility of losing their jobs; 89.0% consider that a larger number of people would be sick if the borders/commercial had not been closed; 63.7% believe the health services are not prepared to deal with the pandemic; 74.9% realize that the Brazilian Unified Health System may not have sufficient service capacity; 63.4% reported anxiety; and 75.6% of commercial workers will experience changes in their income level. Conclusion: the closing of international borders and commercial businesses was related to a perception of physical and mental changes, job loss, and decreased income.

growing speed, with variations depending on the regions, states, and cities. There was a significant increase in the number of cases and deaths, despite social isolation measures intended to contain the virus (1,5) , revealing the current health context is of concern. Brazil exceeded 2 million cases up to July 2020, and lethality reached 3.8% with an incidence of 1,031.8 cases/100,000 inhabitants and 38.8 deaths/100,000 inhabitants. There is potential underreporting, though, considering there is a lack of tests for the Brazilian population. Thus, the number of cases confirmed thus far is expected to be six times higher (1) .
A systematic review reports that because there is no vaccine or medication with robust in vivo scientific evidence thus far, social isolation is the primary strategy to decrease the number of new cases and deaths (6) in the population in general. Scientific evidence confirms that social isolation is efficient; however, it also decreases economic activity in general (5) . A combination of social isolation and the release of essential activities only, associated with individual preventive and control measures, such as the use of face masks and alcohol at 70%, present a more significant effect (5)(6) .
If, on the one hand, social isolation practices have been proven to be a good measure to contain the spread of COVID-19, on the other hand, it directly affects the economy at a global and local level. It is important to note that decreased industry and commercial activities and services, impact the businesses' health.

Results
The participants were 41.5 years old on average (SD±12.3) and had 1.4 children on average (SD±1.4).
Most were women (67.7%), married (57.1%), with children (69.4%), worked in the education sector, in public or private schools (19.6%), with statistically significant differences between professions (p<0.001), as shown in Table 1. as shown in Table 3.  In the questions assessing the impact of social isolation, Table 4 shows that 63.5% of the respondents reported that social isolation caused anxiety, and 32.3% related the onset of body pain they had not previously experienced to social isolation (p<0.001).
Additionally, 7.8% of the respondents reported that social isolation caused the emergence of diseases they had not previously experienced (p<0.001).
The results show that workers from different sectors report that border closure will influence their family income, especially those in commercial/tourism businesses (75.6%; p<0.001). Even workers with some job stability reported income losses ( Table 5).
Analysis of the impact of closing commercial businesses shows that workers in the commercial/ tourism businesses and those in the Others category (i.e., homemakers, students, other occupations) were the most frequently affected, that is, 87% and 60.6%, respectively, reported that the measure influenced or will influence their families' income (p<0.001).
The highest impact of the closure of commercial businesses was reported by those working in commercial/ tourism businesses (87%) followed by 60.6% of those in the others category (i.e., homemakers, students, and other occupations) reported that this measure influenced or will influence their family income (p<0.001).
Whether the closing of borders was an appropriate measure to prevent the spread of SARS/CoV2/ COVID-19, those in the commercial/tourism businesses more frequently disagreed, 18.5% (Table 5). This percentage virtually double folds (36.1%) when this question specifically refers to the closing of commercial businesses (p<0.001). Rev. Latino-Am. Enfermagem 2021;29:e3398.  Regarding the onset of physical symptoms, as verified in this study, it is essential to consider that Even though it is clear that the stay-at-home orders and the closure of borders and businesses will cause families' financial problems, the respondents confirmed there was a need to adopt these sanitary measures.
Nonetheless, the task of balancing the effects of social isolation on the economy and social determinants of health is complex (12,29) .
High-income countries rapidly allocated financial resources to support citizens and businesses as soon as they envisaged the economic threat posed by the COVID-19. The European Union and the USA announced the release of funds, based on stimulus bills, to protect people against economic impacts (29) . The Brazilian government acted in the same direction when it implemented economic measures to decrease the impact of the COVID-19 pandemic (14) .  or illegal ways to obtain subsistence or ensure survival, whether to access essential goods or health services.