At the end of December 2019, at the Seafood Wholesale Market in Wuhan, China, a new variant of the Coronavirus emerged, which causes a respiratory infection capable of producing Severe Acute Respiratory Syndrome 2 (SARS-CoV-2), characterizing the disease COVID-19 ( Coronavirus Disease 2019 ) [1].

One factor that contributed to SARS-CoV-2 becoming a global public health problem is its high potential for transmission, which occurs through fomites (contaminated inanimate materials that serve as a vehicle for transmission) and respiratory droplets from coughing. and/or sneezing (aerosol transmission). The concentration of viral particles in the environment is a determining factor for transmission to occur, with viral viability in aerosol dispersion having been demonstrated for three hours or more [2-4].

Due to this high transmission rate of the virus and its worldwide spread, the status of the disease has changed. On March 11, 2020, the World Health Organization (WHO) declared COVID-19 a pandemic. In Latin America, the first case was registered in Brazil on February 25, 2020 by the Brazilian Ministry of Health [1].

With the arrival of COVID-19 in Brazil, several measures to control and prevent the disease were adopted by local health authorities in different administrative spheres (federal, state and municipal governments), aiming to reduce the spread of the virus. Social physical distancing was the most encouraged measure in all continents affected by the pandemic, as a strategy to contain the speed of contamination, with the aim of not overloading health systems and favoring care for serious cases. However, such distancing caused numerous changes in people’s lives, generating impacts on economic, emotional, psychological and social aspects [5].

Given this scenario, COVID-19 is a public health problem, with serious implications for public health, which causes changes in the population’s lifestyle, especially with regard to social interactions between peers, given the recommendation of the physical distancing for virus prevention and containment [6].

This process of social distancing was generally understood by the population and the media, in practice, as social isolation [5-7], which has had an impact, especially on people’s quality of life. When investigating the immediate impact of the COVID-19 pandemic on mental health, habits and quality of life among adults in mainland China, a study revealed that one week after the blockade of Wuhan imposed by the Chinese government, they found an association of the phenomenon with impact stressful on people [8].

With the COVID-19 pandemic, the isolation measures imposed, such as the so-called quarantine, caused many daily activities to be interrupted or modified, especially those involving human relationships, forcing adaptations for which many people were not prepared. These changes had consequences for people’s psychological well-being and quality of life, causing sadness, panic, and a lot of mental stress. In this sense, broad, negative and possibly long-lasting psychological outcomes (anger, confusion and post-traumatic stress symptoms) may be associated with the length of quarantine; fear of infection; to frustration and boredom; inadequate supplies and inadequate information [9].

This context subjected the population, especially people who were diagnosed with COVID-19, to face many adversities arising from this health crisis. Economic issues, the reality of hunger, misery, social abandonment, the situation of street populations, institutionalized elderly people, refugees, show the social and personal vulnerability felt by the visible finitude with the high numbers of deaths due to the disease [10,11].

In view of this scenario, the stress caused to the population is significant, including feelings of fear, impotence and insecurity in the face of COVID-19; perception of the fragility of the structure of the health system; presence of socioeconomic factors that compromise food security and exposes a complex network of basic aspects of life [10,11].

To cope with this stress experienced during COVID-19, social support is used, which is characterized by ties of affection, consideration, trust, among others, that connect people who share social life and who can exercise influence on the behavior and perception of those who make up the social network. Social support is offered by available social networks, such as: family, friends, neighbors and professionals, who can help in different ways: providing material or financial support, performing household chores, taking care of children and offering emotional support [12].

In this sense, it is known that this type of support promotes the adaptation of individuals when they are faced with adverse situations, such as those imposed by the context of the COVID-19 pandemic. Social support has a direct impact on subjective wellbeing, in addition to promoting health recovery and, above all, improving the emotional aspects affected by the disease [13].

This cross-sectional study is a cohort study subproject entitled “Study of confirmed cases of COVID-19 in Minas Gerais”.

Study Population

The study population consisted of residents in the municipality of Alfenas-MG, diagnosed with Covid-19 in the period from March 15 to October 26, 2020, identified from the compulsory notification record of the State Department of Health of Minas Gerais . With this, the reference population for the study consisted of the 1,923 first confirmed cases of SARS-CoV-2 in Alfenas-MG.

The following inclusion criteria were considered: adults and elderly people (age equal to or greater than 20 years), residents of Alfenas-MG, confirmed cases of COVID-19 through laboratory tests, who did not reside in a nursing home and who did not evolved to death. Among those eligible, there were 1,459 cases that had not been hospitalized and 107 people with a history of hospitalization, totaling 1,566 people who met the inclusion criteria. Thus, from the initial list obtained, 110 elderly residents of a local asylum institution were disregarded, 189 people under the age of 20 years, 21 people with no registered age, 35 cases of death and two duplicate registrations, totaling 357 exclusions.

Composition of the Study Sample

Stratified and proportional random sampling was then considered for the sample calculation and random selection of study participants, with age group and hospitalization as strata. The sample was calculated considering all 107 patients hospitalized in Alfenas-MG until the aforementioned period and adding, in a 2.5:1 ratio, cases from the community. 20% of losses due to refusals or other causes were contemplated. Thus, it was estimated that a sample of 428 participants was necessary. The estimated number gave the sample a power (1- β) equivalent to 88%.

Social Support Scale - EAS/MOSS-SSS (SOCIAL SUPPORT - AS)

The Medical Outcome Study was developed by Sherbourne & Stewart in 1991 [14]. The scale was validated for Brazil by Griep et al. in 2005[15]. The Social Support Scale MOS-SSS (Social Support Scale) assesses the extent to which the person has support from others to face different situations in their life. It was developed for chronic patients, but due to its ease of application, it has been used in other populations. Consisting of 19 five-factor items, identified as social support of the emotional, informational, material, affective and positive social interaction type, and internal consistency indexes greater than 0.91 [14], answered using a Likert-type scale of five points where: 0 (“never”); 1 (“rarely”); 2 (“sometimes”); 3 (“almost always”) and 4 (“always”). So far, there are no standardization studies for the Brazilian population, so it is assumed that higher indices in the total score of the respective factors indicate a greater perception of the type of support [16].

The Medical Outcomes Study Social Support Scale (EAS/ MOSS-SSS) aims to assess how much support each person has to face stressful situations. The scale was developed for the Medical Outcomes Study by Sherbourne and Stewart (1991) [14], and adapted for the Brazilian population in the Pró Saúde study in Rio de Janeiro [15].

The instrument consists of 19 questions, in which the participant must answer from an initial instruction: “If you need it, how often do you count with someone?”. The participant can select one of the five possible answers according to a fivepoint Likert scale: 1 (never); 2 (rarely); 3 (sometimes); 4 (almost always) and 5 (always). The scale has five dimensions of social support: (1) material (provision of practical resources and material help); (2) affective (physical displays of love and affection); (3) positive social interaction (having people to relax and have fun with); (4) emotional (ability of the social network to satisfy individual needs in relation to emotional problems); and (5) information (counting on people who advise, inform and guide) [16].

Despite the scarcity of standardization studies for the Brazilian population, the highest rates of the respective factors configure a greater perception of the type of support. It is noteworthy that, for the sum of the total score, it is not necessary to invert any item [16].

Data Processing

Information collected during face-to-face and remote interviews was automatically transferred via electronic questionnaire to the KoBo Toolbox platform where they were stored. Subsequently, the data were exported to an electronic spreadsheet in Excel format and, subsequently, transferred to the Stata software, version 13.1. For each batch of 50/100 records, the database was subjected to internal consistency tests (assessment of information quality and pattern of missing data). Once this phase was concluded, the final stage of data management was reserved for the definitive categorization of the original variables and the generation of new variables.

Statistical Analysis

The study population was characterized according to sociodemographic factors and aspects related to social support. For characterization, absolute (N) and relative (%) distribution indicators were used, medians (50th percentile), mean values and respective standard deviations.

Ethical Aspects

This study was approved by the Research Ethics Committee of the proposing institution, according to CAAE nº 34746620.6.0000.5142 and Opinion nº 4.317.149, of October 02, 2020. Each participant recorded, by physical or electronic means, their agreement to participate in the study, via the Free and Informed Consent Form. The procedures adopted in this research obeyed the Criteria of Ethics in Research with Human Beings, according to Resolution n°466/12 of the National Council of Health System (CNS).

Social Support and Covid-19

The support network can be understood as the resources made available by people in a situation of individual need and its evaluation can provide information on social integration and interpersonal relationships in times of crisis[15]. Social support represents ways of coping with stressful situations and contributes to the individual response, and can be measured through perception in different areas such as material, emotional or affective [14,17].

Social support is defined as assistance between people with mutual recognition in material and/or information format. It is a reciprocal process with positive effects for those involved. Thus, it allows people to have more sense of control over their lives and an interrelation between them [18].

Social support is configured as one of the dimensions of the stress theory, associated with the characteristics of the stressors, coping strategies and assessment of the situation [19]. It should be noted, however, that social support lacks specificity for its conceptual definition. To identify the perception of social support, it is important to assess the quality, availability, types and perspective of this support [20].

The support structure offered presents a qualitative and functional orientation of the social network [21]. This is understood as shared relationships between people and makes up the identity of the subjects, as it contributes to the feeling of belonging among them. As examples, social networks can involve family members, friends, neighbors and professionals who contribute to the development of possible activities of the individual, such as household chores, child care and financial organization.

Social networks can act during health-disease processes as a source of care and help in adherence to treatment. Thus, they play an important role in health promotion [15]. Having someone who offers social support in times of stress and crisis situations favors better coping. The lower this support, the greater the individual’s susceptibility to the disease with an impact on the morbidity and mortality of the population [13,22,23].

The pandemic, as a mark of crisis, represented a moment when social support became fundamental. With the social isolation measures, there was a significant change in the population’s lifestyle and impact on current social networks. Among individuals from vulnerable groups, facing the challenges of the pandemic was more difficult, mainly due to the lack of resources and social protection [24].

Of the 428 confirmed cases of COVID-19 residing in the municipality of Alfenas/MG, allocated for interviews, 211 were lost for different reasons (Table 1). Considering only “refusals” and “three or more unsuccessful attempts”, the non-response rate was equivalent to 25.5% (38+71)/428, excluding registration filling errors, false positive cases and Deaths.

Regarding the socioeconomic profile of the study population, women represented 55.8% of the sample and men 44.2%. The age groups were 4.1% (20-29 years old), 9.7% (30-39 years old), 15.7% (40 to 49 years old), 30% (60 to 69 years old), 17 .5% (70 to 79 years old) and 5.5% (80 years old or more). In this way, we can see that most of the interviews were composed of women aged between 60 and 69 years. Regarding marital status, 69.1% are with a partner. Regarding schooling, 13.8% studied between 0-3 years, 34.2% between 4-7 years, 29% between 8-12 years and 23% had 13 years or more of regular study.

With regard to housing, 57.6% have a family density of 0.5 to 1 person per room, with 39.2% of respondents living with their spouse and child. Regarding the work situation, 46.1% of the sample worked in the last 3 months, in addition to 37.3% being retired, 10.6% housewives, 4.1% unemployed, 1.4% on leave and 0.5 % students. The per capita income of the study population showed very similar percentages, with 32.3% with income < R$ 712.66, 33.3% with income between R$ 712.66 and R$ 1156.33 and 34.4% ≥ BRL 1156.33. Respondents rated the current economic situation as Good by 39.6% and Regular by 36.9%. Therefore, the study sample is characterized by a majority of elderly women, married and with good housing conditions and a balanced financial situation (Table 2).

When using the EAS MOS-SSS Social Support Scale, the results showed an average of 4.1 (sd 5.7) relatives they can count on and trust and 4.1 (sd 15.3) close friends. We can see that the standard deviation was high for these data, demonstrating that there was a lot of diversity of answers.

The social support network acts as a means of support in coping with adversities, including reducing people’s vulnerabilities in stressful situations [24]. In the context of the pandemic, vulnerable groups drew attention because they had a worse prognosis when compared to the rest of the population. The elderly, people with chronic diseases and people who lack social protection were considered the main risk groups [24].

In the midst of the pandemic, the elderly showed a significant change in their life organization, with significant impacts on the development of daily activities and social bonds. Considering this scenario, such restructuring resulted in two profiles of elderly people, one group with greater functional dependence and the other with subjects who found greater autonomy [24]. In addition to age, gender dimensions also implied the way of coping with the pandemic [24].

In addition to age, gender dimensions also implied the way of coping with the pandemic [24]. This study demonstrated a higher prevalence of women. Regarding social aspects, the literature describes greater social support among females, which may be related to greater participation of women in community activities [25]. In addition, a greater adherence of women is observed when it comes to matters related to health care.

Another point that draws attention, in terms of the difference between genders in the pandemic, is the increase in cases resulting from domestic violence in the female population [24]. In addition, traditional gender values have contributed to a division of domestic tasks burdening women. This gender hierarchy perspective also favors the question that men find more social support in their marital relationships than women [24,26].

Having a support network is related to the reduction of cases of violence. Therefore, these facts raise the urgent need for social support for women, including multiple protection actions incorporated into public policies [24].

It should be noted that the support network can offer social, material, affective, informative or social interaction help, becoming essential in preventing vulnerabilities due to the pandemic. In this sense, the social support received contributes positively to the quality of life [24,27].

Regarding the type of support, the most cited were social and material support, indicating a greater perception of the presence of people who share moments of distraction, as well as people who offer practical support measures, respectively. The types of affective, emotional and informational support presented evaluation levels close to social and material supports, which demonstrates that the research participants considered having a network of people who show loving feelings, share concerns and provide information [16].

Regarding social support, this represented an important support to the participants, through different material, informational or emotional resources, as well as from different sources such as friends, family and co-workers. It is worth noting that this positive effect of social support reflects on health and is related to a better perception of the individual’s quality of life.

Regarding the perception of social support, despite the diversity of responses, it is clear that most people reported to family and friends as a bond of trust to meet their needs. It should be noted that the support network can offer social, material, affective, informative or social interaction help, becoming essential in preventing vulnerabilities due to the pandemic. In this sense, the social support received contributes positively to the quality of life.

As limitations of the study, we point out the cross-sectional design and the number of losses that occurred. Future studies are suggested on mental health complications and the impact on quality of life in people who became ill with COVID-19, especially in the long term.

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