How can COVID-19 pandemic affect men’s health? a sociohistoric analysis

Introduction : The COVID-19 pandemic unveils gender markers linked to masculinities in the sociohistorical way the disease fits in Brazil and in other parts of the world. The objective is reflecting from a sociohistorical analysis how the pandemic of the novel coronavirus in Brazil can affect men’s health. Outline : Theoretical reflection study supported by the theoretical framework proposed by Charles Rosenberg that makes it possible to analyze the epidemic disease from the appearance of its own defining phenomena / characteristics. Results : The following is presented: considerations on the characteristics of the epidemic disease from the framing perspective, the defining elements emerged in a pandemic, and the way how it has been affecting Brazilian men’s sociocultural experience. Implications : Sociohistorical knowledge of the pandemic make it possible to identify current SARS-CoV-2 pandemic phenomena in Brazilian men’s experience, which allow us to deepen social investigations on the disease, transmissibility, potential for lethality, biopsychosocial impacts, to redirect health practices, health education, and to equip professionals involved in combating the pandemic.


INTRODUCTION
Historically and chronologically, epidemics since classical antiquity were constituted of narratives that illuminated the construction of an image marked by tragic events, apprehended with serious illnesses, with similarly frightening symptoms, permeated by terror, deaths, conflicts, disaggregation, invasion of cities, with great extension and high mortality.Interwoven with these contexts, epidemics have found correlations with periods of war, invasion, disaster, destruction, and famine.During this period, epidemics were understood as a natural category, consisting of a grouping of phenomena that were based on the differences identified between a set of phenomena and their binary opposite. 1roughout the evolution of societies, solutions around performing work responsible for dealing with a plague / epidemic and/or a disease, became effective, gaining prominence from the Theory of Germs, which later would materialize in hygiene actions.It is based on fear and anxiety that imperative needs of understanding are created, in order to ensure the desired safety.The explanations about the epidemic begin to reflect intimately the cultural and intellectual assumptions of a given generation, in a given particularity and repertoires available to their time and spaces, which configures greater attention to the emergence of a pandemic, the one capable of global spread and impact. 1 In order to analyze it from a perspective of social constructionism, and transposing it beyond it, contemplating social thinking and social structure, Charles Rosenberg 1 proposes a look from the changes in the social perception of diseases.Given historiographic, multidimensional work, which comprehends the disease as an interactive system, in which such understanding about the disease is able to interact with the manifestations in the lives of women and men in a particular way, extrapolating to the dimension between doctor and patient, doctors and families, medical institutions and the practice of medicine, thus structuring mediations in these established relationships.
Based on this assumption, it is possible to analyze the emergence of the novel coronavirus pandemic in Brazil over time.] Emerged in the city of Wuhan, Hubei province in China, at the end of 2019, the epidemic outbreak revealed unique aspects of a population with particular cultural, dietary, labor, hygiene control and sanitary habits, causing the virus to have rapid spread in Chinese territory and soon afterwards on several continents in the world. 4e to the abrupt illness and mortality of high proportions, global health authorities, like the World Health Organization, declared a global health emergency due to the new pandemic. 5 Among the first measures adopted by countries, quarantine, social distancing, social After the first few months, investigations into measures to combat transmission, such as closing borders between countries, ports, airports, shops, and non-essential services, as well as a massive 2 investment in the production of masks, products for infection control and maintenance of hygiene, health communication through the media and journalism, clinical, genetics, mathematics, and medical and biomedical treatment investigations.
In addition to these efforts, but to a lesser extent, scientific investigations have been pointing out how the population reacted to pandemic and was impacted by it. In Brazil, until May 3, 2020, 101,147 cases had already been confirmed, 7,025 deaths, with a fatality rate of 6.9%.[14][15][16][17] Death data by COVID-19 in Brazil since the beginning of the pandemic in the country have already revealed the prevalence of elderly men with comorbidities.Among the main comorbidities, heart diseases, diabetes, pneumopathies, neurological disease, kidney disease, immunosuppression, obesity, asthma, hematological disease and liver disease stood out, in that order. 18e study was guided by the research question: How can the pandemic affect men's health?Given this context, this study aims to reflect from a sociohistorical analysis how the pandemic of the novel coronavirus in Brazil can affect the health of men.The textual organization sought to encompass two dimensions: epistemological and methodological, so that, the first aims to discuss the theoretical bases proposed by Rosenberg, 1 second, its application in the practical field, male social behavior. In order to overcome these dilemmas, actions Regarding the aspects related to male behavior observed by the digital media in contemporary times since the emergence of the pandemic of the novel coronavirus in Brazil in its first wave, it is clear that the first causes of death in Brazilian states were male.] In addition to these milestones, other multidimensional repercussions of social aspects began to be reported due to the emergence of the pandemic in the country, such as the financial crisis, unemployment, and poverty, mostly affecting the male population, such as the professional category of workers, gravediggers, and others. Aspects such as the diversity of diseases and the uniformity of diseases were substantial to understand their behavior, from the perspective of the diversity of human lives, time, place, lifestyle, course of life, knowledge, and its use social.This differentiation between an individual and a collective illness was extremely relevant so that one could observe that on the one hand there is the result of an individual's life course from its cumulative consequences and interactions present in a standardized way in the environment in which he lives, on the other, in the case of epidemic diseases, they will be observed from a moment in time, a cross-section, represented by a result of causes that are capable of affecting many people at once. 1 Based on this arrangement of understanding, the epidemic disease, which generates a pandemic, redirects medical explanations of the problem, formerly holistic and inclusive, making the appearance of a "normal" disturbance in the maintenance of health and its constituents, like the climatic, environmental and community arrangement, arising from the consequences of a unique configuration of circumstances, responsible for providing greater knowledge about infectious agents. 1 In addition to this advance, as a way of making a leap in the understanding about the term epidemic, seen in the past as a synonym for contagious, the demarcation of the contamination terminology emphasizes the implication on the idea of disorder responsible for subverting health maintenance from the action of an event or agent.Another need to expand knowledge about the epidemic disease was the "predisposition" relationship, which was widely used to explain the influence of individual immunity to the possibility of succumbing or not to an epidemic.In turn, "susceptibility" explained, in a frightening way, the arbitrary selection of victims.

RESULTS AND DISCUSSION
The fact is that all these structures made it possible to outline explanatory tables / models culturally adapted to the time, as a way of understanding how epidemic diseases occurred, composing an element called "configuration". 1 Such contextualization is necessary to demonstrate how, over the decades, societies understood, defined and responded to the disease, based on intellectual, attitudinal, professional factors and public policy actions.
In this context, it involves a significant relationship from three spheres: disease, patient, and doctor.Such spheres are complex, since the disease needs to be seen as an illusory entity, a repertoire of generations, verbal constructions, historiographic, intellectual and institutional reflexes, a social and intrapsychic role and not as a value below the physiological ideal, after all, it involves relationships with demographic changes, declining morbidity, mortality rates, medicalization of society, prolonging life, economic change, municipal sanitation, public health administration, hegemonic enterprise, social circumstances, and individual and intrapsychic identity. 1 a more comprehensive sense, Rosenberg seeks to understand the disease, as well as epidemic and pandemic character, from the logic of the "framework".In this light, "disease as a framework" (a kind of frame) plays a structuring factor in social situations, acting as an actor and social mediator, receiving investments that configure unique social characteristics in a complex network of negotiations, full of value, responsibility, epistemological and ontological status in order to explain, for example, the devastating and episodic infections caused by viruses, and consequently their chronic and diffuse symptoms. 1is framework is composed of "individuality", in which social roles are often shaped from the disease and its biological identity, as well as economic, personal and family dilemmas, which allows that the definitions of public health policies and therapeutic options to be adopted by people take place through understanding the biological character of the disease in its particular dimension. Lifestyle-related issues made the sociocultural aspect more at "stake", as they surfaced, revealing that the number of people who smoke is predominantly male, which makes the lung condition more vulnerable to contamination by the novel coronavirus.] In The president was also involved in conflicts between ministers and anti-democratic mobilizations that had an impact on reckless crowding, increased risk of contamination, disbelief on the part of the population, stress, discontent, strengthening of myths, fake news, and conspiracy theories. 31 is from this cyclical phenomenon that exists in certain bodies and family contexts that the "social diagnosis" is instituted, being articulated with "unity" and "diversity".Therefore, it is necessary to seek to know more about individuals, as well as better understanding the disease experience in time and place, together with the role of culture in definitions, creation of behaviors and attitudes, definition of responses to it, organization of the medical profession and institutional health care.In addition, it implies identifying the distinctions between ontology and physiology, between biological event and socially negotiated construction, in order to understand the pandemic as an interactive system, which interacts with the life manifestations of specific individuals. 1 Brazil, a novel coronavirus has affected vulnerable population groups, and most of this public affected and jeopardized by COVID-19 has been indigenous men.][34][35] It is also concerned with other "key" populations, such as men on the street, blacks, quilombolas, and the poor, men who live in slums and/or who are homeless, men who live in places of difficult access such as the riverside dwellers, the men of the countryside, the forests and the waters (fishermen, shellfish gatherers and others), as these will suffer greater consequences, given the overlapping socio-cultural, educational, territorial structuring inequalities and vulnerabilities in health.
Characteristically, an epidemic disease such as AIDS, for example, coexists in an invoked manner, composed of larger structures of meanings, being able to reflect the continuous interaction that exists between incident, perception, interpretation, and response.In this sense, based on the assumptions provided by Rosenberg 1 , it is possible to understand a pandemic through apparent phenomena, in which they can be read as acts, namely: "act one: progressive disclosure", in which communities take time to accept and recognize an epidemic and later a pandemic, emergence of failures of imagination, difficulties in recognizing threats to economic and institutional interests, and ensuring the emotional complacency of ordinary women and men.There is, in the first instance, fear on the part of traders due to the possible effects generated by the pandemic on trade, while political authorities fear the budgetary effects, in the public order and daily habits.
However, it is only when the situation becomes inevitable that there is public admission of its existence. 1ch theoretical structure contributed by Rosenberg 1 highlights the relevance of combating stigma and social exclusion that emerges with the arrival of the pandemic, making people suffer because they are on the margins of social and health coverage.This is the case of "invisible men" in Brazil, who do not appear on the union's records and, therefore, do not exist for them.Currently, digital media and television journalism have exposed the situation in which long lines of people are seeking emergency aid and most of them are having difficulty accessing, whether it is inaccessibility to technological resources such as smartphones to access a website or download an application and be able to register in order to receive the benefit, whether physical or even documentary.[40][41] An important parallel needs to be observed, which occurs in the existence of the relationship between biologically determined factors, between a chronology of the epidemic intertwined with its social chronology, which could justify the accentuated appearance of incidence of cases and exhaustion of individuals with susceptibility, gradual spread of the epidemic and anticipation of its arrival in the territories, such as the expansion, characterizing the appearance of a pandemic. 1"second act" can be perceived in the After the recognition that the pandemic is real, the "third act: negotiation of the public response" appears, in which it will imply the appearance of collective action, based on the social pressure that is generated by the community, making sure there are crucial and viable decisions to face it.In this act, a dramaturgical phenomenon, a defining characteristic present, would be the constitution of collective rituals, through the interaction of cognitive and emotional elements, such as the imposition of a quarantine, the disinfection of public environments, the use of products to clean the contaminated atmosphere (smoke cars), gathering of people in church, fasting and collective prayers, all in a similar act of community solidarity. 1 In this third act of the pandemic, beliefs, attributions to family origins and political opinions also emerge as pandemic generators (religious and rationalist or mechanistic thinking).In addition, cultural attitudes resulting from public health measures, which can also be linked to belief systems, ideological and political dimensions.
A class dimension has been remarkable, since the targeting of actions centralizes the focus on the poor and socially marginalized, as well as on immigrants, populated in slums, prosperous suburbs, less crowded and apparently less unhealthy, such as the middle class, but not aimed at the rich, labeling them throughout history as the disproportionately likely victims of the epidemic and the spread of diseases.Such a panorama is not what happens with the emergence of the pandemic in Brazil, for example, in which the first identified and reported cases are of upper-class people, as well as the progress of the disease in the country, in which a man fails to comply with the measures of social isolation, makes interstate trips, promotes private parties at home and puts workers and domestic workers at risk, thus causing community transmission of the virus. 42nally, due to the emergence of a "fourth act" represented by "subsidence and retrospection", in which the pandemic usually ceases with a geminate, but not as an outbreak, in which susceptible individuals can flee, die or recover, with an incidence of the disease that gradually decreases, in a generally flat, ambiguous and inevitable sequence for a last act.In this context, an implicit moral structure can be observed, which can be imposed as an outcome.
Could one of them be the fact that the determined In view of this presented panorama, supported theoretically, it is possible to highlight the need to recognize sociohistorical facts as essential elements in understanding the epidemic disease, its potential impact on people's lives and the responses presented by them, as occurs in the male population.In this way, the findings reveal an intimate connection with contemporary times and attract greater attention to men in terms of strengthening strategic health actions, as a way of reducing vulnerabilities and health risks, which directly impact quality of life, well-being and living well for them and the community.
Theoretical reflection based on the theoretical framework of Charles Rosenberg, supported by the work: Explaining epidemics and other studies in the history of medicine,1 to analyze sociohistorical frameworks and theoretical phenomena about the epidemic disease and its potential for generating a pandemic context.For the methodological structuring of the study, the following were revisited: the current literature on the pandemic of the novel coronavirus in the world, its arrival in Brazil, and the intersection with aspects related to the way men are dealing with the problem and how it has been generating impacts for them.To this end, investigations of official documents such as epidemiological bulletins and facts presented in the digital media on the subject were carried out.
have been considered and involve: monitoring cases in real time; applying mathematical and statistical models; defining action strategies; setting up emergency contingency plans; using the media in an advanced way to report the dissemination of false information, such as fake news, suppressing the return of myths, conspiracy theories and denialist practices, such as the refusal of the vaccine; expanding laboratory surveillance; processing, sharing and analyzing epidemiological data; training professional teams; acquiring equipment and materials.19However, there is little or almost no action development around knowledge based on a social bias, about how the population has reacted to the pandemic, just as it is with the male population.Specific phenomena are noted in epidemic diseases, just as in pandemic situations, such as relationships of understanding about the climate, correlations with sin as the result of human behaviors and attitudes considered by the church to be sinful, disordered air, water, bacteria, retroviruses, and others, which add efforts from generation to generation in the search to explain the control of scares from infectious diseases.Such phenomena will be constituent elements of a certain democracy among the hypothetical etiologies that on the one hand approach and oppose the relationship between the natural world and the real world.What prevails in the understanding of an epidemic disease is not exactly the specific contents generated by it, but the function, which is configured as the inevitable act of explanation in itself.In this particular sense, the distinction between individual and collective illnesses is represented logically and historically, expressed in the situation in which several people get the same illness at the same time.1 no enthusiasm to publicly acknowledge the presence of a dangerous intruder of such magnitude.Still part of this act, social dissolution to the responses to admit the emergence of an epidemic disease.It is expected, therefore, escape from possibly contaminated neighborhoods, interruption of revistas.ufpi.brRev Pre Infec e Saúde.2020;6:10549 commerce and communication (social distancing), quarantine institution (feared administratively, but politically convincing), questioning and medical skepticism regarding the contagiousness of the epidemic disease and what could be potential sources of infection. 1In approximation with what Rosenberg theorized in the first act, there are currently situations in Brazil that there is male resistance in the adoption of quarantine measures, social distancing, hygiene control, and the use of individual protective face masks. 1 This situation intertwines with two dimensions: the first concerns the gender relation based on the construction of masculinities, which is impregnated with the hegemonic model in which overstrengthens the idea of the strong body, the invincible, unshakable man, resistance and consequently autoimmune to coronavirus and the second to the social representation of the disease from the accesses made and made possible to men, appearance of an epidemic disease, as well as in the context of a pandemic, what Rosenberg 1 called: "managing randomness", as a way to point out the emergence of an acceptance on the existence of a pandemic, which implies, in a certain way, the appearance of demands, the creation of a moral and transcendent structure, based on submission, consolation, formerly linked to religion and fundamentalism, which give rise to spiritual assumptions, as well as the birth of explanations more secular and mechanistic, forces of human rationalization based on moral convictions and values attributed to biological processes, based on a dual relationship: health or disease, individual sin or collective sin. 1 In addition, the following are identified in a pandemic context, explanations of phenomena based on the logic of the promise of control, involved in minimizing the sense of vulnerability, formulations of hypothetical schemes to explain predisposition, susceptibility, risk factors, relationship between behavior, lifestyle and environment, thus characterizing the social management of the pandemic.