On March 11, 2020, the World Health Organization (WHO) declared the Coronavirus Disease 2019 (COVID-19) pandemic, an infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a member of the coronavirus family [1,2]. The ease of transmission and the lethality associated with the progression of symptoms significantly impacted the global economic and political systems and led to the collapse of healthcare systems worldwide [3]. The number of confirmed cases globally exceeded 186,411,011, with over 14.9 million deaths reported [4]. By 2024, Brazil had recorded 34 million infections, and the death toll surpassed 700,000 [5].

In 2021, the state of Amazonas was considered the global epicenter of the disease and gained international attention because of the rapid increase in population mortality rates [6,7]. The number of deaths related to COVID-19 in Amazonas between March and August 2020 was also higher than the national average compared to the same period in the previous year [8], highlighting the vulnerability of this population.

Faced with the exponential rise in infections and the absence of effective pharmaceutical interventions to contain the virus, the WHO recommended social isolation. In regions where infection rates were rapidly increasing, lockdown measures were implemented, both of which were adopted by Brazilian state governments [9]. The economy was severely impacted, and in countries and regions marked by inequality, the effects on physical and mental health were particularly pronounced [10,11].

From a socioeconomic perspective, rural populations, particularly small-scale farmers, saw their income severely compromised because of difficulties in marketing their products and the impact of the virus on health, which hindered their ability to maintain family farming activities [12]. Despite being a crucial component of the food system, family farming has historically received limited attention from public policies and government investments. To address this, strategic alternatives were proposed to support family farming, including the development of conduct guidelines and informational materials about the virus for designated trading areas, the distribution of masks and hand hygiene supplies, the implementation of rural credit programs, and the adoption of virtual platforms for the commercialization of agricultural products [13].

Food practices were significantly affected during the implementation of social isolation measures across various countries. Populations exhibited changes in dietary behaviors, food preparation methods, and the quality and availability of food in the market. Additionally, the variety of foods was reduced in regions with higher infection rates [14]. The crisis triggered by COVID-19 marked Brazil’s return to the Hunger Map, a period characterized by the weakening of social organization and government actions to curb rising unemployment and poverty rates. Vulnerable populations were disproportionately affected by the increased cost of unprocessed foods and faced greater challenges in the acquisition of food items in sufficient quantity and quality [15].

Data from the II Inquérito Nacional sobre Insegurança Alimentar no Contexto da Pandemia da COVID-19 no Brasil (II VIGISAN, Second National Survey on Food Insecurity in the Context of the COVID-19 Pandemic in Brazil) revealed that the northern region had the highest rate of severe Food Insecurity (FI) (25.7%), with 18.6% of rural residents experiencing hunger [16]. Consequently, the riverine population of Amazonas faced the dual impact of economic hardship and the catastrophic state of public health and funeral services during the first two years of the pandemic in the region [6].

The Amazonian riverine population has a unique way of life shaped by the ethnocultural fusion of various peoples, particularly indigenous ancestors, in terms of healing practices, food practices, and transportation methods. From the construction of their homes to the production and preparation of regional foods, these practices reflect the profound symbolic relationships they have established with the forest and the river: as sources of life and as life itself [17]. For traditional riverine communities in Amazonas, who are part of the “populations of the rural forests, and waters” [18], inequalities are exacerbated by the noticeable difficulty in accessing essential services such as healthcare, education, food, security, employment, transportation, and others [19-21].

Regarding food practices, the main challenges faced by this population include their distance from urban centers, the seasonal flooding and receding of rivers that affect food availability, and the inability to store perishable food for extended periods due to limited access to electricity and the consequent lack of refrigeration appliances [20,22].

While studies on riverine populations have been conducted, none have specifically explored their food practices during the pandemic. This study highlights the perceptions of these communities, which require complex logistics for research implementation [21]. As outlined, given the changes imposed by the pandemic, the economic crisis, and the factors that characterize the vulnerability of riverine populations, the objective of this study was to understand the perceptions of Amazonian riverine communities regarding the effects of the COVID-19 pandemic on the economy and food practices.

This study is part of a master’s dissertation on the perceptions of Amazonian riverine communities regarding the effects of the COVID-19 pandemic. This part of the research focuses on perceptions and aspects of food. This is a descriptive, observational field study of a qualitative nature with intentional sampling, conducted in July 2022, during the fourth wave of COVID-19, in riverine communities of Coari in the Amazon state, which has 70,616 inhabitants and 224 communities [23]. This municipality is 467 km from the state capital, Manaus. The first author traveled by river for approximately 30 hours to reach Coari. From Coari, the communities were accessed by small boat, a journey of four hours.

This study was approved by the Research Ethics Committee of the Universidade Federal de São Paulo, No. 5.315.669, Certificate of Presentation of Ethical Appreciation - CAAE: 55829222.2.0000.5505. The 32 recommendations proposed by the Consolidated Criteria for Reporting Qualitative Research [24] were followed. In order to receive authorization from community leaders to conduct the study, the first author made contact on the cell phone of leaders she knew due to assistance provided at the beginning of the pandemic. The messages were sent in January 2022 and contained information about the objectives and methods of the study. In February 2022, when the leaders were in the urban area and had telephone signal, the messages were read and the authorizations were signed. The river dwellers included their formalized participation by signing the Informed Consent Form.

This study included adult participants residing in riverine communities and infected by COVID-19 in the first and second waves, using the snowball technique, which involves a network of referrals starting from an initial indication [25] made by community leaders. During the sample composition, there was no refusal or withdrawal of participants. In order to guarantee anonymity, the letter “P” was assigned to male participants and the letters “PP” to female participants, numerically ordered from one to twelve. For the conclusion of the sample, the point of saturation of the interviews was considered, which refers to the absence of new elements or themes recorded in the speeches [26]. In this study, repeated contents related to the effects of the Covid-19 pandemic on the economy and food practices were considered as saturation criteria.

The sociodemographic variables used to describe the profile of the interviewees were age, sex, self-reported race/color, educational level, occupation, and social class. The information is drawn from two instruments: the “Sociodemographic Health Profile Questionnaire for Riverine Populations in the COVID-19 Pandemic”, developed by the authors, and the Questionário Critério de Classificação Econômica Brasil (CCEB, Brazilian Economic Classification Criteria Questionnaire), which defines consumer classes A1, A2, B1, B2, C1, C2, and D-E [27]. Data collection was conducted through a semi-structured interview with open-ended guiding and probing questions, divided into the dimensions of changes in the riverine living context during the pandemic, healthcare access during the pandemic period, and understanding and coping with COVID-19.

The analyzed data regarding food practices resulted from the dimension “changes in the riverine life context during the pandemic” in the following questions: “What changed in your work (occupation) during the pandemic?”; “Did COVID-19 cause any damage to agricultural and fishing production?”; “Did you receive or financially help someone (family member and/or community member)?”; “Tell me a little about your family mealtimes after the arrival of COVID-19”; “Was there a lack of any local food (family farming) that was previously accessible? If so, what kind?” and “Did you stop buying any of the items available in the urban area? If so, why?”.

The development of the questionnaire and interview guide involved analysis by a committee of experts composed of two researchers. A pilot study was conducted with three individuals from the Amazon region to assess comprehension of the questions. The original questions were retained with modifications only to the language used. Participant observations regarding social representations, traditional practices, and environmental characteristics were recorded in the field diary [26].

The first author, who conducted all interviews, holds a degree in psychology, has experience working with vulnerable populations, and was a master’s student in a health-related postgraduation program during the data collection period. The interest in the study’s topic emerged from the author’s experience as a volunteer psychologist providing care to riverine communities during the first year of the pandemic.

The prior engagement enabled the first author to familiarize herself with the field where the research would be conducted, to hypothesize the main challenges faced by riverside communities affected by COVID-19, as well as to establish a rapport with the local population before the study commenced. The relationship between the researcher and the interviewee extends beyond the mere act of data collection; it also encompasses the impact of this interaction on the information that emerges and the inherent responsibility in the resulting social understanding of the issues addressed [26].

Although they understood that the research did not involve a direct benefit to them, the interviewees were interested in giving visibility to the effects of the Covid-19 pandemic on the riverine population, contributing to the development of new research in the health area and enabling future improvements of public policies aimed at the studied group.

The interviews were conducted using language adapted to local terminology, in the participants’ homes, without the presence of other individuals. The administration of the instruments took approximately 40 minutes, and each session, which occurred once, was audio-recorded and transcribed verbatim. The transcriptions were returned and read back to the participants via the provided telephone contact. No significant corrections that altered the substance of the responses were made. The recorded data were under the custody of the first author, who deleted them upon completion of the transcriptions.

Thematic content analysis was selected for the processing and analysis of the data, developed in three stages as described by Minayo [26]: (a) pre-analysis: the organization of the research corpus, which consisted of interview transcripts and field diaries, was carried out. Hypotheses were revisited, and indicators (a priori codes) were identified based on the objectives to be addressed; (b) material exploration: identification of recording and context units with the delimitation of excerpts and coding. Identification of emergent codes (a posteriori); creation of the category system that gave rise to the analyzed nuclei; and (c) treatment of results, interpretation, and conclusion. It is noteworthy that the analysis process was conducted manually without the use of software. The notion of “perception” adopted by the authors for the interpretation and analysis of the data is guided by the principle of cognitive therapy, which understands perception as a product of life history and as an influence on the expression of feelings and behaviors [28].

The study included 12 riverside dwellers, comprising seven women and five men, whose characteristics are outlined in Table 1. The participants’ ages ranged from a minimum of 29 years to a maximum of 54 years old. Three participants reported being single, while the others were married or in a common law union. The terms used to describe skin color were self-declared, with notable descriptors including “brown”, “mixed race”, “yellow”, “black”, and “dark-skinned”. Although all participants exhibited Indigenous features, they employed distinct terms that reflect the historical processes of miscegenation and colonization in the formation of these communities [6].

Regarding educational attainment, only P1 and P10 reported completing basic education, while PP4 and PP5 had completed higher education (both were teachers in their communities).

The primary occupations reported were agriculture and fishing. P10 worked as a Community Health Agent, and P11 was a pathology technician responsible for identifying and referring cases of malaria.

The participants were classified into the two lowest socioeconomic strata, C2 and DE, based on the scoring system of the CCEB [27]. No points were assigned for car ownership; however, a total of 22 canoes, 14 motorboats, and 5 boats were reported. The classification proposed by the CCEB does not encompass the full range of characteristics of the riverine population, resulting in an unrealistic classification of the investigated group. It is noteworthy that riverine communities are not included in the group considered to be in a state of destitution, as they derive their sustenance and housing from the land, forests, and rivers. However, these resources are insufficient to overcome the barriers to improving their quality of life [20].

Regarding the qualitative data, three thematic nuclei emerged from the thematic content analysis: “Daily Bread”; “Empty Pocket”; and “Empty Plate”. The following will present the eating practices prior to the pandemic, which were grouped under the thematic nucleus “Daily Bread”, and the transformations of these practices due to the economic crisis and virus protection measures, which gave rise to the thematic nuclei cores “Empty Pocket” and “Empty Plate”. It is noteworthy that the title of the present study emerged from the statement of one of the participants, P7 (44 years old). He aptly represents the riverside experience during the pandemic and its nuances: “I didn’t change my activity, because there’s not much to change here, right? [...] it became harder for us to sell and when we did sell, it was cheaper, right? [...] the only thing that decreased was our money, right? It hit us in the pocket and left us with an empty pocket and an empty plate” (P7, 44 years old).

This study gathered the perceptions of riverine communities regarding the effects of the pandemic on the economy and food practices. Food consumption in these communities is closely linked to the seasonality of fish and family farming products, which were the key elements ensuring food security during the pandemic. As observed in the general population, the restrictive measures imposed during COVID-19 had a greater impact on the most vulnerable groups.

The perception of the interviewees reinforces the findings that lower-income groups were more impacted by the restrictive measures during the COVID-19 pandemic, in economic and social terms. The riverine population, marked by vulnerability, had their food practices strongly transformed during the pandemic due to the absence and/or decrease of food from urban areas, as well as the decline in sales of their products. The findings present the resulting accentuation of social inequalities and poor public management during this period. The reported context indicates the need to strengthen policies aimed at traditional peoples and small rural producers through incentives, sustainability actions that aim to articulate local strategies to the complex Amazonian territory in guaranteeing the human right to adequate food.

Future studies should encompass more communities and participants, consider the riverine cultural richness, and promote the participatory production of knowledge in order to enable the integration, valorization, and development of these individuals in the economic sphere.