Thursday, March 25, 2021

Brazil: FIOCRUZ Calls For Stricter Measures To Combat COVID-19



The worsening COVID epidemic in Brazil - once centered primarily in Amazonas state (see Brazil: Amazonas Transfers 235 COVID Cases To Other States Amid Critical Oxygen Shortage) - has expanded to include virtually the entire nation, leading FIOCRUZ (Fundação Oswaldo Cruz) to declare The biggest Sanitary and Hospital Collapse in the History of Brazil last week. 

Driven in large part by the P.1 COVID variant - which has demonstrated a high re-infection rate (see The Lancet: Resurgence of COVID-19 in Manaus, Brazil, Despite High Seroprevalence) - the number of cases and deaths reported in March far exceed anything Brazil has seen during this pandemic. 

(COVID Deaths In Brazil)


In their latest special Bulletin Colapso do Sistema de Saúde (Collapse of the Health System), FIOCRUZ calls once again for strict measures to slow or prevent the spread of COVID-19. 

"Since the beginning of March, the country has witnessed a framework that denotes the collapse of the health system in the Brazil for the care of patients who require complex care for Covid-19. Researchers from the Fiocruz Covid-19 Observatory, responsible for the Bulletin, point out that this collapse was not produced in March 2021, but over several months, reflecting the ways of organization to face the pandemic in the country, in the states and municipalities. Below we highlight 6 factors that characterize this collapse."
Although the P.1 variant remains a relatively minor player outside of Brazil, the events of the past two months in South America should give us pause, as P.1 continues to show up in increasing numbers around the world.
Below you'll find the (translated) press release on this week's Boletim Extraordinário. .
Bulletin indicates adoption of strict measures to block Covid-19


Renata Moehlecke (Fiocruz News Agency)

Released on Tuesday (23/3), the new Covid-19 Fiocruz Observatory Extraordinary Bulletin calls attention to the need for the adoption of strict measures to block the transmission of the disease in all states, capitals and municipalities that are in the critical alert zone. The main recommendations pointed out are the restriction of non-essential activities for about 14 days, to reduce approximately 40% of transmission, and the mandatory use of masks by at least 80% of the population. 

The document produced by Fiocruz Covid-19 Observatory also highlights the worsening of the national scenario, which has extremely high values ​​of cases and daily deaths by Covid-19, the worrying permanence of the trend of accelerating the transmission of Sars-CoV-2 and the very critical situation of bed occupancy rates. ICU Covid-19 for adults in the Unified Health System (SUS) throughout Brazil.

"Since the beginning of March, the country has seen a picture that shows the collapse of the health system in Brazil for the care of patients who require complex care for Covid-19", say the Observatory researchers. "This collapse was not produced in March 2021, but over several months, reflecting the ways of organizing to face the pandemic in the country, in the states and in the municipalities".

According to the data, there were, on average, 73 thousand daily cases and 2 thousand deaths per day in the last analyzed epidemiological week (period from 14 to 20 March 2021). In addition, the number of cases grows at a rate of 0.3% per day and the number of deaths by Covid-19 increased to 3.2% per day, an even greater rate than in previous weeks. There has also been a disproportionate increase in mortality in the country, from around 2% in late 2020 to 3.1% now in March. "The scenario is worrying, as it indicates that there may be a situation of lack of assistance and failures in the quality of care provided to patients with severe conditions in Covid-19", comment the experts. "The inability to diagnose serious cases correctly and in a timely manner, added to the overload of hospitals,

Regarding the occupancy rates of beds in the ICU Covid-19 for adults in the SUS, the data obtained on March 22 continue to indicate an extremely critical situation in Brazil. The Bulletin highlights, in the North region, the departure of Amazonas from the critical zone to the intermediate alert zone, now with a rate of 79%. On the other hand, he warns of the worsening of the situation in the Southeast: in the last week, in Minas Gerais, the rate increased from 85% to 93%; in Espírito Santo, from 89% to 94%; in Rio de Janeiro, from 79% to 85%; and in São Paulo, from 89% to 92%. The South and Midwest regions maintained rates above 96%. Piauí (96%), Ceará (97%), Rio Grande do Norte (96%) and Pernambuco (97%) stood out with the worst rates in the Northeast region.

The researchers warn that, in this moment of crisis, it is urgent to rigorously adopt measures to block transmission in almost all states and capitals that are in the critical alert zone, as well as in the municipalities that are part of health regions where there are high rates of occupancy of ICU beds Covid-19. "The coordination and integration of these measures, articulated between the different levels of government and with broad participation by society, is vital at this moment. Thus, even if several municipalities and states have already adopted these measures, it is essential that municipal, state and federal governments all move in the same direction to expand and strengthen them, since partial and isolated adoption will lead us to the prolongation of the health crisis ", they affirm.

The document presents a list of urgent measures aimed at containing the health crisis and the collapse of the health system. "For these blocking measures to be successful, they must be adopted together, requiring about 14 days to produce results in reducing transmission rates by approximately 40%, requiring daily monitoring to track their impacts on reduction of cases, occupancy rates of hospital beds and deaths ", highlights the Bulletin , which also takes as a basis for the recommendation the Letter of the National Council of Health Secretaries (Conass) and studies carried out in other countries.

"Increase the availability and use of masks, with the goal that at least 80% or more of the population uses them properly; campaigns for the free distribution of multi-layered cloth masks, in areas and points of greater population concentration and a low percentage of use, combined with governmental and non-governmental campaigns on its importance and the correct way of use should be part of this strategy ", complement the researchers in the document.

"The continuity of the scenarios in which we have the growth of all indicators for Covid-19, such as transmission, cases, deaths and occupancy rates of ICU beds, results in a collapse that affects the entire health system in the country and an increase in deaths for lack of assistance ", highlight the scientists in the Bulletin. "This is a scenario that is not only a health crisis, but also a humanitarian one, if we consider all its impacts".