Thursday, March 04, 2021

FIOCRUZ Special Bulletin: Brazil's Worsening Pandemic Situation



It is no secret that Brazil - which is being heavily impacted by both the P.1 and P.2 variant - has seen an abrupt, and devastating rise in COVID cases (and deaths) since December.  

This winter wave has been the subject of intense scrutiny, since some hard hit areas had been assumed to have reached significant (75%+) community immunity, suggesting both enhanced transmissibility and a high rate of reinfection.

The Lancet: Resurgence of COVID-19 in Manaus, Brazil, Despite High Seroprevalence

Brazil: Fiocruz Technical Note - SARS-CoV-2 P.1 Variant In Amazonas State

Brazil MOH Confirms Reinfection With COVID Variant P.1 In Amazonas

Yesterday's report from Imperial College London: Preprint - Genomics and Epidemiology of a Novel SARS-CoV-2 Lineage in Manaus, Brazil, only helped solidify those concerns.  

Amid an uptick in media reports suggesting that the pandemic in Brazil is worsening, yesterday FIOCRUZ (Fundação Oswaldo Cruz) - one of the most prestigious scientific research institutes in South America - released the following Boletim Extraordinário on Brazil's worsening pandemic. 

The situation in Brazil is described in this report as alarming, and it calls for enhanced measures to bring it under control.  A cautionary tale that regions considering abandoning social distancing and other NPIs may want to consider. 

First the (translated) summary from FIOCRUZ, followed by some excerpts from the report.

Covid-19: technical note points to worsening pandemic


By: Regina Castro (CCS / Fiocruz)

In a special edition, the Covid-19 Fiocruz Observatory Bulletin publishes a technical note with a warning that, for the first time since the beginning of the pandemic, there has been a simultaneous worsening of several indicators throughout the country, such as the growth in the number of cases and deaths, the maintenance of high levels of incidence of Severe Acute Respiratory Syndrome (SARS), the high positivity of tests and the overload of hospitals.
At the moment, 19 Federation Units have occupancy rates for ICU beds above 80% - in the previous Bulletin they were 12. The alarming scenario, according to the analysis, represents only the tip of the iceberg of a level of intense transmission in the country. In view of this, the researchers believe it is necessary to adopt more rigorous non-pharmacological measures.

The Extraordinary Bulletin presents a set of data on cases, deaths and occupancy rates of beds in the ICU Covid-19 for adults in the country - related to the Unified Health System (SUS) - verified on March 1, in contrast to those observed in 22 February, and published in the latest Covid Observatory Bulletin-19 Fiocruz. This rapid growth starting in January, according to the investigation, is the worst scenario in relation to the occupancy rates of ICU beds Covid-19 for adults in several states and capitals, which concentrate most of the health resources and the greater population and sanitary pressures involving its metropolitan regions.

Given this situation, researchers at the Covid-19 Fiocruz Observatory emphasize the need to adopt more stringent measures to restrict circulation and non-essential activities, according to the epidemiological situation and service capacity of each region, assessed weekly from technical criteria such as bed occupancy rates and an increasing trend in the number of cases and deaths.

The edition draws attention to the fact that the current situation - which combines a health and social crisis simultaneously - requires measures that involve the Brazilian health system in the areas of surveillance and health care, with the reinforcement of primary care (PHC) and surveillance actions in health, in addition to actions to mitigate the social impacts of the pandemic, especially for the most vulnerable.


Some (translated) excerpts from the report follow:

For the first time since the beginning of the pandemic, throughout the country there is a simultaneous worsening various indicators, such as the growth of the number of cases, deaths, the maintenance of high levels incidence of SARS, high positivity of tests and the hospital overload. 

This Extraordinary Technical Note from the Covid-19 Observatory Fiocruz presents a set of data, involving cases, deaths and occupancy rates of ICU beds Covid-19 for adults in the country and related to the SUS, observed on 01 March as opposed to those released last week, obtained on February 22, 2021, and released in the last newsletter:

The data presented, although alarming, constitute just the tip of an iceberg on a plateau of intense transmission in the country.

Case Epi Curve

Fatality Epi Curve


New level of pandemic and need to combine measures for coping
At the moment of the pandemic, paradoxes are combined. On the one hand, the many advances in science, which make it possible to improve prevention and control measures, the diagnosis and treatment of patients and to develop vaccines in a short period; on the other hand, the uncertainties surrounding both the new variants and what remains to be known about their impact on the reinfection processes and vaccine efficacy, as well as the long period of exposure of society to the SARS virus-- CoV-2 and Covid -19, with all its economic, social and health impacts.

We are facing new challenges and a new level, requiring the construction of a national agenda to confront the pandemic, mobilizing the different powers of the Brazilian State (executive, legislative and judicial), the different levels of government (municipal, state and federal), companies, institutions and civil society organisations (local level national level). This agenda should combine mitigation measures which should last until the end of the pandemic, with measures of suppression whenever the occupation of COVID-19 ICU beds is above 80%, as well as those involving communication to further strengthen these measures.

Whereas the pandemic combines a health crisis and social at the same time, it is also essential to combine measures involving our health system in its surveillance and health care capabilities, as well as economic measures to mitigate the social impacts of the pandemic, especially for the most vulnerable. The combination of these measures has been pointed out by several national entities, such as the National Council of Health Secretaries (CONASS) and the Brazilian Association of Collective Health (ABRASCO), which systematized below. 
Non-pharmacological measures Mitigation measures
 • Maintenance of all preventive measures (physical distance, wearing masks and hand hygiene) until the pandemic is declared closed.
Suppression Measures 

• Adoption of stricter measures to restrict circulation and non-essential activities, according to the epidemiological situation and service capacity of each region, assessed weekly based on technical criteria such as bed occupancy rates and an increase in the number of patients. cases and deaths.

 Communication Strategies to Expand Mitigation and Suppression Measures

 • Immediate implementation of communication plans and campaigns in order to clarify the population and reinforce the importance of prevention and vaccination measures.

 Measures involving the health system

• Legal recognition of the state of health emergency and the provision of extraordinary resources for SUS, with immediate contribution to State and Municipal Health Funds to guarantee the adoption of all the assistance measures necessary to face the crisis.

• Strengthening health surveillance in its territorial dimension and integrated with Primary Health Care, aiming at control and care measures: early detection, laboratory investigation (including the expansion of genomic surveillance in the country), isolation, quarantine and active search for suspected and confirmed cases, as well as teleconsultation strategies.

• Expansion of care capacity at all levels, including clinical and ICU beds for Covid-19 combined with protection, training and enhancement of health professionals.

 • Acceleration of vaccination for the entire population coordinated by the National Immunization Program (PNI) of SUS.

Measures to mitigate social impacts, especially for the poorest and most vulnerable 

• Approval of a National Economic Recovery Plan, with immediate return of emergency financial assistance for the duration of the state of emergency, combined with existing social policies to protect the poorest and most vulnerable. 


 (Continue . . . .)

Whether Brazil is simply an outlier, or a harbinger of the next phase of this pandemic, is unknown. But it does illustrate that this COVID pandemic still has `legs', and if given half a chance, can quickly roar back with a vengeance.