Wednesday, April 07, 2021

Brazil: FIOCRUZ Update - Pandemic May Remain at Critical Levels in April

 

A record 4,195 Deaths (Apr 6th) in Brazil - Credit JHU CSSE COVID-19 Data.

#15,899

While there is growing optimism in the United States that the worst of the COVID-19 pandemic may be behind us, there remain a number of disconcerting pandemic hotspots around the world that remind us how fragile our gains may be.

France, Iran, India, Turkey, Argentina and even Canada have reported recent surges in cases and deaths, but nowhere has COVID's recent resurgence hit harder than in Brazil.

Ten days ago, in Preprint: Sudden Rise In COVID-19 Case Fatality Among Young & Middle Aged Adults - Paraná, Brazil, we looked at the likely cause of Brazil's massive second wave which began in December; a homegrown COVID variant dubbed P.1.

Earlier evidence had suggested the P.1 variant was more transmissible than the `wild type' COVID, and it has been linked to reduced antibody recognition - which may increase reinfection risks and potentially lower the effectiveness of current vaccines, but reports of increased mortality - particularly among a younger cohort - adds yet another layer of concern. 

While P.1's impact outside of Brazil has been limited, we've also seen evidence that it has made inroads around the world, sparking concerns that what is happening in Brazil today may begin to happen elsewhere in the months ahead. 

To date, more than 350 P.1 variant infections have been reported in the United States across 25 states. Due to limited (and often delayed) testing, the actual number is believed to be much higher. 

Over the past two months we've been monitoring the deteriorating situation in Brazil primarily through publications and updates from FIOCRUZ (Fundação Oswaldo Cruz), and fast-tracked studies and pre-prints published online, including:


Yesterday FIOCRUZ published their most recent weekly analysis, along with the following (translated) summary.  While there are some signs (primarily lower ICU occupancy rates) in a handful of states that suggest the pandemic may be loosening its grip, the outlook for April remains grim. 


Covid-19 Observatory: Pandemic may remain at critical levels in April
4/6/2021
Regina Castro (Fiocruz News Agency)

The newest Covid-19 Observatory Extraordinary Bulletin Fiocruz warns that the pandemic may remain at critical levels throughout the month of April, prolonging the health crisis and collapse in health services and systems in Brazilian states and capitals. The analysis shows that the Sars-CoV-2 virus and its variants remain in intense circulation throughout the country. In addition, the overload of hospitals, observed by the occupation of ICU beds, also remains high. The bulletin is produced by the Covid-19 Observatory: Information for action by Fiocruz.

“During the last Epidemiological Week 13, there was an acceleration in the transmission of Covid-19 in Brazil. Due to the accumulation of cases, several of them serious, resulting from exposure to the virus even in March, the virus remains in intense circulation throughout the country ”, explain the researchers. According to the data, a further increase in the lethality rate was also observed, from 3.3 to 4.2%. This indicator was around 2.0% at the end of 2020. The researchers of the Bulletin warn that this growth may be a consequence of the lack of capacity to diagnose, correctly and in a timely manner, serious cases, added to the overload of hospitals.

Based on this scenario and based on the premise that “the essential thing is to protect health and save lives”, the researchers at the Covid-19 Fiocruz Observatory, responsible for the study, argue that it is essential at this time to adopt or continue urgent measures , which involve the containment of transmission rates and case growth through blocking or lockdown measures , followed by mitigation measures, with the aim of reducing the speed of propagation. Having as reference the Letter of the State Secretaries of Health to the Brazilian Nation, published by the National Council of Health Secretaries (Conass) on March 1, 2021, the analysis points to the need for greater rigor in measures to restrict non-essential activities for all states, capitals and regions of health that have an occupancy rate of beds above 85% and an upward trend in the number of cases and deaths. 

In order to achieve the expected results, the study highlights that these blocking measures need to be at least 14 days long and, in some situations, longer, depending on the extent of the application's rigor. In the view of the researchers, the adoption of combined and complex measures is essential, as well as the coherence and convergence of the powers of the State (Executive, Legislative and Judiciary), as well as the different levels of government (municipal, state and federal), in favor of these blocking measures.

“Consistency and convergence are fundamental in this moment of crisis so that the blocking measures are effectively adopted in order to leave the state of health collapse and progress to a stage of pandemic mitigation measures, reducing the number of deaths, cases and rates transmission and effectively saving lives, ”they say.

Among the proposed blocking measures, are the prohibition of face-to-face events, such as concerts, congresses, religious, sports and related activities throughout the national territory; the suspension of face-to-face activities at all levels of education in the country; the national curfew from 8 pm to 6 am and on weekends; the closure of beaches and bars; the adoption of remote work whenever possible, both in the public and private sectors; the establishment of national and international sanitary barriers, considering the closure of airports and interstate transportation; the adoption of measures to reduce overcrowding in urban public transport; expanding testing and monitoring those tested, isolating suspected cases and monitoring contacts.

The results of the investigation also point out that it is essential to insist on efforts to strengthen the network of health services, including different levels of care and surveillance, with extensive testing, purchase and expansion of vaccine production, and acceleration of vaccination. "It is also essential to guarantee conditions so that the population can remain in a protected home, limiting the movement of people in cities only for the execution of truly essential activities", guide the researchers.

ICU beds for Covid-19

Between March 29 and April 5, 2021, occupancy rates for Covid-19 ICU beds for adults in the Unified Health System (SUS) decreased in Roraima (from 62% to 49%), Amapá (from 100% to 91%), Maranhão (from 88% to 80%), Paraíba (from 84% to 77%) and Rio Grande do Sul (from 95% to 90%). In the opposite direction, worsening in Sergipe stands out, with the rate rising from 86% to 95%. Except for these changes, the data obtained on April 5, 2021 still indicate relative stability of the indicator, at very critical levels, in most states and in the Federal District. Access the full Newsletter for more data.

          (Continue . . . )

The fast-paced vaccination campaign here in the United States is expected to blunt the impact of P.1 (and other emerging variants), although how much of a negative impact these variants will have on vaccine effectiveness remains largely unknown. 

While boosters shots, designed to specifically target these new variants may be required, even limited protection from today's shot could help prevent a repeat of Brazil's healthcare crisis here in the United States. 

But that can only happen if vaccine uptake continues to be strong going into the summer. 


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