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Underreporting makes it difficult to fight covid-19 in Brazil

Gustavo de Paula
Por Gustavo de Paula,
CEO e Fundador da Asset School e criador do método de ensino Asset.
Publicado em 28 de março de 2020

The pandemic of the new coronavirus, which has already left more than 2,900 infected and 77 deaths in Brazil, according to the Ministry of Health, has been imposing a series of challenges on the Brazilian authorities, and experts point out flaws in coping with the disease.
Initially, case accounting was hampered by the form provided by the Ministry of Health to notify suspected covid-19, the respiratory disease caused by the Sars-Cov-2 coronavirus. In the document, there were only the options “was out of the country” and “had contact with someone with symptoms”. sand the answer was negative for both questions, even if the person had symptoms of covid-19, the case was not considered suspect.

Because of this gap, the first patient who died of the disease in the country, on March 16, was not on the balance of suspected cases. Confirmation of covid-19 came only after death. The victim was a 62-year-old man from São Paulo who also suffered from diabetes and hypertension.

After the first death and confirmation of the occurrence of local transmission in the country, the Ministry of Health changed the protocol, failing to consider suspect cases only those who were abroad and / or had contact with someone with symptoms.

Last Saturday, the executive secretary of the Ministry of Health, João Gabbardo dos Reis, said that any Brazilian who had “flu-like syndrome” would be considered a possible infected by the coronavirus. The ministry also announced that, contrary to what had been done since the beginning of the disease outbreak in Brazil, it would no longer disclose the numbers of suspected cases.

“This measure reflects the country’s approach to most public health problems: giving preference to treatment, not prevention. The main reason for the exponential growth in the current scenario is that transmission occurs even before the onset of symptoms. and treating already infected patients who are in the process of expressing the clinical signs and symptoms of the disease is something that becomes unsustainable in the long term, as new patients will continue to emerge, “says public health specialist Fábio Teodoro de Souza, from the Pontifical Catholic University of Paraná (PUC-PR).

Lack of tests

Even before the problem with the forms to report suspicions of the disease was verified, other flaws were verified in the government’s conduct in relation to a then possible crisis caused by the disease.

“The first containment of the cases at the airports was already a failure. Those arriving from travel were not even asked if they had a fever. Then, a mediocre pragmatism prevailed in relation to the tests: we had no [kits para testes]therefore, we would not test it “, says the doctor in public health Lígia Bahia, from the Federal University of Rio de Janeiro (UFRJ).

The fact that the country still carries out few tests indicates that the contamination by coronavirus in Brazil must be underestimated. The Ministry of Health itself, on Wednesday, acknowledged that there is an important underreporting of serious cases in the system, but stated that the responsibility lies with the hospitals and health units that receive these patients.

A survey of the Our World in Data project, linked to the University of Oxford and funded by the Bill and Melinda Gates Foundation, showed that the countries that most test patients for coronavirus are the ones that have the most infections. In Brazil, the statistic shows only 13.7 tests per million inhabitants in mid-March.

By way of comparison, at the same time, South Korea had tested 6,148 people per million; Germany, 2,023 per million, and the United Kingdom, 960 per million. Among 59 countries that reported the number of tests per inhabitant, Brazil ranked 53rd. According to the research, the tests are crucial for an adequate response to the pandemic.

Another problem pointed out by the pulmonologist Margareth Dalcolmo, from the National School of Public Health (ENSP) of Fiocruz, would be the occurrence of deaths by coronavirus in the public network without diagnosis. In an interview with the newspaper The globe published, the expert said that this is because sepsis and lung diseases are very common and there are no tests for the entire network.

Fiocruz also points out that there was an explosion of hospitalizations for people with severe respiratory failure after the first patient with coronavirus was detected in the country, on February 25. In the last week of February, 662 people were hospitalized with acute respiratory disease and had symptoms such as fever, cough, sore throat and difficulty breathing. The information was released by the newspaper Folha de S. Paulo.

In the period between 15 and 21 March, new admissions rose to 2,250 patients across the country. According to leaf, the number was calculated based on official notifications sent by health units, public and private hospitals to the Ministry of Health. According to Fiocruz researcher Marcelo Ferreira da Costa Gomes, heard by the newspaper, the huge increase in hospitalizations may have been caused by covid-19.

Discrepancy between data

Another point of attention related to the outbreak is that there is a discrepancy between the data released by the Ministry of Health and the state departments. On Sunday, for example, while the Ministry of Health reported 50 confirmations of the disease in Paraná, the state health department registered 54. This is due to the delay in the official processing of information registered on the federal platform by the states and explains the mismatch of information .

For Souza, the discrepancy negatively affects the state and municipal management of the disease, since it could interfere with the sending of medical supplies, personal protective equipment and health professionals by the federal government.

“The exact notification of the number of confirmed, suspicious cases and those under observation provides the federal government with important data for decision making, not only from a medical point of view, but also from a legislative point of view and in relation to the social and labor measures of preventive isolation Such an integral approach between the different spheres of power is indispensable to mitigate the proliferation of cases of the disease “, says the expert.

In the opinion of André Luiz Marques, professor and researcher at Insper, the differences observed so far are small, concentrated in some states, and would not be enough to impact centralized definitions.

“Of all the serious concerns we have at the moment, this would be one of the smallest. But we have to monitor over time to see whether that ‘alligator mouth’ will increase or not,” he points out.

Chronology of coronavirus in Brazil
First case in Brazil
After having spread to about 40 countries, killed more than 2,700 people and infected more than 80,000, the first case of the new coronavirus is confirmed in Brazil. He is a 61-year-old man who traveled to Italy on business. (2/26)

Secom chief tests positive for coronavirus
The Planalto Palace informs that the communication secretary of the federal government, Fábio Wajngarten, tested positive for the coronavirus. He had just returned from a trip with Bolsonaro to the United States, where they both met with President Donald Trump. (3/12)

Pro-Bolsonaro acts in several cities
Ignoring requests from health authorities to avoid crowds, protesters take to the streets in favor of the government and against Congress and the Supreme Court. President Jair Bolsonaro participates in protest and greets supporters. (3/15)

Brazil registers first deaths from the new coronavirus
First victim is a 62-year-old man from São Paulo who suffered from diabetes and hypertension. Later, a hospital in Niterói, Rio de Janeiro, announces the death of a 69-year-old man with symptoms of coronavirus. (3/17)

Bolsonaro’s delegation to Miami has 18 infected
Among those infected are ministers Augusto Heleno (Institutional Security Office) and Bento Albuquerque (Mines and Energy). The confirmation that people who traveled with Bolsonaro are infected causes the dismissal of several Planalto officials. Bolsonaro says his tests were negative. More cases in the party would be confirmed in the following days. (3/18)

Paulo Guedes announces benefit to informal worker
The government announces that it will pay a R $ 200 voucher to informal workers, who correspond to 41% of the workforce, according to IBGE. Initial actions against the coronavirus crisis covered only formal workers, leaving out a large part of the population, who are unemployed or informal. (3/18)

Government restricts entry of foreigners
The measure that restricts the entry of people from Europe and several Asian countries for 30 days to curb the spread of the coronavirus is beginning to take effect. The ordinance does not apply to native or naturalized Brazilians or immigrants with a residence permit in the country. (03/23)

Bolsonaro minimizes virus in speech
The president makes a statement on the national radio and television network in which he calls on the country to “return to normality”, asking that commercial establishments do not close their doors and that people leave confinement at home. He calls the covid-19 “gripezinha” and speaks of “hysteria” due to the pandemic. Bolsonaro is the target of clutches for the eighth consecutive day. (3/24)

States maintain isolation measures
In a videoconference meeting, governors from 26 states discuss emergency actions to curb the spread of covid-19 and say they will continue to follow the rules of social isolation based on the recommendations of the World Health Organization. (25/03)

Goiás and Santa Catarina record first deaths from coronavirus
Goiás and Santa Catarina confirmed on Thursday (26/03) the first deaths due to the new coronavirus. Two other deaths were reported in Pernambuco. With the fatal case in Goiás, all Brazilian regions have now died from the Sars-Cov-2 virus. The state is the fifth outside the Southeast – the region most affected by the pandemic – to report death related to the pathogen.

House approves help of up to R $ 1.2 thousand for informal
The plenary session of the Chamber of Deputies approved an emergency aid for three months, in the amount of 600 reais, intended for self-employed, informal workers and without fixed income during the crisis caused by the pandemic of the new coronavirus. The matter will be analyzed by the Senate. The aid can reach 1.2 thousand reais per family.

Source: https://www.time24.news/t24/2020/03/underreporting-makes-it-difficult-to-fight-covid-19-in-brazil-news-and-analysis-on-the-most-relevant-facts-in-brazil-dw-2.html

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