“War scene” in a Brazil on the edge: collapsed hospitals and a peak in mortality

RIO DE JANEIRO.- The outlook in Brazil is alarming. The hospitals have collapsed, with a lot of patients who died while waiting for a bed in intensive care, the variant of coronavirus Highly contagious is spreading across the country, President Jair Bolsonaro insists on unproven treatments, and the only attempt to create a national plan to contain Covid-19 was not very consistent.

Indeed, over the past week, Brazilian governors have attempted to do something that Bolsonaro stubbornly rejects: has developed a proposal for states to help curb the country’s deadliest virus outbreak to date. The plan was to include a curfew, a ban on mass events, and limits on the hours that non-essential services can operate.

But the final product, unveiled on Wednesday, was a purely declaratory document a page that included general support to restrict activity but without any specific measure. Six governors, still fearing to face Bolsonaro, refused to sign him.

The one from Piauí state, Wellington Dias, told AP that, Unless the pressure on hospitals is relieved, more and more patients will have to endure the disease without a hospital bed or hope of receiving treatment in an intensive care unit.

“We hit the limit all over Brazil; Exceptions are rare, ”said Dias, who heads the Governors’ Forum. “The possibility of dying without help is real.”

These deaths have already started. In the richest region of Brazil, São Paulo, at least 30 patients have died this month while waiting for an intensive care place, according to a count published Wednesday by the information site G1.

Intensive care units for Covid-19 patients have reached critical occupancy levels more than 90% in 15 of the 27 state capitals, according to the Fiocruz biomedical center.

In Santa Catarina, in the south of the country, 419 people waiting for a bed in an intensive care unit, and in neighboring Rio Grande do Sul, the USI They are at 106%, with more patients than their attention span.

“More rigid measures”

Alexandre Zavascki, doctor of the capital of Rio Grande do Sul, Porto Alegre, described the constant arrival of patients with respiratory problems. “I have many colleagues who sometimes leave the rooms to cry. It is not the medicine that we are used to practicing. It is a drug suitable for a war scenario“Said Zavascki, who oversees the treatment of infectious diseases at a private hospital.” We see that a good part of the population refuses to see what is going on, they are resisting the facts. These people may be next. to walk into a hospital and they will want beds. But there won’t be ”. The country, he added, needs “more rigid measures” from local authorities.

Despite the president’s objections, the Supreme Federal Court of Brazil confirmed the competence of cities and states to impose restrictions on activity. Yet Bolsonaro has consistently condemned any restrictive measure, claiming that the economy must remain active and this isolation would cause depression. The measures were relaxed at the end of 2020, when infections and deaths from Covid-19 declined, the campaign for municipal elections has begun and Brazilians who have returned home are fed up with quarantine.

The latest rally is being driven by the P1 variant, which the country’s health minister said last month, It is three times more transmissible than the original. It first became dominant in the Amazon city of Manaus, and in January forced hundreds of patients to be airlifted to other areas.

Brazil’s inability to contain the virus since then is increasingly seen as a concern not only for its Latin American neighbors, but also as a warning to the worldWorld Health Organization (WHO) Director General Tedros Adhanom Ghebreyesus said at a press conference on March 5.

“Across the country, the aggressive use of public health measures, social measures, will be very, very crucial,” he said. “Without doing things that impact transmission or suppress the virus, I don’t think there can be a downward trend in Brazil.”.

The more than 10,000 deaths reported last week in Brazil were its worst mark since the start of the pandemic, and this week’s tally is on track to be even higher after nearly 2,300 deaths were recorded on Wednesday alone, breaking the previous day’s record.

“Governors, like much of the population, are fed up with all this inaction,” said Margareth Dalholm, a leading pulmonologist at the state-run Fiocruz Institute. The proposed pact is vague and will remain symbolic unless it is far reaching and confronts the federal government, he added.

Curfew

The National Council of State Ministers of Health asked last week the implementation of a nationwide curfew and quarantines in regions where hospital capacity is close to its maximum. Once again, Bolsonaro objected.

“I will not decree it,” the president said in a law on Monday. “And you can be sure of one thing: my army will not go out into the streets to force people to stay in their homes.”

The restrictions could already be noticed outside the presidential palace after Federal District Governor Ibaneis Rocha implemented a curfew and partial confinement. Rocha warned on Tuesday he could increase restrictions, excluding only pharmacies and hospitals, if people break the rules. Currently, the waiting list for a bed in an intensive care unit in the region is 213 people.

Bolsonaro told reporters on Monday that the curfew is “An affront, unacceptable” and that even the WHO believes that locks are not adequate because they disproportionately affect the poor. Although the United Nations Health Agency recognizes the< effets négatifs profonds >> of this measure, she points out that some countries have no choice but to impose very strict measures to slow infections and that governments must make the most of the extra time spent on testing. and case monitoring, as well as patient care.

This nuance escaped Bolsonaro. His government continues to seek miracle solutions which for the moment have only served to fuel false hopes. Any idea seems worthy of consideration, except those of public health experts.

As Europe and the United States ramp up their vaccination programs and succeed in reducing severe cases, the federal government has slowly started vaccination. To date, only 2% of the 210 million Brazilians have received two doses.

Instead, the Bolsonaro government has spent millions to produce and distribute antimalarial pills, which in rigorous studies have shown no benefit. However, the president approved this drug. He also supported the treatment with two drugs to fight the parasites, neither of which proved to be effective. On Wednesday, he again praised his ability to avoid hospitalizations during a ceremony at the presidential palace.

Bolsonaro also sent a committee to Israel this week to evaluate an untested nasal spray that has been called a “miracle product”. Dalholm, whose sister is in intensive care, called the trip “really pathetic”.

Camila Romano, a researcher at the Institute of Tropical Medicine at the University of São Paulo, hopes the test her lab is developing to identify disturbing variants, including P1, will help monitor and control their spread. In addition, he calls for stricter government action and citizens to do their part.

“Every day there is a new surprise, a new variation, a city with a health system collapsing,” Romano said. “We are now in the worst phase. If this is the worst phase, it is because unfortunately we do not know what will happen ”.

AP and Reuters agencies

THE NATION

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