Brazil Covid-19: City in Sao Paulo state says it could be forced to remove patients from ventilators as cases rise across country

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Coronavirus cases are on the rise in Brazil and the country’s health systems are increasingly overwhelmed. In almost every state in Brazil, intensive care unit (ICU) occupancy rates are at or above 80%. Some of them are at 90% or more, and a few have exceeded 100% occupancy, forcing them to refuse certain patients.

State governors, city mayors and local medical staff now say they are running out of supplies to treat even Covid-19 patients who have received precious intensive care beds. Stocks of drugs that facilitate intubation could disappear within the next two weeks, according to a report by the National Council of Municipal Health Secretaries. And the National Association of Private Hospitals of Brazil (ANAHP) predicted that private hospitals would run out of drugs needed for the intubation of Covid-19 patients by Monday.

In the coastal city of Sao Sebastiao, in the state of Sao Paulo, Mayor Felipe Augusto resorted to public appeals over the weekend for more supplies from the state government.

“Our stock lasts until Monday, and will only be used for patients who are already intubated. The problem is that the lack of these drugs requires extubation – that is, you will have to remove this patient who is in a serious condition and intubated and change to respiratory masks. A huge risk, “the mayor told CNN Brasil, a CNN affiliate on Saturday.
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Doctor Juan Lambert, head of the largest hospital in Sao Sebastiao, told CNN on Sunday that 10 Covid-19 patients were intubated in his hospital and that the state government had saved them time by sending them a week of supplies after Augusto’s plea was broadcast to the media. .

“Thank goodness the secretariat has reached out and made us a priority in distributing supplies.” Lambert said.

But with the whole country expanding to accommodate new cases skyrocketing, even Brazil’s richest state may not have much more to offer. On Saturday, the Sao Paulo state health department predicted that stocks of drugs in public hospitals used for intubation would only last for an extra week.

In an official statement to CNN, the department said it had demanded “express and urgent action” from the Brazilian health ministry. The ministry did not respond to repeated requests for comment.

A national crisis

Nearly a quarter of Covid-19 deaths worldwide in the past two weeks have been in Brazil, according to a CNN analysis. At least 294,042 people have died in the country since the start of the pandemic.

Last week, the National Front of Mayors of Brazil (FNP) sent a letter to President Jair Bolsonaro and the Ministry of Health calling for “immediate action” from the federal government to provide sedative drugs and oxygen to intubated patients. with Covid-19 and other diseases.

“It is unreasonable for people, Brazilian citizens, to be led to such a desperate death by drowning in the dry or to have to be tied up and hold their conscience during the delicate and painful process of intubation and throughout the entire process. period when people are kept intubated, ”the letter says.

The Federal Council of Pharmacy (CFF) also warned that there was evidence of a shortage of neuromuscular blockers, sedatives and other drugs used in intensive care, such as midazolam, essential for safe human intubation.

These are not the first such warnings. In August 2020, a report by the National Board of Health – an agency linked to the Brazilian Ministry of Health – described the risk of drug shortages amid the pandemic.

“The shortage of these drugs is jeopardizing the entire structure provided for health care during the pandemic … because even with available beds, without these drugs, it is not possible to perform the procedure, which can cause the whole health system to collapse, ”wrote the chairman of the board, Fernando Pigatto, chairman of the board.

A call to change tactics

Bolsonaro, who celebrated his 66th birthday on Sunday, has seen the rate of public disapproval rise as Covid-19 persists in the country. A survey by the Datafolha polling institute last week showed 54% disapproval of its handling of the pandemic.

The president refused to approve the lockdown measures, arguing that it protected the freedom of citizens and the economic health of the country. His administration also said state-level officials are empowered to take precautionary measures.

However, Bolsonaro announced last week that his government has taken legal action to prevent governors and mayors from imposing certain restrictions, after several curfews passed and other strict measures. “It is a state of siege, which only one person can decree – me,” he said.

More than 500 leading Brazilian bankers, economists and politicians published an open letter in the country’s largest newspapers on Sunday asking the federal government to rethink its approach to the pandemic.

“This recession … will not be overcome until the pandemic is brought under control by competent action by the federal government. This underutilizes and diverts the resources at its disposal, including by ignoring or neglecting scientific evidence in design. pandemic control measures, “wrote the bankers and economists.

“We are on the threshold of an explosive phase of the pandemic and it is essential that public policies now be based on data, reliable information and scientific evidence,” the letter read.

CNN’s Hira Humayun and Caitlin Hu contributed to this report.

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