Covid-19 experts have no doubts. Brazil is experiencing another wave of the disease caused by the coronavirus. In two weeks – between 05/20 and 06/02 – the number of cases of covid in Brazil rose 122%, going from 14,000 to 31,000 confirmed cases.
The actual amount of infections, however, is underestimated. The number of tests currently carried out in the country is very low. In May, the SUS performed only 176,000 tests, against 1.7 million in January. Without concrete data to prove the increase in the number of cases, the population is left without information and cannot act to protect itself.
Testing is essential for the detection of infections in time to break the chain of transmission and also to assist the decision-making of health managers. “In Brazil, little has been tested, in all waves. We never had testing strategies, and even after more than 2 years of pandemic, we still don’t have a policy for that”, says Alexandra Boing, an epidemiologist at the Federal University of Santa Catarina ( UFSC), of the Brazilian Association of Collective Health (Abrasco) and member of the Covid-19Br Observatory.
The tests have been performed, as a rule, in symptomatic patients. “We don’t have regular tests available for asymptomatic people, we don’t have clarification for the population about the importance of testing”, says Boing. “Neither were the surveillance teams reinforced to be able to act on these positive cases identified”, she says.
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Even without tests, however, it was already possible to identify the new wave. One of the most reliable tools to predict the behavior of covid, the joint research between the University of Maryland (USA) and Facebook showed a reversal in the downward trend in cases in Brazil on April 11.
This survey is done through the social network with a “covid-like” symptom questionnaire. As the survey reaches a large number of people and the results are computed immediately, it is able to capture changes before the official numbers, which depend on testing.
It is likely that this wave does not cause as many deaths as seen in 2020 and 2021. This is due to vaccination, which also caused the proportional number of deaths in the country to plummet in the wave of January 2022. Even so, there is concern. “Vaccines do not prevent transmission: the more the virus is transmitted, the greater the chance of new variants appearing”, explains Boing. “In addition, studies show that even non-serious cases can lead to long-term covid, in which people have sequelae for months or years after infection,” she says.
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There are multiple causes for the increase in cases. One of them is the arrival of the cold season in the South and Southeast. This is the time when the incidence of respiratory diseases increases greatly in these regions, due to the tendency to close environments for greater thermal comfort. The numbers in the North and Northeast are not showing high at the moment.
According to Isaac Schrarstzhaupt, data scientist and coordinator of the Covid-19 Analysis Network, the Brazilian hospital system has always had difficulties in dealing with the seasonality of respiratory diseases. “Even before the pandemic, there was a lack of ICU beds at that time,” he says.
With covid, the situation is much more serious. “Today in Brazil we have about 100 deaths a day from just one disease. Until 2019, this number did not reach 15, considering all causes of Severe Acute Respiratory Syndrome (SARS)”, he explains.
Even considering a scenario of less concern about the notification, since there was no pandemic, the numbers are discrepant. In 2020, the daily average of SARS deaths reached 730 and grew to 1,100 in 2021. In 2022, there are 340 deaths per day, 22 times more than in 2019.
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End of the health emergency
The scenario in hospitals is worsened with the end of funding for extra beds by the Ministry of Health, one of the many consequences of the end of the health emergency in Brazil, determined in April. Without that money, opening beds will be much more difficult than in 2020 and 2021.
Another consequence of this decision by the Bolsonaro government is symbolic. “When the emergency is over, there’s an implicit message that everything is fine,” says Schrarstzhaupt.
The easing of transmission containment measures, which took place during the first half of 2022, also impacted the numbers. The end of mandatory masks indoors in several states and cities made the virus circulate more easily. “The country already had fragile prevention measures and, in two and a half years of the pandemic, it has not implemented any measures to monitor the quality of air in the environments”, says Boing.
For her, the end of mandatory masks, a highly effective measure and low individual and collective cost, did not and does not make sense in the country. “Now we are reaping the results of the decisions and the wrong messages from the public authorities”, she believes.
Most transmissible variants
Another point that helps to form the picture of covid today is the emergence of more contagious variants. Omicron variants called B4 and B5 are even more transmissible than the original strain. They also have an immune escape in relation to the first variants of the omicron, B1 and B2. As they were only detected in the country at the end of May, there is a likely scenario for these variants to contaminate people who had covid a short time ago.
The stagnation of vaccination against covid in Brazil is another reason that helps to increase cases. No state has been able to universalize the second dose in the vaccine. The so-called booster dose, essential for maintaining protection against the disease, has much lower adherence. In São Paulo, the state with the highest vaccination coverage, only 58% of the population is immunized with the third dose. Piauí, Paraná, Rio Grande do Sul and Minas Gerais have about 50% of the population fully immunized.
For Boing and Schrarstzhaupt, the actions to control the pandemic remain the same. It is necessary to reinforce vaccination, with aggressive campaigns, active searches for health services, mobilization of the population and combating fake news. It is essential to resume the mandatory use of mask in closed environments. This measure does not prevent the transmission only of covid, but of any respiratory disease.
Other measures are the expansion of testing and the tracking of cases and contacts to occur to isolate and interrupt the chain of transmission and alert the population about the real risks of this moment.
In an ideal scenario, the country should be making an effort to implement air quality monitoring in environments to be able to guide actions that improve circulation in schools, shops and other closed spaces for public use. “We are in a moment of great threat to nature, which ends up creating opportunities for the emergence of new pathogens”, says Schrarstzhaupt. “Better ventilation of environments is a fundamental action in the long term, as new pandemics are likely to emerge in the coming years”, she adds.
Editing: Glauco Faria