WHY BRAZIL FAILED TO COMBAT THE NEW CORONAVIRUS
Fernando Alcoforado
Consultor de planejamento estratégico, regional e de sistemas de energia
Fernando Alcoforado*
This article aims to demonstrate Brazil's failure to combat the new Coronavirus. On 05/20/2020, we published the article Brazil towards the collapse of the health system on various websites including Academia.edu and SlideShare. In this article, we affirm that the supply of beds has been decreasing day by day in several capitals and that, considering the pace of evolution of the Covid-19 pandemic in Brazil, the intensive care units (ICUs) available in the country would not be sufficient to attend to demand. It seems that our prognosis is coming true because the collapse of the health system is close due to the lack of national coordination in the fight against the new Coronavirus and the adoption of the easing of social isolation. This situation is close to occurring in several states in Brazil whose ICU capacities are close to collapsing due to the inability to meet demand.
The current data on the ICU bed occupancy rate presented below confirm our projections that indicated the imminence of the collapse of the health system in Brazil.
Occupancy rate of ICU beds by states in Brazil
Acre - 86.8%
Alagoas - 71%
Amapá - 63.9%
Amazonas - 86.8%
Bahia - 81%
Ceará - 91.8%
Federal District - 88.4%
Espírito Santo - 72.3%
Goiás - 94.4%
Maranh?o –83.7%
Mato Grosso - 87.1%
Mato Grosso do Sul - 87%
Minas Gerais - 72.6% (SUS)
Pará - 81.7%
Paraíba - 69%
Paraná - 95%
Pernambuco - 92%
Piauí - 75.4%
Rio de Janeiro - 62.8%
Rio Grande do Norte - 89.4%
Rio Grande do Sul - 95%
Rond?nia - 96.3%
Roraima - 80%
Santa Catarina - 91.4%
S?o Paulo - 71.1%
Sergipe - 62.4%
Tocantins - 80%
These data from the state health departments show occupancy rates of ICU beds in the Unified Health System (SUS) in 80% or more in 18 states (and above 80% in 17 states), which is already considered critical by the Covid-19 Observatory committee, linked to the Oswaldo Cruz Foundation (Fiocruz). The rate is over 90% in eight states. Doctors point out that the scenario is one of collapse. Alerts were not lacking. Even in December, Fiocruz already said that, without proper care and maintenance of social isolation, in the midst of the year-end festivities, the Brazilian health network could collapse. Among the factors that would contribute to the worsening of the pandemic, the demobilization of extra beds in the field hospitals was mentioned, the occupation of beds by other health problems that were dammed during the advance of the covid-19 epidemic, the greater circulation of people , the difficulties in identifying cases and their contacts due to low testing and the relaxation of social distancing, of the use of masks and hygiene.
According to Fiocruz, the consolidated data for the country confirm the formation of a level of intense transmission of covid-19, with no state showing a significant downward trend in the last three epidemiological weeks in the number of cases and deaths due to covid-19. The maintenance of high rates of the disease, as well as the overload of hospitals, may also be due to exposures that occurred at the end of 2020 and in January 2021, with the occurrence of year-end parties, clandestine festivals and intensified travel. In the midst of the serious situation, governors began to enact more restrictive measures, such as closing trade. The measures are too late for a situation that was already foreseen by specialists, with a lack of control actions, parties of year-end and carnival. One fact is evident, what the country is experiencing reflects a lack of control of the pandemic.
Public authorities have never had pandemic control. What they did was increase the number of beds to assist the sick. But the control of the pandemic consists of minimizing cases of covid-19. For that, there must be testing, social isolation and mass vaccination. This is all a complex operation that requires hard work in all spheres of society. In Brazil, none of this has been done. Just increase the number of beds will not be effective. With the health system on the verge of collapse, the incompetent Minister of Health, Eduardo Pazuello, points to the increase in the number of beds in the Intensive Care Unit (ICU) as one of the priority actions of the new phase of the pandemic. Experts and the World Health Organization (WHO), however, warn that, without other measures, increase the number of beds is not effective. Increase the number of beds and not working to reduce transmission is the same as “wiping ice”.
Currently, there is no point in increasing the number of ICU beds. You have to reduce the number of infected people. The solution lies in the use of a mask, measures of social distance, lockdown and mass vaccination. If the number of infected people continues to increase, the beds will never be enough. Brazil is close to collapsing its health system because the ICU beds are already at the limit of their capacity. In view of this catastrophic situation for the health system in Brazil, we affirm that there is no alternative but to speed up mass vaccination and adopt the “lockdown” immediately to stop the growth in the number of infected and dead that should be applied throughout the country, especially in cities and regions that are critical from the point of view of the health system's service capacity.
Imperial College London has conducted a study on the new New Coronavirus in several countries around the world. Report on Brazil, prepared on May 8, 2020 by Thomas A Mellan, Henrique H Hoeltgebaum, Swapnil Mishra and others, entitled “Report 21: Estimating covid-19 cases and reproduction number in Brazil”, predicts that, at worst scenario for Brazil, if no one is quarantined and if the tests are not multiplied, as is the case today, there would be up to 188 million contaminated (equivalent to 88% of the entire Brazilian population) and 1.1 million dead. More than 6.2 million people would pass through hospitals in the country because of the new coronavirus collapsing the health system. In a quarantine scenario only for the elderly, the number of deaths would vary between 322 thousand and 530 thousand, depending on the transmission rate and public health measures. In the best scenario calculated with 75% of the entire population in quarantine, with tests for all suspected patients, the number of deaths from covid-19 in the country would not exceed 44,300. In these conditions, at the peak of the pandemic, there would be a demand for 72 thousand beds at the same time. Therefore, with the best quarantine scenario for 75% of the entire population, it could save up to 1 million people in Brazil, calculates Imperial College.
The number of infected and dead is increasing dramatically in Brazil. Currently, 10,587,001 infected and 255,720 deaths from the new coronavirus have been registered. Bolsonaro, who opposes social isolation, tried on 6/6/2020 to criminally omit data from the country's pandemic so that the Brazilian population would not be aware of the seriousness of the situation and would not pressure the federal, state and municipal governments to adopt the lockdown. This attitude of the Bolsonaro government led the press to take the initiative to disclose the real number of infected and killed by the new coronavirus. Bolsonaro placed the incompetent General Pazuello in the Ministry of Health who made him inoperative in fighting the pandemic, in addition to opposing the vaccination of the population and not acting to negotiate vaccines in sufficient quantity to vaccinate the entire population as soon as possible.
In addition to the lack of national coordination by the Bolsonaro government in combating the new coronavirus, some governors and mayors have adopted numerous ineffective measures that were not sufficient to prevent the pandemic from advancing. In an attempt to avoid the collapse of the economy, they made social isolation more flexible, contributing to the increase in the number of contaminated and killed by Covid-19. It has been shown that a premature recovery of the economy has caused unnecessary suffering and death in the country. If everything continues as it is today, and considering the studies at Imperial College, Brazil could reach 188 million infected and 1.45 million dead. By easing social isolation, government officials will be contributing to the collapse of the health system and to the collective murder of 1.45 million inhabitants. This will be the price to be paid by the Brazilian people, especially by the most vulnerable population thanks to the irresponsibility of the federal government that contributed to the expansion of the pandemic in Brazil.
It can be concluded from the above that it was an irresponsible act to resume economic activity, except the essential ones, prematurely as it has been happening in Brazil because it caused unnecessary suffering and death. Brazil should only resume economic activities when the curves of those infected and killed by the new Coronavirus were falling, a fact that is not the case at the present time. The health of the population must be considered a priority and not the resumption of economic activity. The correct strategy at the moment should be to adopt the lockdown and mass vaccination to make the curve of infected and killed by the new Coronavirus start to decrease so as not to put pressure on the health system.
Lockdown cities and regions should only be released gradually in the same way as in China with the entire population wearing a face mask, being subjected to constant temperature measurements, in addition to the population being controlled using a QR code (Quick Response code) municipal health system that would function as an immunity passport. In several Chinese cities, there is a QR for each inhabitant, reporting their health status based on both their own statements and data available to the government. Thus, citizens receive codes marked in green, yellow or red. Only residents with a green code can move freely around the city. Yellow and red code holders must remain in quarantine and register daily on an internet platform to provide information, until they obtain the green code.
In addition to the lockdown and mass vaccination to be adopted by states and municipalities, income should be distributed by the federal government to the populations, especially the vulnerable ones, to avoid that, due to the need for survival, they are forced to leave their homes to work in offices or on the streets. In other words, the federal government should pay people not to take to the streets so as not to contaminate or be contaminated by the virus. Measures should also be adopted by the federal government to help companies, especially micro, small and medium-sized companies, to survive in this moment of falling revenues, as well as states and municipalities to avoid their insolvency due to the drop in tax collection. Only the federal government has the capacity to put these measures into practice.
For these measures to be successful and result in the successful fight against the new Coronavirus in Brazil, coordinating action by the federal government is urgent. The indispensable condition for Brazil to win the war against the new Coronavirus is for the government at all levels and the population to be united against the common enemy. Unfortunately, in Brazil, this situation does not exist because the President of the Republic Jair Bolsonaro is against the social isolation of the population, systematically disrespecting all restrictive measures to the agglomeration of people. In his compromising action in the fight against the new Coronavirus, Bolsonaro says that people should go back to work. The fact that Bolsonaro assumes this attitude is encouraging a large number of people to leave the isolation in which they find themselves and return to the street as is already occurring in several cities in Brazil, contributing to the increase in the number of contaminated and killed by the new Coronavirus. The end of the social isolation of many people is also related to the fact that they need to work in order to survive since the Bolsonaro government does not offer people and companies the conditions necessary for their survival.
In addition to acting to destroy the effort of governors and mayors to fight the new Coronavirus, the Bolsonaro government does not act with the necessary urgency in the economic plan with the release of the financial resources to help vulnerable populations to fight hunger, companies in general to avoid bankruptcy and states and municipal governments to avoid their insolvency. Brazil urgently needs strategic alignment of the federal government with states and municipalities in health actions with those of an economic nature to combat the new Coronavirus. Very hardly, the Bolsonaro government will adopt the measures proposed here that leads us to the conclusion that Brazil will fail to combat the new Coronavirus, resulting in the collective murder of about 1.8 million inhabitants.
* Fernando Alcoforado, 81, awarded the medal of Engineering Merit of the CONFEA / CREA System, member of the Bahia Academy of Education, engineer and doctor in Territorial Planning and Regional Development by the University of Barcelona, university professor and consultant in the areas of strategic planning, business planning, regional planning and planning of energy systems, is author of the books Globaliza??o (Editora Nobel, S?o Paulo, 1997), De Collor a FHC- O Brasil e a Nova (Des)ordem Mundial (Editora Nobel, S?o Paulo, 1998), Um Projeto para o Brasil (Editora Nobel, S?o Paulo, 2000), Os condicionantes do desenvolvimento do Estado da Bahia (Tese de doutorado. Universidade de Barcelona,https://www.tesisenred.net/handle/10803/1944, 2003), Globaliza??o e Desenvolvimento (Editora Nobel, S?o Paulo, 2006), Bahia- Desenvolvimento do Século XVI ao Século XX e Objetivos Estratégicos na Era Contemporanea (EGBA, Salvador, 2008), The Necessary Conditions of the Economic and Social Development- The Case of the State of Bahia (VDM Verlag Dr. Müller Aktiengesellschaft & Co. KG, Saarbrücken, Germany, 2010), Aquecimento Global e Catástrofe Planetária (Viena- Editora e Gráfica, Santa Cruz do Rio Pardo, S?o Paulo, 2010), Amaz?nia Sustentável- Para o progresso do Brasil e combate ao aquecimento global (Viena- Editora e Gráfica, Santa Cruz do Rio Pardo, S?o Paulo, 2011), Os Fatores Condicionantes do Desenvolvimento Econ?mico e Social (Editora CRV, Curitiba, 2012), Energia no Mundo e no Brasil- Energia e Mudan?a Climática Catastrófica no Século XXI (Editora CRV, Curitiba, 2015), As Grandes Revolu??es Científicas, Econ?micas e Sociais que Mudaram o Mundo (Editora CRV, Curitiba, 2016), A Inven??o de um novo Brasil (Editora CRV, Curitiba, 2017), Esquerda x Direita e a sua convergência (Associa??o Baiana de Imprensa, Salvador, 2018, em co-autoria) and Como inventar o futuro para mudar o mundo (Editora CRV, Curitiba, 2019).