March was the month with the highest mortality from the covid-19 pandemic in Brazil, but the scenario could get even worse. The warning comes from health authorities in the face of a dangerous and unfortunately persistent advance of the disease in the country: slow vaccination, front lockdowns and a lack of national coordination to standardize initiatives that could optimize medical care.
“Last month, we had approximately 66 thousand lives lost. Almost daily, we heard record numbers of cases and deaths from the disease. We heard about the lack of places in the health service in several places in Brazil. And even with the horrible numbers to which we’re watching today, I believe we haven’t hit bottom yet, that the situation could be worse. A survey conducted by the University of Washington showed that now, in April, we can have 100,000 deaths. awareness of people, that the problem is serious, worrying, is very sad. It is necessary that, whoever can, stay home “said doctor Leonardo Weissmann, consultant to the Brazilian Society of Infectology.
Data compiled from hospitals in the country drew attention in recent days because it almost sounds like a death sentence: 80% of intubated patients die in Brazil. In a country with a denialist government where there is not even an official campaign with guidelines on what to do in the face of symptoms, experts say that several factors contribute to such bad numbers: from late demand for care to the absence of protocols, basic and general conducts aimed at medical units.
“So far, we have not had a leadership, a coordinated communication between the spheres of federal, state and municipal government. As a result, each one ends up doing what he likes, often ends up disseminating false information, treatment with drugs that are not effective. It is necessary that we have a Ministry of Health that takes action, develop protocols based on health, that, if necessary, ask for help from medical societies. If you do not have this support from the Ministry of Health, it will be very difficult for us to be able to control this situation and reduce the number of deaths in the country “, sentenced Weissmann.
Lots of politics around the disease
A member of the management committee of HRAN, a public reference hospital against Covid-19 in Brasília, physician Ricardo Monteiro gives an example of how this new virus requires rapid and coordinated actions. The center that regulates ICU beds has worked well for several diseases, but it is often an obstacle to the current scenario.
“In the morning, the patient receives the green bracelet, of lesser severity, and then changes to yellow. In the afternoon, it is already orange. And at night, it has turned red. If we do not have the agility to be able to mobilize this patient, he will evolve with certainty for a serious condition. So, bureaucracy gets in the way. That is, the regulatory complex for these beds has made patients delay in receiving assistance. If we could create a way to have greater mobility agility for these patients, it would be very positive. ”
In an interview with RFI, Monteiro lamented that drugs without proof have gained panacea status, and other procedures have saved lives.
“The early oxygen support for a person in need, the corticosteroid support and the anticoagulation support is what is saving lives today in Brazil and in the world. This is being proven, each day stronger, it is a window that has changed the natural history of the disease in the sense of trying to control the virus, as well as the vaccine. It is very important that we do not politicize the disease, but it is very politicized. bed management, hospital management, input management, and so on, “he says.
At HRAN in Brasília, Monteiro’s team managed to reverse the situation of many patients by assigning anesthesiologists, experienced in the subject, the task of intubating patients, something that most Brazilian units could hardly do due to the lack of personnel. “Anesthetists are on standby, within five minutes of the intubation request they are there, already in the procedure.”
Monteiro said that although the coronavirus is much more widespread, reaching more and more younger people and without comorbidity, the Brazilian population does not seem to be experiencing the epicenter of a pandemic. “Last year, when they saw that the disease was getting very close, people, out of fear, out of fear, stayed at home. Nowadays you cannot, even with all the lockdown measures, stop the circulation.”
Bolsonaro’s allies, who have a table full of amendments, sometimes harden the speech by charging shares and talking about CPI, while the Brazilian president plays his part on the scene, sometimes appealing to his faithful followers, sometimes trying to show less resistance to the vaccine. The opposition, in turn, uses the government’s loopholes to criticize the president.
“Bolsonaro, since the beginning of the pandemic, has made an option: to use all the instruments he has as president of the Republic to create obstacles in any attempt to control the pandemic. And one of the fundamental instruments that he used was the military intervention he made at the Ministry of Health over the past few months. He prevented the Ministry of Health from playing any decisive role in controlling the pandemic. The Ministry of Health did not conduct orientation campaigns, did not take a position on the need to lockdown in the regions that were in a pre-collapse of the health system, did not coordinate the purchase of medicines and supplies “, said the former Minister of Health and member of the External Commission of the Chamber of Deputies on Covid, Alexandre Padilha (PT / SP).
Congressman Aliel Machado (PSB), who chairs the Chamber’s Science and Technology Commission, still has hope for the new Health Minister, Marcelo Queiroga, but he is also critical of the government’s stance so far. “From the beginning, the government made serious mistakes in the conduct of this pandemic, starting with negationism. But now, with the number of deaths, problems in the distribution of vaccines, it has no alternative but to listen to science. And a war of war continues. narrative, the president finding one thing, the minister finding another. We hope that Brazil will win with the new minister, who in some moments is already more favorable to the right measures. ”
On Wednesday, the Federal Supreme Court will decide whether, at the worst moment of the pandemic, states and municipalities can bar services and masses at religious centers. Appointed by Bolsonaro to the court, Minister Nunes Marques released the spaces when analyzing a case. Gilmar Mendes, when deciding on another action, kept the temples closed as determined by the São Paulo government. The plenary, which tends to follow Mendes, will resolve the issue.
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