By GIL VICENTE REIS DE FIGUEIREDO*
What we have seen happen in the last five months has been an explosion of irresponsibility in the most diverse areas, especially in the political, ideological, health and economic management of the crisis by the federal government
Introduction
In April of this year I published on the website the earth is round an article entitled restriction measures, in which I presented scenarios for the COVID-19 pandemic in Brazil, largely using, as a reference, the work of a group of researchers from Imperial College[I] (London), published a few days before; I showed that, according to that study, a careful management of the crisis would limit the number of deaths in our country to around 40.000.
What we saw happen in the last five months, however, was an explosion of irresponsibility in the most diverse areas, especially in the political, ideological, health and economic management of the crisis by the federal government. Today, still far from a tragic outcome of the pandemic in Brazilian lands, the loss of lives already exceeds 127.000.
We point out three basic measures that could have avoided this path: sustaining, until otherwise defined, the measures to restrict social contacts then adopted; swift and sufficient transfer of resources to the most fragile sectors of Brazilian society – the unemployed, informal workers, micro-small-medium entrepreneurs without working capital capable of facing the seriousness of the situation, among others; and an approach that, from a health point of view, considered the knowledge disseminated by the scientific community and its organizations, without counterinformation capable of producing a boomerang effect, and was the organizing pole of a coordinated policy of massive testing, tracking and monitoring of those infected , and the debate on technical models that would make it possible to define, later on, which protocols and in which temporal-geographical sequence to progressively lift the confinement.
What was seen to happen was precisely the opposite, in almost every respect. The pressure for an end to confinement was constant, criminally encouraged from the top of the federal government, through repeated statements disqualifying the impact of the disease, affirming – falsely – the existence of curative drugs and, thus, discouraging the continuity of isolation ; the transfer of the necessary financial aid, in turn, was inefficient and time-consuming, requiring long queues that constituted new risks of contamination; and, finally, sanitary and scientific guidelines were ignored.
Even more worrying is the finding that, almost half a year later, an effective network for testing and monitoring cases has not been built here to effectively control the pandemic and guarantee a relatively safe return to the 'new normality'. The publication "Coronavirus (COVID-19) Testing-Statistics and Research – Our World in Data”[ii]testifies to this regrettable reality: according to the information contained in Table 1 below“only countries for which data are available were included, which corresponds to 66% of the world's population” – in other words, Brazil is, along with the remaining third, outside the corresponding reliable statistical base, relegated to the blank of “No data".
In addition to registering the lack of information on the percentages in question, the diagnosis that follows (same source) evaluates the countries that have demonstrated the best and worst testing capacity, worldwide:
“Data from Slovakia, Thailand, New Zealand, South Korea and Germany show that these countries monitored the pandemic well from the beginning and quickly brought it under control after the initial outbreak and were able to reduce the number of cases” [ …] “The data of the Brazil, Mexico, United States, Panama, India, Pakistan, South Africa and Nigeria show that few tests are carried out there, compared to the size of the respective outbreaks. Additionally, these countries regrettably report that there are still a large number of new cases on a daily basis.”
Even more serious is the fact that Brazil is among the eight countries in the world with the highest global incidence of cases per 1.000 inhabitants.[iii] and that, among these, it is the one with the lowest testing capacity for the new coronavirus – as shown in Table 2 and Graph 1, below.
graphic 1
Brazil: the least tested among the eight countries with the most cases of COVID-19 in the world
The correlation between high testing and low mortality is strong, with dire consequences: among the eight countries mentioned, Bahrain, what more tests, have today 72 deaths per million of inhabitants, while in Brazil, the one that tests less, the number of deaths is 593 per million of inhabitants.
1 – Comparative evolution of the pandemic: Brazil, France, Germany, Italy and the USA
As a result of the immense neglect here, combined with the disqualification of elementary principles to be fulfilled in the current health crisis, such as the one referring to the use of a mask, often violated by the President himself, Brazil is experiencing an announced scenario of distressing chaos and uncertainty. that the COVID-19 pandemic has had a huge impact on the planet – however, a comparison between some countries in Europe, the USA and Brazil shows, in this regard, essential differences.
1.1 Comparative death curves
Graph 2 below reveals that, in Brazil, the pandemic has behaved quite atypically: here, there has been a constant increase in the number of accumulated deaths over the last four months, with no reduction in the slope of the curve, unlike what happened in the vast majority from other countries, such as France, Germany, Italy and the USA, where, after about 1,5 to 2 months, a process of progressive cooling of the disease began.
graphic 2
This reality becomes even clearer when the 7-day moving average of new deaths is consulted (Graph 3).
In the USA and in the analyzed European countries, the plateau that precedes the drop in deaths is short, lasting less than 15 days, whereas, in Brazil, there is a stabilization in the range of 4 to 5 deaths per million (between 800 and 1000 people , daily) for a period approaching 120 days, which caused additional loss of around 100.000 lives, in relation to what would have happened if the disease had been controlled in a similar way to what happened in most other countries in the world.
graphic 3
1. 2 Response to the pandemic
There are other indicators that can be analyzed to assess the adequacy of various countries' responses to the pandemic. One of these is the set of projections indicated in the pioneering study by Imperial College researchers who, taking into account a significant set of factors, presented in March this year, country by country, an assessment of dimensions and scenarios of future loss of life resulting from the new coronavirus, including the 'early suppression', considered the least worst possible[vi]. Today, almost six months later, we compare, in Table 3, the projections of that study with what actually happened.
These numbers, summarized in Graph 4, are striking: in Germany the number of deaths did not reach half of the projections made, while, in Brazil, which presented the most negative numbers among the five countries, was almost three times bigger.
graphic 4
2 – COVID-19 in Brazil
Although the political-ideological-sanitary bias is an important parameter for understanding the discrepancies pointed out in relation to other countries, it should be noted that it is not the only one, since the continental dimension of Brazil led – as also occurred in the USA – to the existence of different trajectories of COVID-19 in different states and municipalities, with different intensities and temporalities.
2.1 The evolution of the number of deaths
In the second half of March 2020, the city of São Paulo became the initial epicenter of the pandemic in Brazil, brought by travelers returning from Europe. From there the disease quickly spread to Rio de Janeiro, where from May onwards there was even greater acceleration.
graphic 5
From the São Paulo – Rio de Janeiro axis, COVID-19 advanced, from mid-April onwards, to Amazonas and, subsequently, to Pará and the rest of the northern region (Graph 6), where the impact was immense, due to the precarious conditions of local health systems and, additionally, due to the meager distribution of existing health resources, generally concentrated in the capitals.
graphic 6
The next region to be affected was the Northeast, especially after the end of April/beginning of May, and the main ports of entry were Ceará and Pernambuco.
graphic 7
In the Midwest (and in Graph 8 we also include Minas Gerais and Bahia, where the disease had a similar trajectory) the pandemic effectively took hold from June onwards. With the exception of Mato Grosso, where there is a reduction in the death rate, COVID-19 is not yet in clear decline in these states.
graphic 8
The last region to be hit was the South (Graph 9); the worst phase apparently occurred in August.
graphic 9
Graphs 5, 6, 7, 8 and 9 are on the same scale, which allows us to observe that the pandemic, in addition to having intensified in different regions at different times, affected the North and Northeast of the country in a differentiated and serious way,
2.2 Evolution of the number of cases
While the new death curves, in Brazil and in the world, outline signs of a global retraction of COVID-19, Graph 10 (of new cases[viii]) presents contradictory trends, especially in countries – such as France, among others – where the number of daily deaths has already been sharply reduced, and in which the recent increase in the number of cases could seem – worryingly – the beginning of a 'second wave' '.
graphic 10
However, there has been no further increase in the number of deaths. Some explanatory hypotheses have been put forward, among which: the change in the age profile of new infections, which today are concentrated in younger age groups, in particular as a result of the greater circulation of young people and tourists in the European summer; increased testing of asymptomatic cases; and evidence that COVID-19 generates an important degree of immunity – albeit not yet fully understood – in previously hardest-hit settings.
It would still be rash to anticipate what the coming months have in store, specifically for Brazil. The considerations that follow, therefore, should be seen as simple and mere projections of what appears to be a declining course of the disease that, despite the irresponsibility of our leaders, follows its own dynamics.
2.3 Models and projections – which are NOT predictions
In recent months, many scientific works have been published on COVID-19, and, in particular, several epidemiological models and respective projections have been revisited.
There are several approaches, such as the one that presents the pandemic as a complex object, based on a heuristic modeling proposal guided by occurrence plans and hierarchical interfaces[ix]; or the one that uses systems of linear differential equations[X]; or the one that accompanies the evolution of the disease, seeking to approximate the values of a certain type of function to the observed data. In this last line, Se Yoon Lee recently proposed[xi]the use of generalized logistic curves[xii] (Richards growth curve model[xiii]). The application of the latter method to COVID-19, in the Brazilian case, results in the graphs in the ANNEX (author's elaboration).
3 - Conclusion
It is important to reaffirm, finally, that one cannot assume, much less believe that the projections indicated here will be confirmed automatically, which would be a very serious error, since they depend – as long as there is no vaccine – on the continuity and deepening of the measures and care that need and must be taken.
In particular, it is fundamental: that social distance be continued, without crowds like those that have been seen recently in Brazil; that the use of all personal protective equipment is increasingly disseminated and encouraged by public authorities; and that, above all, in our country, in the shortest possible time, a comprehensive and efficient program for testing cases, locating contacts, isolating and monitoring patients is structured.
Without a firm collective awareness that all these measures are essential and necessary, the COVID-19 pandemic will not retreat just to endorse some mathematical models.
Annex
We indicate below projections – in lilac – for the behavior of the COVID-19 pandemic, considering the parameters that best fit generalized logistic curves to official data (https://covid.saude.gov.br/) available until September 4, 2020, by Brazilian state. On each chart, the orange curve represents the 7-day moving averages (cases) and the black curve the 14-day moving averages.
We insist, once again: 'projections' cannot and should not be confused with 'forecasts', for several reasons, among which: 1) the available information may not be reliable (incorrect reporting); 2) and, above all, the future may not reflect the past, in particular because the behavior of the population and a set of other parameters may not correspond to the previous history.
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*Gil Vicente Reis de Figueiredo is a retired professor at the Department of Mathematics at UFSCar.
Notes
[I]The Global Impact of COVID-19 and Strategies for Mitigation and Suppression. March 26th, 2020. Patrick GT Walker*, Charles Whittaker*, Oliver Watson, Marc Baguelin, Kylie EC Ainslie, Sangeeta Bhatia, Samir Bhatt, Adhiratha Boonyasiri, Olivia Boyd, Lorenzo Cattarino, Zulma Cucunubá, Gina Cuomo-Dannenburg, Amy Dighe, Christl A Donnelly, Ilaria Dorigatti , Sabine van Elsland, Rich FitzJohn, Seth Flaxman, Han Fu, Katy Gaythorpe, Lily Geidelberg, Nicholas Grassly, Will Green, Arran Hamlet, Katharina Hauck, David Haw, Sarah Hayes, Wes Hinsley, Natsuko Imai, David Jorgensen, Edward Knock, Daniel Laydon, Swapnil Mishra, Gemma Nedjati-Gilani, Lucy C Okell, Steven Riley, Hayley Thompson, Juliette Unwin, Robert Verity, Michaela Vollmer, Caroline Walters, Hao Wei Wang, Yuanrong Wang, Peter Winskill, Xiaoyue Xi, Neil M Ferguson, Azra C Ghani, Imperial College COVIE-19 Response Team. Available in: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news–wuhan-coronavirus/?fbclid=IwAR0GeexFNu6ezOVclPBVW5x3Z3yOn5N1X6siDO5P7ezUOm_UwOUu31RBoAY Accessed March 27, 2020.
[ii]Accessible on the page https://ourworldindata.org/coronavirus, which bears the seal of the University of Oxford and is a reference for research work on COVID-19.
[iii] Among the 156 countries in the world that have a population of over one million inhabitants.
[iv]This is the reference page of USP-Ribeirão Preto publications posted inhttps://ciis.fmrp.usp.br/covid19/analise-brasil-e-mundo-testes/, with regard to testing capacity for COVID-19. Accessed September 8, 2020.
[v]Graph 2 was prepared as follows: the record of accumulated deaths was recorded, for each country, from the day on which the fifth death occurred – this date corresponds to 'day 1' of each country. Thus, similar phases (in time) of the epidemic in different countries are compared.
[vi]In this scenario, it is assumed that adequate social distancing measures are taken before the number of deaths reaches 2 per million, over the immediately preceding week.
[vii] The sources for the data presented above are the values contained in the Imperial College study, on the one hand, and, on the other, the following official pages (accessed on September 9, 2015), respectively, with regard to the current amount of Deaths: https://covid.saude.gov.br/; https://www.zeit.de/zustimmung?url=https%3A%2F%2Fwww.zeit.de%2Fwissen%2Fgesundheit%2Fcoronavirus-echtzeit-karte-deutschland-landkreise-infektionen-ausbreitung; https://coronavirus.1point3acres.com/en; https://www.gouvernement.fr/info-coronavirus/carte-et-donnees; is http://www.salute.gov.it/nuovocoronavirus
[viii] The source used is, as before, the page https://ourworldindata.org/coronavirus
[ix]Modeling of the Covid-19 pandemic as a complex object (Samajian notes) Naomar de Almeida FilhoOn http://orcid.org/0000-0002-4435-755XInstitute for Advanced Studies, University of São Paulo, São Paulo, Brazil. 2020 (June 26)
[X]What is the estimate of ICU beds for the care of adult patients at the peak of the COVID-19 pandemic in Porto Alegre? Study with SEIHDR mathematical model, Cristiano Lima Hackmann, Carlos Schonerwald, Jair Ferreira and Maurício GuidiSaueressig, UFRGS, Brazil. 2020 (09 Jul)
[xi] Estimation of COVID-19 spread curves integrating global data and borrowing information, Se Yoon Lee, Bowen Lei, Bani Mallick, University of Texas, emhttps://journals.plos.org/plosone/article/authors?id=10.1371/journal.pone.0236860, PLOS ONE. 2020 (July 29)
[xii] It is a function of time with four parameters: F(t; ϴ1, ϴ2, ϴ3, ε) = ϴ1.[1+ε.exp {-ϴ2 .(t-ϴ3 )}]^(-1/ε); The modeling proposal, in the specific case of the COVID-19 pandemic, is to find, on a given date (in this case, September 04, 2020) the values of the parameters that, for successive values of t, on all previous dates, more fit the empirically observed data.
[xiii] Richards F. A flexible growth function for empirical use, Journal of experimental Botany. 1959; 10(2): 614-616.
