Covid-19: integrality at risk

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By Cicero Nardini Querido

It is not possible to think of health as disconnected from other social processes, such as employment, housing, transportation, access to food, prevention and medication.

It shouldn't be a secret to anyone anymore that the diseases that affect human beings receive more or less attention from society depending on the groups they affect, the economic impact they cause and the political context that surrounds them. The media repercussion and investments directed towards research and health care are more guided by this envelope than by a strictly technical and disinterested analysis of the impacts on morbidity and mortality.

The neglect of the public eye to the emergence of HIV, when the disease was reduced to a “gay cancer”, is clear and relatively recent evidence. The persistent worldwide impact of diseases classified by the WHO as “neglected tropical diseases” (among which dengue fever, Chagas disease, leprosy) leaves us in no doubt. Surprisingly outside this list, tuberculosis causes more than 1 million deaths worldwide every year, according to data from the same WHO.

In recent months, all public attention has turned to the Covid-19 emergency. The disease caused by the new coronavirus actually has immense potential for transmissibility, in addition to an apparently higher lethality than other common respiratory infections. Because of its potential gravity and above all because of its impact on health systems around the world, it cannot be treated with negligence: neither by health authorities, nor by each of us, individually.

Approaching the issue in a cynical and irresponsible way, as the Brazilian president does, is yet another expression of his hate speech and the necropolitics he cultivates, in the context of a pandemic or outside of it.

However, in a context in which many questions have not yet been answered, even by the greatest scholars on the subject, it is essential to maintain a critical eye on the measures being implemented. We have no reason to believe that, while the epidemic continues, people will stop dying or suffering from other health problems, such as cardiovascular disease, chronic kidney failure, cancer, etc. It is worth asking whether an intensive allocation of beds, resources and professionals to care only for Covid-19 cannot make assistance to the other health conditions of our population precarious.

There is great vigilance over the Covid-19 numbers, and great interest, on the part of government officials, in publicly boasting more favorable results. This cannot happen, however, at the expense of harming the health of the current “invisible”, violating basic principles of our health system, such as comprehensive care.

Furthermore, it is not possible to think of health as separate from other social processes, such as employment, housing, transportation and access to food and medication. To do so would be to reduce “health” to a very specific and biased section of statistics, presumably assuming that everyone will be impacted by these measures in the same way, in a country that is absolutely unequal.

The fundamental debate that is imposed is not that of health “versus” the economy, as some have put it, but a discussion to be held fundamentally within the field of health, in its most comprehensive conception. The only certainty, so far, is that only a universal and properly financed health system can mitigate the impacts of an epidemic like the current one.

Amid so much uncertainty, wash your hands and defend (all) the SUS.

*Cicero Nardini Querido is a specialist in internal medicine from the Faculty of Medicine of the University of São Paulo (FMUSP), and assistant physician at the University Hospital of the University of São Paulo (HU-USP)

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