Measures to combat the pandemic

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By Arthur Chioro*

The Ministry of Health should, since January, have taken measures to mitigate the effects of the Coronavirus. Mandetta, squeezed by Bolsonaro's denial of the seriousness of the situation and the inability to fight Paulo Guedes, did not act, wasting precious time.

In three weeks, since the confirmation of the first case of Covid-19, on February 26, we have already recorded 1.629 cases and 25 deaths, confirming the explosive trend of the disease in other countries. The situation is extremely serious and even we, specialists in Public Health, still cannot say, with precision, what the behavior of the epidemic will be, how long it will last, nor its extension in number of cases and deaths.

Just theepidemiological flat earthers”, led by the President of the Republic, who should be responsible for leading the efforts to face the pandemic in our country, is that they are still capable of disregarding its gravity and its tragic economic and social effects, especially those devastating ones that the the epidemic may have on the poorest, homeless people, people deprived of liberty, who live in tenements, slums, who are malnourished or who live in vulnerable conditions.

The coming days and weeks may indicate more clearly what will happen. It is not improbable, as the WHO Director General warned, that here, and in many countries in the southern hemisphere, there will be two or more waves. The first, which we are already experiencing, with an unforeseen number of cases, followed by a more important one, starting in autumn/winter, particularly in the coldest parts of the country, such as the states in the south and southeast.

The seriousness of the situation requires leadership and coordination and this seems to me to be the most critical point in the response that the country has been giving to Covid-19. Since the confirmation of the new epidemic, at the beginning of January, we have had enough time to prepare a set of prevention strategies and to organize the response to deal with cases (mitigation), preparing the country for a long and difficult battle, but this, unfortunately , was not done properly.

Despite the insane actions of the president and part of his ministers, the epidemic was initially treated following the technical precepts recommended by the WHO, since the Ministry of Health has a qualified technical team for the epidemiological surveillance actions that it tried, without success, in addition, as in other countries, to prevent the arrival of the Coronavirus. However, the necessary measures were not taken in time to mitigate the impact from the emergence of cases.

This is due, in part, to the federal government's disorganization and lack of leadership, and Bolsonaro's own opposition to the measures that need to be taken. But, fundamentally, they result from the effects of the neoliberal economic policy of Guedes and Bolsonaro, which defunded and made the SUS precarious. In 2019, 9,5 billion reais were cut from health and, this year, another 4,5 billion. Since the institution of the ceiling amendment, in 2018, health losses amount to 22,5 billion reais.

The resources announced now by the federal government, when cases are already increasing, are not even enough to increase the need for new hospital and ICU beds. The announcement made by the Minister of Health, that he will transfer the R$ 2 per inhabitant to preventive actions, is even outrageous. For comparison purposes, it allows purchasing only one soap or 58 ml of hand sanitizer for each citizen.

The response to the epidemic is being carried out in a profoundly uncoordinated way. Given the inability to act, the conduct of actions was passed on to governors, mayors and health secretaries. Integrated and coordinated action by the federal government would be essential.

The health network was not prepared to handle the cases. It is known that 80% are mild and must be treated at the UBS. But the primary care teams are mostly without doctors, due to the lack of structure of the “More Doctors” program. Mandetta and Bolsonaro were the biggest enemies of “More Doctors” when they were deputies. The Bolsonaro government destroyed the program and claimed that placing doctors (Brazilian or Cuban) in the capitals and municipalities of metropolitan regions was a political use by Dilma and the PT.

It now realizes the huge mistake and announced 5 thousand more doctors, including for these municipalities and regions. But they will not call the Cuban doctors who are available, because they have handed over the authorization validation to the CFM. Following the rites of the announcement, and with the slowness with which the process has been conducted, it is likely that the doctors will only arrive at the UBS at the end of the epidemic.

Despite the time available for preparation, the contracting of hospital and ICU beds, which are already insufficient to meet the usual demand of the SUS, has not been programmed and executed so far. The Ministry did not acquire enough tests either, and could have reinforced Fiocruz's budget to produce or import them.

Municipalities and their workers were not prepared for this phase of the pandemic. In many localities workers were not trained. Complaints that they don't have enough personal protective equipment keep coming. Attention flows were not previously established. There was also no articulation with supplementary health to prepare the participation of the private sector in combating the epidemic. See the example of Prevent Senior, in SP.

We've had since January to prepare this structure and take such measures, but the Ministry of Health, squeezed by the president's attitude of denying the seriousness of the situation, and the inability to stand up to superminister Guedes and claim the necessary resources, was just on the plan rhetorical and did not act, wasting precious time.

Many measures can and should be taken, such as an emergency call, and in 15 days make available another 10 doctors, including the thousands of Brazilian doctors trained abroad and the Cubans who are waiting for Revalida, to work in the UBS of the capitals and metropolitan regions. The intensive use of telemedicine for guidance and consultation of less severe patients is essential. Tests must also be guaranteed for everyone who needs them, as well as guaranteeing the necessary protective materials for health workers.

For serious cases, it is necessary to guarantee access to the hospital network, with an emergency expansion of hospital beds and ICU beds, with an expansion in the supply of public beds, emergency hiring of beds in Santas Casas and private hospitals, opening of field hospitals on an emergency basis to supply excess demand where needed. The acquisition of equipment (respirators) and consumables is essential.

For this to be possible, it is fundamental to release resources in sufficient quantity so that states and municipalities can, in a decentralized, organized and integrated way, structure this operation on an emergency basis, which should have been done since February. This will only happen with the immediate and definitive repeal of the effects of EC 95 on the health budget.

It is also imperative to coordinate and regulate health plan operators and private hospitals so that they offer their installed capacity to care for their patients and those who are referred by the SUS, as well as establishing care protocols for supplementary health with the obligation of care and testing when necessary. In addition, require the elaboration of a contingency plan by each health plan operator.

In addition, maintaining investment in communication – safe and transparent and prevention measures, calling on society to help control the epidemic, both by adopting physical distancing measures and strict hygiene habits.

Essential measures must be adopted in essential services, such as reducing and scheduling working hours, accompanied by reinforcement of the bus fleet at intermediate times; frequent cleaning of premises and vehicles; supply of 70% alcohol in places where people pass and in vehicles, with signage for guidance; availability of clean toilets always stocked with water, liquid soap and paper towels.

It is also up to society to fulfill its part, with serenity and great responsibility. Health services should only be sought in the presence of fever, dry cough or secretion and when you have difficulty breathing. This is important to ensure that the UPA and hospitals are not overcrowded and that the teams can dedicate themselves to caring for the most seriously ill patients.

Strictly following the guidelines and determinations of the health authorities is essential. People must stay in their homes, observing hygiene and social isolation care. Taking full care of the elderly and people with chronic diseases, immunosuppressed or with disabilities, situations in which there is a significant increase in the risk of serious manifestations of the disease and deaths, is essential.

More than ever, we need to put solidarity into practice, including to ensure the survival of those who live alone, on the streets and in conditions of greater social and economic vulnerability, in precarious conditions of sanitation and housing. Be supportive of informal, domestic workers, and those in the area of ​​health and essential services, who will not be able to suspend their activities.

*Arthur Chioro is a sanitary doctor and former Minister of Health

Article originally published on Folha Santista

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