herd impunity

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By PAULO CAPEL NARVAI*

In Brazil, with more than 100 deaths and more than three million cases, health (and the SUS) is “touched” by a general. It looks like a parallel universe, or fantastic literature, in the style of Cortázar or García Márquez.

Every crisis, as the saying goes, is a drama for some and an opportunity for others. In the health crisis caused by the COVID-19 epidemic, the drama affects everyone, in some way. Be it those who, out of stupidity, do not realize the phenomenon in which they are immersed, be it also the “Inocentes do Leblon”, of which Drummond spoke (1) and Chico Buarque updated for pandemic times (2). Yet the opportunities are right there, close at hand.

In La Paz, Bolivia, with cemeteries without any ground to bury the dead, or the lack of anyone to do so, the opportunity arose for businessman Carlos Ayo (3) who developed an unusual solution to the problem of unburied bodies on an industrial scale, created in Riobamba, Ecuador (4): the mobile crematorium. A device is attached to a pickup truck that travels through the metropolitan area of ​​La Paz and, along the way, turns bodies into ashes. The problem is solved and the entrepreneur, engineer, makes a living. It looks like magical realism, but the solution that reverses the problem of Mayor Odorico Paraguaçu n'The Belovedby Dias Gomes (5), it's just reality. Life reverses art.

In Brasilia, to the scorpion, which abounds and even kills (6) in the territory where the capital of the Republic is located, naja snakes have joined in recent months (7) and even unbelievable sharks (8). In the gardens of the Palácio da Alvorada, an emu pecked the President of the Republic who reacted(!) to the animal by pointing a box of hydroxychloroquine at him.

While the media reports on the animals of Brasilia and political scientists give way to boring analyzes about whether the State (or the government?) is fascist or not, in the National Congress the health crisis makes the spotlight point to the SUS. Senators and deputies realized that the pandemic highlighted the importance of the universal health system for the country. But they don't want “this SUS that doesn't work”. Part of the media echoes Minister Guedes: the SUS is bad because it is state-owned. Its operation depends on public servants. It needs to be privatized. In the Chamber of Deputies, Rodrigo Maia (DEM-RJ) leads the parliamentary attack on the SUS, euphemistically called its “strengthening and modernization” (9).

Social movements, health entities and specialists have, for some time, a good diagnosis of the problems faced by the SUS and have been indicating ways to face them, as verified in the 16th National Health Conference, held in 2019 (10). The diagnosis highlights the underfunding of the system, the division of management promoted by the poorly named Social Health Organizations (OSS), the fragility of administrative controls that leads to the theft of public money by protected gangs and even directed by politicians, the professionalization of workers at a national level with the creation of a SUS State career, among others. In short: constitutional solutions to chronic problems, from within and strengthening the qualities of the SUS, under the principle that health is not a commodity and that it is in the public interest to universalize access to its actions and services. But Maia and part of the media have been putting themselves in the opposite camp, advocating health as a commodity. For this reason, they seek “in the market” what would be the solution to what they consider “problems of the SUS”: they want private services, regulated by vouchers. Guedes wants everything in the SUS to fit into a spreadsheet and that the role of the State is only to “negotiate” values ​​with businessmen in the sector. The crisis generating business opportunities.

With the Ministry of Health without a minister, Brazil imitates Argentina under Mauricio Macri (president from 2015 to 2019) who simply extinguished the ministry, hastily reorganized by Alberto Fernández so that that country could face COVID-19. In Brazil, with more than 100 deaths and more than 3 million cases, health (and the SUS) is “touched” by a general who would understand (?) logistics and who has been dedicating himself to the delirious 'Placar da Vida', which counts the number of 'recovered cases', and according to which our country is “among the world leaders in recovered patients, which demonstrates the correctness of the Brazilian government's actions in response to the pandemic”. It looks like a parallel universe, or fantastic literature, in the style of Cortázar or García Márquez. But it is the Bolsonaro government imposing its post-truth, insulting intelligence and, by the way, the World Health Organization. SUS public servants continue without a professional career and are poorly paid, dying in the face of the pandemic, at the system’s municipal base: there are no official numbers, but there would be around 1.500 across the country, in mid-August 2020.

While Bolsonaro evades his attributions as the country's main representative, and tries to hold governors and mayors responsible for the health crisis, the interim general he appointed to the Ministry of Health put all his knowledge of logistics into practice and appointed him to the position of maximum representative of his portfolio in Pernambuco an unknown person in the field of Health, without technical training and inexperienced. She would just be a friend, whom he trusts.

According to the newspaper The Globe, the general wanted, perhaps taking advantage of the momentum, to appoint his daughter, also without experience in the area, to a health position in the City Hall of Rio de Janeiro (11). In Rio, logistics failed and the nomination did not materialize. This is one of the problems of the SUS: the provision of management and advisory positions is not linked to a career in the State, nor does it imply any qualification requirement for the functions (12). In August, Bolsonaro withdrew from appointing a businessman in the bar and restaurant business, equally scientifically unprepared, to coordinate the area of ​​oral health, one of the most successful of Lula's governments.

Another very serious problem faced by the SUS is the lack of control in government purchases, generally made without the participation of qualified professionals and, sometimes without foundation in scientific bases or even contradicting them. The federal government has been using public money to produce and distribute hydroxychloroquine, a drug whose effectiveness against COVID-19 has no basis in scientific evidence, not even Anvisa's approval.

The mayor of Itajaí, SC, purchased and distributed 1,5 million tablets of ivermectin, an antiparasitic drug, not recommended for COVID-19. He paid for it, with SUS resources, R $ million 4,4 (13). He justified his decision by stating that he could not “watch the band go by” and, therefore, would have decided to include the drug in the protocol adopted in the municipality. With the failure of this strategy, he incorporated the anal application of ozone to his, let's say, “therapeutic arsenal”, assuring that “this gives an excellent result”. He also suggested homeopathy for the treatment of the disease.

The mayor of Itajaí is a doctor. In the strictly clinical context, when health professionals care for their patients, it is understandable that, alongside the prescription of medication and the recommendation of varied care, secondary procedures that produce physical and psychological comfort are adopted or admitted. In this context, we seek to contemplate religiosity and respect for ancestral practices, for example.

Such practices are common in indigenous health and in actions aimed at some ethnic-religious groups. There are, in principle, unavoidable incompatibilities between maintaining a therapeutic base supported by scientific evidence and contemplating varied beliefs and cosmogonies. A popular saying enshrines this approach in the classic: “prudence and chicken broth don't hurt anyone”.

But it is clear that clinical practices should not be mechanically transformed into public policies. I usually exemplify with blood transfusions: for religious reasons a doctor may not accept the procedure. But this professional, if invested with a public office, does not have the right to decide individually on such procedures. As a health director, he acts on behalf of the State and is therefore obliged, by legal requirement, to follow recommendations accepted by the scientific community and which, in general, are included in the foundations of public policies.

One of the most common serious political mistakes made by authoritarian or inexperienced rulers is to confuse their opinions and desires with what the government they act on behalf of should do. In the health area, such errors usually produce disastrous effects. When those who govern confuse the res publica with your home, private life invades the public sphere and there is almost always damage to matters of general interest. (14).

Currently, however, a mayor, like the one in Itajaí, feels entitled to decide on which drugs should or should not be included in the “city protocol” and define its “therapeutic arsenal”. For being a doctor. But not just the mayor. The President of the Republic, an ex-military man, thinks it is up to him to decide on medicines to be used in public policies. And take chloroquine! And give him hydroxychloroquine...

While wasting SUS resources on drugs with no proven efficacy, deepening the denial of the pandemic and its severity and refusing to coordinate nationally the fight against the pandemic, Bolsonaro sends to the National Congress the bill (PL) of Budget Guidelines for the Union for 2021, cutting resources, bleeding the SUS and ignoring the National Health Council (CNS). According to the Intersectoral Budget and Financing Commission of the CNS, the approval of Bolsonaro's PL will imply a loss of BRL 35 billion in relation to the resources allocated to the Health portfolio in 2020.

The chronic underfunding of the SUS thus dramatically evolves into underfunding, continuing the strategy of stifling the public system to open the way for private business in health. All of this openly confronting the Constitution and current legislation. The CNS reacted and is calling for the repeal of EC 95/2016 and the implementation of “another rule to control public accounts that does not weaken social policies and bring harm to the population” (15).

Among the other rules requested by the National Health Council is the containment of the theft of public money from the SUS by companies called Social Health Organizations (OSS). Many OSS are just “criminal schemes” to divert resources from the SUS (16). It is urgent to stop these attacks, but it is not easy to move forward in this, as the schemes involve powerful people with influence in the three powers, at the federal, state and municipal levels. The SUS is not sufficiently protected. Legislation that could help curb looting is not produced in parliaments, as failure to produce it is part of the scam.

None of that, however, matters to the Maia-Guedes duo in their privatist fury. They believe that the “invisible hand of the market” will redeem the SUS and bring us better days. It will not be easy to contain them, but this is the main task at this juncture. Dismantle the fallacies of this soft talk to put the ox to sleep.

Boi is a successful animal in the National Congress, whose bench is almost always in the company of the bullet and the Bible benches, ensuring governability to the collapse of the Bolsonaro government, and preventing the advancement of more than five dozen requests for his impeachment, which accumulate on the table of the Chamber of Deputies. Maia is Bolsonaro's zealous protector who doesn't let anything go. But society continues to react and ask for an end to misfortune.

In mid-August, the 'Black Coalition for Rights' filed yet another impeachment request, number 56. There are 11 reasons, but the central argument is that the federal government commits a crime against public health with its policy of omission to the pandemic, abandoning vulnerable populations and making mistakes by denying emergency aid requests made by poor people (17).

In an analysis carried out in the first months of the Bolsonaro government, in 2019, André Singer produced an expressive image of its composition, which would have two wings: the military and the… psychiatric (18). Today, the government continues with two wings, which could be classified as the “deliver everything”, under the leadership of Guedes-Mãos-de-Scissors, and the “explore everything”, led by Vice President Mourão and the military. that surround you.

The “deliver everything” wing pursues the goal of cutting “public spending”, even if this means bleeding education and public health. But without touching a single penny destined for the payment of interest and maintenance of the public debt, a scheme by which the financial system holds the Brazilian State hostage, as the country works to pay interest on the debt, which is never audited nor is it known where it came from. nor where will it stop. Another name for this is loan sharking. For Guedes, the State serves this purpose: to drain fiscal resources into the financial system.

The “exploit everything” wing is against this 'deliver everything' by Guedes and his ultraliberal policy. Against, 'ma non troppo'. You can privatize, they say, but you have to go slowly and think about governability, opinion polls about the government, little mouths, clientelism, commissioned positions in state-owned companies, in short, the possibilities for various businesses provided by the control of federal power . In short, all of this that a member of the president's family described as “a little money” to get public works going. It is necessary, according to this wing, to invoice using the State machine. Invoicing has, in this case, several meanings, from inflating the president's inauguration schedule, in an election year, and already thinking about 2022, but, above all, the possibility of containing the advance of impeachment requests.

Bolsonaro will sooner or later be punished. He may even survive impeachment calls and bring his government to the end of its term. His numerous crimes, however, will be punished, although his “cattle” remain legally unpunished throughout the country, as they are unreachable by law, unless a crime has been committed. fundamentalists of laissez-faire epidemiological and herd immunity crosses, the animals whose representatives were sent to Brasília and wallowed for several months in the playpen at Praça dos Três Poderes returned to their habitats, expelled from the place by the governor of the Federal District. Mainly responsible for the genocide of COVID-19, they roam the country, calling for “freedom, God and family”. They reject isolation, distancing and even masks. They disrespect state agents. They tear up fines and throw them at public authorities. They feel like the heroes of freedom.

Maybe immune, probably unpunished. There are millions inflating the popularity of the torturer apologist. Herd impunity is as or more important these days than herd immunity, which epidemiology manuals talk about.

There is no updated news coming from Brasília about the fate of the sharks discovered there, but it is certain that, to the unrest of the rats, cobras were discarded in the woods and the scorpions remain circulating, in droves, in the capital of the Republic. Animals from Brasilia.

*Paulo Capel Narvai is Senior Professor of Public Health at USP

Notes


  1. Andrade CD. Inocentes do Leblon. In: Feeling of the World. Rio de Janeiro: Pongetti; 1940.
  2. Chico Buarque. The Innocents of Leblon [Internet]. 2020.
  3. Bolivia U. Engineers create a portable crematorium oven in La Paz [Internet].
  4. Altamirano M. Mobile crematorium in Riobamba [Internet].
  5. Gomes D. the beloved [Internet].
  6. Narvai PC. Brasilia, a scorpion and other venomous animals. Other Health [Internet]. 5 Jul 2019.
  7. Alves M. Naja that stung a student in the DF is rare and has poison that can kill. Correio Braziliense [Internet]. 8 Jul 2020.
  8. PCDF finds shark bred in captivity in Vicente Pires. Jornal de Brasília [Internet]. 10 Jul 2020.
  9. Maira M, Torres R. The strange “SUS reform” that Rodrigo Maia plots. Other [Internet]. 27 Jul 2020.
  10. 16th CNS. Consolidated National Report of the 16th National Health Conference (8a+8). [Internet]. National Health Council. 2019.
  11. Daughter of the interim Minister of Health wins a position of trust in Rio Saúde, a public company of the city hall. RJ1. G1 [Internet]. 23 Jul 2020.
  12. Narvai PC. Oral health in SUS: reject politics and prioritize the area [Internet]. Journal Odonto. 2020.
  13. Mayor suggests application of ozone in the rectum to treat coronavirus. Carta Capital [Internet]. 4 Aug 2020.
  14. Narvai PC. cariogenic government. Jornal Odonto [Internet]. 5 Jun 2019.
  15. Sampaio C. Campaign calls for national mobilization against the risk of losing BRL 30 billion in Health in 2021. Brasil de Fato [Internet]. 13 Aug 2020.
  16. JP Fields. Gilmar Mendes orders the release of Alexandre Baldy, target of Lava Jato. See [Internet]. 7 Aug 2020.
  17. Black Coalition for Rights files request for impeachment against President Jair Bolsonaro [Internet].
  18. Singer A. If you run, the animal catches. Folha de S.Paulo [Internet]. 2 Mar 2019.
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