The Brazilian response for the COVID-19 pandemic

Filipe Canto Oliveira

PhD candidate at the School of Pharmaceutical Sciences of Ribeirão Preto (FCFRP-USP), University of São Paulo

The Brazilian Unified Health System (Sistema Único de Saúde - SUS) is one of the largest public health systems in the world, especially regarding its National Immunization Program. According to the former Brazilian ministry of health, Luiz Henrique Mandetta (2018-2020), the country is capable of easily vaccinate more than 2 million people in a day [1] . He also emphasizes that Brazil has more community health agents than soldiers in its army, with primary health care units even in the most remote areas of the country. This large, structured and centralized health system could have been a great advantage for Brazil during the COVID-19 pandemic, by an early and rapid vaccination of the population.

A study performed in the city of Serrana, Brazil, in November of 2021, showed that when 81.3% of the adult population were vaccinated (27,406 participants), the CoronaVac immunization was 95% effective for preventing Covid-19-related hospitalizations and presented a reduction of 94.4% of the deaths caused by Covid-19 [2] . This was only one of many studies at the time showing the effectiveness of the vaccination. However, poor political and strategic decisions brought a much worse scenario for Brazil.

The executive branch of the federal government, in particular, chose to invest and recommend the use of non-approved drugs for COVID-19, as chloroquine and ivermectin. Drugs that according to several scientific studies have no proven efficacy against the disease [3] [4] [5] . The Federal Government also discouraged its citizens to be vaccinated or even use masks [6]. Thus, the Brazilian Federal Government failed to vaccinate much earlier its population and supported nonscientific initiatives, leading to a catastrophic health situation in the country.


Relatives of covid-19 infected patients leave after long hours of waiting in line to refill their oxygen tanks in Manaus.

Due to the lack of management, families must bring oxygen tanks to save their relatives' lives. The responsibility of the Federal Government in this critical situation was later investigated in a parliamentary commission of inquiry.


Photo: Marcio James/AFP. January 19, 2020

Moreover, there were also episodes of communication gaps between the government and the population. In June 2020, the Federal Government stopped sharing the total number of deaths caused by COVID-19, in one of the peaks of the pandemic, and deleted the data from their website [7]. In face of this reality, an independent group of communication vehicles needed to start to work to collect and to share the data about the COVID-19 pandemic.

It is well known that trustworthy, timely and accessible public health data is essential for policy and decision-making, as well as to help epidemiologists and other health/science professionals to understand, track and map the spread of a certain disease. During the pandemic, Brazil used two main health information systems to notify suspected and confirmed cases of Covid-19.

For hospitalized patients in Brazil, the Ministry of Health incorporated testing for SARS-CoV-2 into the existing surveillance for severe acute respiratory illness (SARI). Case notification is compulsory, and the records are stored in the SIVEP-Gripe (Influenza Epidemiological Surveillance Information System). This system was created during the influenza H1N1 pandemic in 2009 and has been maintained since then to monitor SARI cases and for the surveillance of unusual events associated with this syndrome in the country. The other system E-SUS Notifica was launched in March of 2020, especially to aid in the pandemic. It is an online system that health surveillance workers can input data in it and other health professionals are able to follow it in real time.

Despite the existence of these systems, there is still no accurate and updated data on the Covid-19 spread. These systems depend on manual data input, which requires sufficient qualified professionals to type, treat and analyze the huge amount of data that the notifications produced. Some Municipal governments, entities responsible for feeding these platforms, were overwhelmed by the task. Not only did they have to update these systems, but also they had to daily report to the population the number of cases, deaths, hospitalizations, etc., and keep up with their normal work demand. This created a delay in the data input, especially in cities where the Health Surveillance team was scarce.

Therefore, there should have been more investments in hiring frontline health workers and supporting and equipping Municipal Health Departments. Sadly, many professionals in the health area, as well as politicians, forget that data input, treatment, analysis and communication is essential to understand the spread of any disease and to take effective measures against it. Without the existence of trustworthy and timely data, we are blind to the real situation of the disease in the population.

Health workers from the Unified Health System (SUS) in São Paulo, responsible today for multiple tasks.

Photo by Cecília Bastos, USP Imagens

Unfortunately, during the pandemic, Brazil had its own Federal Government not working to give its citizens and agencies a real picture of the situation. On the contrary, the Brazilian Federal Government underestimated the gravity of the Covid-19 situation and chose to adopt nonscientific measures to deal with it. Those attitudes certainly brought several negative impacts for the entire population and led to a high number of hospitalizations and deaths.

Brazil has a large and unified public health system, with an enormous capacity of vaccination and different online platforms to share and understand public health data. However, poor Federal Governance led to a delayed response to the COVID-19 pandemic in the country, bringing disastrous results. The Brazilian Unified Health System tried to assist the population and control the pandemic despite the existent barriers like insufficient resources, health professionals and lack of support from the Federal Government. Hopefully, government leaders will learn from this experience and make better decisions in the future.

Filipe Canto Oliveira

PhD candidate at the School of Pharmaceutical Sciences of Ribeirão Preto (FCFRP-USP), University of São Paulo

Filipe Canto Oliveira has bachelor degree in Chemistry by the Faculty of Philosophy, Sciences and Letters of the University of São Paulo (FFCLRP-USP). He carried out academic activities at Bowling Green State University (USA) from 2013 to 2014, receiving funding from the Science without Borders program (CNPq and CAPES). Currently, he is a Direct PhD candidate at the School of Pharmaceutical Sciences of Ribeirão Preto (FCFRP-USP), under the guidance of Prof. Dr. Ivone Carvalho, working on the development of new drugs for Chagas Disease. Contact info: filipe.oliveira@usp.br | Personal Website

Footnotes:

[1] PODCAST, Flow. Mandetta – Flow Podcast #401. Youtube, June 5, 2021. Available at: <https://www.youtube.com/watch?v=O0dw-FUuTok>.
[2] Borges, M. C., et al. Projeto S: A Stepped-Wedge Randomized Trial to Assess CoronaVac Effectiveness in Serrana, Brazil. Available at <SSRN: https://ssrn.com/abstract=3973422 or http://dx.doi.org/10.2139/ssrn.3973422>.
[3] Heidary, F., Gharebaghi, R. Ivermectin: a systematic review from antiviral effects to COVID-19 complementary regimen. J Antibiot 73, 593–602 (2020). https://doi.org/10.1038/s41429-020-0336-z
[4] Popp M, Stegemann M, Metzendorf M-I, Gould S, Kranke P, Meybohm P, Skoetz N, Weibel S. Ivermectin for preventing and treating COVID‐19. Cochrane Database of Systematic Reviews 2021, Issue 7. Art. No.: CD015017. DOI: 10.1002/14651858.CD015017.pub2.
[5] Gasmi, A., Peana, M., Noor, S. et al. Chloroquine and hydroxychloroquine in the treatment of COVID-19: the never-ending story. Appl Microbiol Biotechnol 105, 1333–1343 (2021). https://doi.org/10.1007/s00253-021-11094-4
[6] Epoca. Relembre ataques de Bolsonaro contra as vacinas em 2021. O Globo. 2021. Available at:<https://oglobo.globo.com/saude/epoca/relembre-ataques-de-bolsonaro-contra-as-vacinas-em-2021-25334915>.
[7] Machado, R., et al. Governo deixa de informar total de mortes e casos de Covid-19; Bolsonaro diz que é melhor para o Brasil. Folha de São Paulo. 2020. Available at: <https://www1.folha.uol.com.br/equilibrioesaude/2020/06/governo-deixa-de-informar-total-de-mortes-e-casos-de-covid-19-bolsonaro-diz-que-e-melhor-para-o-brasil.shtml>.
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