RIO DE JANEIRO, BRAZIL – There were 5,990 Covid-19 cases recorded in Sweden last Friday alone. Another 6,600 in Portugal on Saturday. In Germany, a record 23,542 cases of the disease, also on Friday. The rise of a second Covid-19 wave in Europe has cast a gloomy doubt on Brazil. How prepared should we be to tackle the potential for a further rise in the number of cases and deaths in the country, as is the case abroad?
Brazil has clearly failed to deal with the pandemic as Europe did. Our social distancing and lockdown was partial and the country experienced an internalization of the disease in the months following the increase of cases in large cities like São Paulo, Rio de Janeiro, Fortaleza and Manaus. Infection and death rates maintained a plateau for months and began to show a downward trend only in the last few weeks, when cases began to decline here.
While we experienced the downward trend in the number of cases in several states, according to official data, the increase in new cases in the United States and Europe left citizens concerned about the possibility of a second wave or even a continuation of the first wave.
Some figures in the increasing number of hospitalizations have been worrying experts and authorities. Last week in São Paulo state there was an increase in ICU hospitalizations: there were 1,009 new requests, 18 percent more than the week before. Despite this, the number is lower than the peak in July, when there were almost 2,000 new daily hospitalizations in the state.
By 8 AM on Monday, November 16th, the media outlet consortium pointed out that Brazil has reached the mark of 165,813 deaths from the disease and 5,860,636 cases – with 138 deaths recorded in the past 24 hours by 8 PM on Sunday. The rolling average of deaths in Brazil in the past week was 491, up 22 percent over the average of two weeks ago. The country had not experienced a rising trend in deaths since June 4th. Underreporting can further change the total.
Even if the numbers seem low, they are still worrisome. For a country that was experiencing a plateau of cases, the rise can lead to an increase in the number of deaths.
According to infectologist Carlos Fortaleza, professor at UNESP (University of São Paulo) and member of the Covid-19 Contingency Committee in the state of São Paulo, the fact that we have been unable to isolate as much in Brazil as in Europe is not an indication that a second wave here is discarded.
“Nothing can guarantee that a second wave will not occur in Brazil. We are flexibilizing, but we have to be prepared to go back and close down again if necessary,” says Fortaleza, reiterating that even the reopening plan in the state of São Paulo provided for a return to situations of greater or lesser closures.
According to Celso Granato, physician and clinical director of the Fleury Group, Brazil is not yet undergoing a second wave of SARS-CoV-2, despite the drop in the number of cases in recent months. “We had a high peak and we are experiencing a very slow decline. Our daily rolling average of deaths is still too high for us to have emerged from the first wave,” he says.
Despite the new rise here, researcher Ester Sabino, of the Institute of Tropical Medicine of the University of São Paulo (USP), identifies crucial differences between the situation in Europe and Brazil. In her opinion, Europeans had undergone an isolation that has almost zeroed the number of new Covid-19 cases in most countries, while in Brazil this has not happened. “The pandemic was somewhat controlled, now it’s rising again, so we’re in the process of finding out how long this initial immunity from the coronavirus will last. We have not emerged from the first wave. And the greatest concern now is whether or not people can be reinfected,” says Sabino.
For Jorge Kalil, director of the immunology laboratory of Incor, who disagrees with Granato, we are in fact experiencing a second wave of cases, almost like in the United States, the epicenter of the disease in the world and where specialists are discussing the possibility of a third wave. There, a million new cases were recorded in a single week. The U.S. has already passed the 11 million confirmed Covid-19 cases.
“Cases are increasing greatly, not only in Brazil, probably because people have returned to their usual activities and are not taking all the necessary precautions,” he explains.
Irrespective of whether or not we are experiencing a second wave, infectologists and specialists are keeping an eye on the potential increase in the number of cases in the country. For Fortaleza, this can be seen in the policy of ICU beds that were created to address the disease. “ICU bed occupancy in São Paulo stands at about 40 percent. Sixty percent of beds are vacant. If we were sure there wouldn’t be a second wave, we would close half of these beds,” he said.
More Youths on the Street
The main difference between the first period of the disease in Brazil and the current moment we are experiencing, lies in the age group that is most affected by the virus.
If between the months of March and August there was an upward curve in people over 40, now young people are more at risk of infection. In other countries, the same conclusion was reached over recent months.
The assumption is that young people, tired of social distancing, and believing that they are at lower risk and because they do not belong to any risk group, will ultimately ignore the risks of the disease. In France, for instance, a study conducted by the government pointed out that the virus is circulating mainly among people between the ages of 20 and 39.
For the British Health Minister Matt Hancock, the main culprits for the rise in cases that occurred in the country are young people who ignore the social distancing rules. The United Kingdom ranks seventh highest in the number of cases of the disease, behind other countries that are European, such as Russia, France and Spain.
“There is an increase in cases in class A and B and I believe this happens because people will go back to bars and restaurants, and are having social meetings,” explains Incor’s Kalil, who believes that young people are the new “culprits” for a new spread of Covid-19 in Brazil.
“Older people, either because they are retired, or because they work from home, manage to isolate themselves more. Young people can’t bear it. They go out more and are less afraid because they know that the illness is not usually as serious. Cases have increased because of the degree of exposure,” says Granato, Fleury Group’s clinical director.
For Kalil, the number of cases in Brazil should continue to rise until the end of the year, particularly with festivities like New Year and Christmas.
“We see that Brazilians can’t restrain themselves, and I think that at the end-of-the-year festivities people won’t be able to do what should be done. I’m very afraid of what will happen at the end of the year and all summer, not only in open spaces, but also in closed places,” he said.
Last week, a study conducted by Stanford and Northwestern universities pointed out that the risk of Covid-19 infection is higher in hotels, restaurants, bars and gyms that do not respect rules such as social distancing and wearing masks during meals or exercising.
What About Herd Immunity?
With over 5.8 million confirmed cases in the country and some cities heavily affected by the disease, many expected that the herd immunity phenomenon would prevent a second wave of Covid-19.
Herd immunity is based on the premise that immunizing part of the population – with a vaccine or antibodies after the body has fought the disease, for instance – ensures that the disease will be difficult to spread. There will be fewer people getting sick with the virus and its incidence tends to drop.
In September, a study showed that 66 percent of the population of Manaus could have been infected by Covid-19, and research suggested that the city was entering the so-called “herd immunity”. This was not the case. Shortly thereafter, the number of cases started to rise again in the capital of Amazonas: a 117 percent increase in October, compared to the preceding month, suggests that the infection had reached people who had not yet contracted the disease.
According to Fortaleza, a serological survey in the city of São Paulo should show no more than 30 percent of the population immune to the coronavirus. This leaves 70 percent of the population susceptible to the disease and renders a second wave possible.
“We are experiencing a situation that does not warrant an aggressive lockdown; neither does it warrant a return to pre-pandemic life. Our situation is one of surveillance. We have to stay at home as long as possible, to go out only when necessary, to wear a mask and to expose ourselves as little as possible, avoiding crowds”, says Fortaleza, recalling that balance lies in monitoring the situation to make the right decisions from an epidemiological perspective.
Source: Exame