RIO DE JANEIRO, BRAZIL – The new surge in Covid-19 infections has prompted governments to reopen or extend the operation period of field hospitals throughout the country, as a means to unburden and prevent the collapse of the healthcare network.
The total death toll from the virus in Brazil is now close to 200,000. The emergency structures served a significant share of demand in the first semester of 2020, but were also connected to suspected embezzlement and planning shortcomings.
Patient care in temporary centers was reinstated in capitals such as Fortaleza, Teresina and Belém – in the latter, for light and moderate cases. It is also an alternative in the interior and in metropolitan regions, which have a more limited supply of beds, in states such as São Paulo, Minas Gerais and Ceará.
In Osasco, Greater São Paulo, the field hospital closed in September and reopened last month to care for mild cases. It offers 70 beds, but could reach 300. Early this week, the city had a 57% occupancy rate of its emergency beds for Covid-19. The new administration in Diadema announced its plan to erect a facility. In Bauru, the state renewed the contract that would have ended last week, given the increase in the number of patients; Araraquara did likewise.
In Ilhabela, on São Paulo’s northern coast, in December the plan was to set up a structure for patients of other diseases and release beds to Covid patients.
The new Mayor Toninho Colucci ordered the facility to be dismantled, which was still incomplete. He chose to install up to 20 beds in a municipal building. He says he will save R$900,000 and convert it into a permanent hospital. He has not yet said if he will follow the previous administration’s plan to accept non-Covid patients. The city has seen an increase in the flow of tourists in recent weeks, which may raise the virus transmission rate.
One of the problems of field hospitals is investing in a structure that will be dismantled. Walter Cintra, professor of Hospital Administration at the Getúlio Vargas Foundation (FGV), believes that the temporary facilities may be needed with higher contagion after the end-of-year parties. But he sees alternatives.
“Completing the deployment of hospitals that have not been fully outfitted, and reopening hospitals that have been shut down for some reason in the past. After the pandemic, these beds could be used for other purposes, particularly in the SUS (National Health System) which lacks beds,” he says.
The new mayor of Presidente Prudente is demanding more beds or field hospitals. “It’s the state’s responsibility, not the municipality’s.” According to the state rating, the city is in the red phase (most restrictive). Thomas resisted closing trade, but gave in following a petition filed by the Prosecutor’s Office. The State Health Secretariat reported that it is monitoring the situation in order to prepare beds, whenever needed, and assist managers.
On alert
The risk of an explosion in cases after Christmas and New Year’s Eve is an argument of the city of Varginha, Minas Gerais, to prolong the contract. “We asked the federal government for an extension, which is part of the structure management by sending resources. The situation was under control, but in December it worsened and we felt it was best to maintain the operation until at least February,” says mayor Verdi Lúcio Melo. “You go for a walk in the city and out of every ten people, three are wearing masks.”
There are two other hospitals in the city: a regional one, which serves neighboring cities, and a private one, with an ICU occupancy rate of 66% and 72%, respectively. The field hospital has eight more beds – half of them occupied.
In Mariana (Minas Gerais), even then mayor Duarte Júnior had to be hospitalized in neighboring Ouro Preto to be treated for the disease in December. The local field hospital was ready, but it only began to be used from the end of the year, when the Mariana and Ouro Preto hospitals had 100% of their ICUs occupied.
The government of Minas Gerais – which set up a field hospital in Belo Horizonte that was never used – says that the network is now better equipped than it was at the start of the health crisis. “In the beginning, we had a war-like scenario. The times are very different,” says state Health Secretary Carlos Eduardo Amaral, in a video sent by his staff.
Pernambuco state is considering reopening 102 intensive care beds in the Petrolina field hospital. According to the government, the ICU occupancy rate in the state has increased to 80% and to 66% in wards in recent weeks. In Mato Grosso do Sul, the Cassems Hospital, in the Campo Grande private network, began to reassemble the structure intended for Covid patients in its external area.
In Cascavel (Paraná state), a field hospital operating in the Events Center has its structure ready to be reactivated, with stretchers, oxygen tanks and additional equipment, but it will only be put into operation if cases continue to rise, says the City Hall.
Rio closes facility
Rio de Janeiro City Hall announced on Tuesday the closure of operations at the Riocentro Field Hospital, in the city’s west zone. It was the last temporary facility for exclusive care of Covid-19 patients still in operation. All patients have already been transferred to other facilities. Equipment and healthcare professionals will be directed to other care centers.
The municipality set up the Riocentro hospital, which had up to 500 beds (100 of which in the ICU), but decided to close it, despite the pandemic surge. The Secretariat explained that the decision is based on experts’ advice. They recommend the reopening of inactive beds in the public network, in specialized hospitals, which will result in significant cost reduction.
In a press conference on Tuesday, the Secretariat confirmed the opening of 343 new Covid-19 beds – 193 of them in the public system and 150 in the private. According to the portfolio, 80 beds have already been opened at the Ronaldo Gazolla Municipal Hospital and another 20 at the Souza Aguiar Municipal Hospital.
“Some R$250,000 per day are expected to be saved with the opening of beds at Ronaldo Gazolla,” reported the Secretariat. The portfolio also said that “the daily rate of Riocentro field hospital costs around R$12,500, well above the average of private hospitals.”
The ICU bed occupancy rate for Covid-19 in the municipality’s SUS network (including beds in municipal, state and federal facilities) currently stands at 91%.
According to state Health Secretary Carlos Alberto Chaves and Municipal Secretary Daniel Soranz, the regulation of SUS beds for Covid-19 throughout the state will be unified as of next week. According to the state, over 900 beds have been opened since November.
In Santa Catarina, Governor Carlos Moisés said that the investment will be directed to Santa Catarina’s public and charitable hospitals. By the weekend, all of the state’s regions recorded over 85% occupancy of their hospital system for Covid-19.
Source: O Estado de S. Paulo