RIO DE JANEIRO, BRAZIL – The medicine was bitter, but it seems it worked. One month after emptying the streets in a lockdown that closed even the markets, Araraquara, in São Paulo’s countryside, now sees far less crowded health centers and ICUs.
Between February 21 and March 21, the daily average of the new coronavirus cases in the state increased 40%. In Araraquara, however, it dropped 58%. The day before yesterday, another encouragement: it was the first time in 44 days that the city did not register any death by Covid-19. Praised by specialists, the experience has also motivated other city governments to tighten restrictions.
Araraquara was the first city in São Paulo with more than 100,000 inhabitants to ban the circulation of vehicles and people throughout the day, except in exceptional cases. Public transportation was suspended, and other essential services were drastically restricted.
When the measure was adopted on February 21, the health network had collapsed, with 100% occupancy of hospital beds and serious patients transferred to distant cities. The circulation of the P.1 coronavirus variant originating in Manaus, which studies have shown to be more transmissible, had also been confirmed.
The first ten days were of total lockdown and intense inspection – with blitzes and fines of up to R$6,000 (US$1,100). After 13 days, there was no more waiting in line for ICU beds. “We knew that the measure would work, but we didn’t expect it to come so fast, beyond our expectations. We are living a much calmer situation”, celebrates the Municipal Health Secretary, Eliana Honain. The fall in the dissemination of the virus also appears in the proportion of those infected.
At the Vila Xavier Emergency Care Unit (UPA), the gateway for Covid-19 cases, almost 500 patients per day arrived in the third week of February. Now, this number has dropped by half.
“For the professionals who work on the front line, there is no doubt that the lockdown has had positive effects on the decrease in patients and reduction in hospital occupancy,” says nurse Emanuelle Laurenti, technical director of hospital management who is responsible for UPAs and two back-up hospitals for Covid-19.
According to her, “in such turbulent and sad times, dealing with this disease without the certainty that the patient will stay alive,” it is necessary to thank all those involved in this fight.
In February, the ICUs were fully booked for almost the entire month. In March, this occurred only three days. Now, with other cities in the interior, Araraquara is helping its neighbors. Half of the 194 people hospitalized in the city yesterday were from out of town. In the ICUs, 60% are from other cities.
With full hospitals and patients in line for ICU, neighboring São Carlos has 27 inpatients in Araraquara, 45 km away. This week, the Santa Casa of São Carlos even requested the transfer of its 30 ICU patients due to exhausted stocks of medicines; however, it was able to retain the patients after other hospitals loaned medicines.
“You can set up a thousand beds. If you don’t contain the contamination, it is impossible to contain the high demand”, recognizes the Secretary of Health of São Carlos, Marcos Palermo. Among the most recent measures, the city decreed an optional day off on the 1st and hefty fines for those who rent leisure areas for events. But he rules out lockdown.
Manager of a funeral home in Araraquara, Rosana Cabral, estimates a 40% increase in burials during the most critical phase. “This year, our funeral home even did nine attendances in a weekend, something I’ve never seen before,” she says, who has worked in this area for 11 years. The reduction in pressure in the sector was observed only last week. The weekly average of deaths dropped 39%.
“We saved lives, and now we can work within the emergency phase decreed by the state government,” says Mayor Edinho Silva. With softer rules than the lockdown in Araraquara, João Doria’s administration has increased restrictions on commerce and banned school classes and collective religious services. Still, there is no veto on the circulation of people and vehicles. The measure lasts until April 11.
Resistance and example
Not everyone, however, was satisfied with the extreme closure. The Araraquara Commercial and Industrial Association installed billboards in the city with the sentence: “Mr. Governor and Mayor, there is no contamination in the companies, we need to work”. The association even obtained a temporary order allowing the businesses’ reopening, but the courts soon revoked the decision.
Lucas Paravani, an employee of an equipment company, criticized the lockdown. “The only people who supported the lockdown were those who were guaranteed a month’s salary. For those who didn’t work, it isn’t easy. Civil servant Claudia Carrera, on the other hand, praises the lockdown. “Even the worst denialist should have the humility to recognize that today we have beds, even for him.”
The mayor says the measure is tough but necessary. “We have to keep up the isolation for the health system not to collapse, since vaccination is not yet at the ideal speed,” he says, who also relies on other actions, such as isolating infected people.
On the other hand, the good results have stimulated more rigorous restrictions in other cities. The neighboring towns of Américo Brasiliense, Boa Esperança do Sul, Rincão and Santa Lúcia closed everything soon after Araraquara did.
In São José do Rio Preto, the lockdown went into effect on March 17th and is valid until the 31st. Residents are forbidden to circulate on the streets without a valid reason and can be fined R$ 1,250. Gas stations can only serve drivers of essential service vehicles.
Ribeirão Preto closed essential activities and prohibited people from circulating as of the 17th, with the hospital network on the verge of collapse. The lockdown lasted five days, and the results are being evaluated.
Infectologist Carlos Magno Fortaleza, from Unesp, remembers that the lockdown has already worked well in other countries, like Portugal. In Araraquara, it could have been more effective if the whole region had adopted it. “They are interrelated cities and Araraquara is also related to the Triângulo Mineiro (an area in the neighboring state of Minas Gerais). If there is virus in other cities, there is a risk of it coming back. Therefore, it is not a perfect situation, but it is much better than before.
It is also important to observe the isolation time. “In Araraquara, the lockdown only started to show results after the 14th day. People who speak against isolation expect results in three or four days, which doesn’t work,” he highlights.
For Raque Stucchi, an infectologist at Unicamp, a national lockdown is not feasible, but it would be important to have a regional lockdown.
“Without a doubt, lockdown brings economic impact with restrictions on activities. To minimize it, government aid is mandatory, both with emergency aid, such as tax reduction, an extension of payment terms of charges, subsidies to maintain jobs.”
The emergency aid was interrupted in December but will be resumed in April, with smaller amounts – from R$150 to R$375. Last year, monthly payments ranged from R$300 to R$1,200.