RIO DE JANEIRO, BRAZIL – Despite a slowdown in the rates of admissions to Covid-19 ICU beds in the state of São Paulo, epidemiologist Paulo Lotufo, 64, believes that this is not the time to allow flexibilization, because the numbers are still high, as well as in the possibility of facing a third wave of the disease.
The expert’s opinion is in line with a study suggesting that relaxing restrictions prematurely is a detrimental factor in the fight against Covid-19. The statement is from a group of researchers who have been monitoring state measures since the start of the pandemic.
In their view, the premature relaxation of measures that lead to crowding may accelerate the spread of the disease and the loss of credibility in the state strategy.
On Sunday, the Doria administration started a transition phase, with the reopening of stores, from 11 AM to 7 PM, and the authorization of religious ceremonies. On April 24th, the measure will be extended to the service sector.
QUESTION – How do you analyze the current moment of the pandemic in the state of São Paulo?
PAULO LOTUFO – We are currently experiencing a tragic moment, because we have all sorts of negative conditions: increase in cases, hospitalizations, deaths. At the moment there is a slowdown, but still with very high levels, higher than in May. The main concern is how this reduction in mobility will be implemented. The evidence we have is that all these measures have reduced transmission.
Ideally, the emergency situation should have been extended for a while longer, and the red phase until Mother’s Day. Trade would then have to adapt. Why do I say this? Because Christmas was catastrophic and it is feared that Mother’s Day will be something similar.
Q. – So this is not the time for easing up?
PL – Not yet, because we have very high numbers and we need to come down to lower figures to have peace of mind. At least get to numbers that we reached in the capital around August, September.
Q. – On the bed occupancy rate?
PL – No, the bed occupancy rate, to me, is an administrative fact. You can increase beds and decrease the rate. The most important thing is the number of new cases, hospitalizations, ICU admissions, and deaths.
Q. – When we talk about a slowdown in hospitalizations, what actually happens: do more people die and hospitalizations drop, or is transmission lower?
PL – The mortality is relatively low in relation to the number of cases – it’s 3%, 4%, at most. So it has no great impact on the number of hospitalizations. What is really determining is transmission.
Q. – The virus is more violent compared to last year. What has changed, apart from the variants?
PL – The strains have a component that I am actually describing as fabulous, because it has not even reached 1% of the genome of our cases. My interpretation is that what happened in 2020 was a higher containment of people: when relaxation began, there were several moments of an over-spread with a very large viral load. The other interpretation is that there was a delay in seeking medical attention. We are tired of seeing people with symptoms [of some disease] who say they are fine and seek medical attention too late.
The other possibility is using the famous early treatment, which is a profoundly stupid term, because either the treatment is timely or late. Another possibility, colleagues say, is people who think they are better protected with early treatment. They become more infected, take longer to seek care, and when they do, they are more critical. I saw a banner in Curitiba, during a demonstration, that I thought was very cool: ‘Why vaccine if we have chloroquine?’ It manages to very well describe these people’s reasoning, who can’t tell the difference between a vaccine and medicine.
Q. – Do you believe in the third wave?
PL – I think it’s possible, yes, because the political question is totally in favor of all the social distancing measures not being able to be maintained – this thanks to the President of the Republic.
Q. – Will Marcelo Queiroga be a successful Minister of Health, in your opinion?
PL – He has already completed 28 days. Nelson Teich, who stayed for 28 days, didn’t have a great understanding of epidemiology, but he was a person with other skills. One important thing that Teich did was when the Oxford University/AstraZeneca vaccine came out and it needed clinical trials, but there was no money. He secured donations, went to Fiocruz and managed to get phase 3 done here. He began to set up the whole information system to streamline data. What I see from Minister Queiroga is that he is only following protocol. He tries to preach some things like “the country of masks” and, two hours later, Bolsonaro is walking around without a mask. I don’t think he’s going to leave office because he has other interests. He has disclosed some additional ideas and if he pursues them, he might do some good.
Q. – Is public transportation and the opening of schools to blame for the large number of cases?
PL – Not schools. Transmission in schools is relatively low. My slogan is “school is the last to close and the first to open.” Public transportation, yes, it is the big problem. In areas with many intersections, more in the center, the local population was showing higher transmission levels.
Q. – What would be the solution?
PL – I think that we are paying, not only São Paulo, but Brazil and Latin America, for the insane form of urbanization that was done. Rather than concentrating more in the central area so that the distance would be shorter with more diversity, we made this madness. Cidade Tiradentes [a lowcost housing project] is the ultimate example of total madness. You put 200,000 people in a place that had nothing and they needed to go out to work. These are places you should build and bring people to. You already have all the public benefits there. But, no, you leave some areas deteriorated and you throw the people in the pits of hell. That motto, “My House, My Life, my end of the world.”
Q. – In your opinion, what would be the solution to vaccinate the population more quickly, other than more doses?
PL – In the beginning, I was a heavy critic of what was done. I’ll give a positive example. Campinas is a big city, they set up a central location and sent everyone in through the internet, WhatsApp, phone to schedule an appointment. They administered the first dose. People were registered and were told that they were going to take the second dose at the UBS (local health center). If patients didn’t show up in three or four days, they would come after them. When they were very old, they would administer it at home. I advocate that the first dose be centralized and the second dose in the UBS, to allow searching for absentees.
PAULO LOTUFO, 64
Epidemiologist and professor of clinical medicine at USP’s School of Medicine.
Source: Folha de S.Paulo newspaper