Number of Covid ICU Beds Funded by Ministry of Health in February Half That of January

RIO DE JANEIRO, BRAZIL – Despite the worsening of the coronavirus pandemic in Brazil, this February only half of the ICU beds to treat patients with Covid-19 funded by the Ministry of Health in January will be available – in the health emergency, the federal portfolio pays part of the costs alongside states and municipalities.

According to data presented by the Ministry last week, there were 7,717 beds in use last month and 3,187 in February. A total of 13,045 beds lack federal authorization, points out the survey made by the National Council of State Health Secretaries (CONASS), with data up to January 20th, and there is no prospect of a quick solution, as it would depend on budget funds that still need to be voted in the National Congress.

The situation is worrying local administrators, who will need to pay for these expenses amid a surge in cases and hospitalizations – and the resulting need for more beds. Several regions in the country are experiencing strong pressure on their healthcare systems: eight capitals have over 80% of their ICU beds occupied. CONASS points out that several states are closing beds, when they should be expanding the network, because they are unable to afford to keep them operating.

Local personnel fear that other parts of the country will experience dramatic situations such as Amazonas in a scenario where a new and potentially more transmissible strain is circulating and vaccination is still slow in the country.

“It is feared that the same will occur in other places in the country. This is the worst moment to close beds,” argues the president of CONASS and Health Secretary of Maranhão, Carlos Lula.

Although there was a sharper cut this year, Carlos Lula explains that cuts in the Ministry’s ICU beds for Covid-19 have been gradually occurring since mid last year. “We reached 17,000 beds and today we have around 3,000 authorized. It’s as if the Ministry is saying that now states and municipalities will have to sustain assistance on their own. This can ultimately lead to a shortage of beds,” he says. According to him, the Ministry funded these ICU beds with R$1,600 and states and municipalities paid the balance, since the daily cost averages R$2,500.

The president of CONASS says that the problem has been referred to the Ministry of Health on several occasions, including stressing the need to include these resources in the budget to tackle the disease.

He recognizes that the portfolio has lost resources, but a solution was needed given the fact that the pandemic is not over. “Either the Ministry did not plan or it planned for Covid-19 to end last year,” he says.

Carlos Lula says that now this is a complaint of all states and municipalities, adding that the Ministry’s reactions merely point to the fact that it is trying to negotiate budget resources with the Federal Government. “They are not saying anything more than that. The budget proposal is insufficient. Basically, it is the 2019 one with an extra 1%, as if Covid-19 had not existed in 2020,” he adds. A committee is still being formed in Congress to discuss, with a delay, this year’s federal government budget.

Brazil has again registered over 1,000 deaths per day from the coronavirus and is faced with concerns over a new strain found in Manaus that could potentially be more transmissible. On Thursday, February 4th, another 1,232 new deaths were registered, with the country reaching more than 228,000 official deaths in the pandemic.

“Unless we take immediate action, there will certainly be a much more serious crisis,” conceded the Ministry’s deputy Secretary of Specialized Health Care, Maria Inez Pordeus Gadelha, during a meeting last week.

She said the financial availability must be addressed to meet the demands for beds made by the states and suggested that managers use the R$864 million released by the so-called “war budget” to fight the pandemic late last year to meet the need for beds.

At the time, the executive secretary of the National Council of Municipal Health Secretaries, Mauro Junqueira, agreed that these funds could be used to pay for beds for the time being, but considered the need for dialogue with Congress because even these resources are limited.

“We need to talk to Congress because the MP [Provisional Measure] resource is for the purchase of vaccines and there is none for new beds. And the R$864 million may be enough for a month or two given the surge [of the pandemic]”. However, Carlos Lula considers the portfolio’s proposal “technically flawed” because the resources have already been allocated for use in other measures to fight the pandemic.

“I don’t think this is an appropriate move because you pay the ICU ahead, not backwards. What is our reality? We are reopening closed beds or opening new beds because of the worsening pandemic,” he explains. “It’s surreal where we have placed ourselves today in terms of sustaining the healthcare network.”

The cut has impacted all states, despite the economic inequalities between them, says Carlos Lula. In Maranhão, where he serves as Health Secretary, there are only 15 beds financially supported by the federal government at this time. “This state does not have large resources. But this is a complaint even from the wealthiest states. Santa Catarina is saying that it must close beds because it can’t afford them,” says Carlos Lula.

São Paulo’s Health Secretary Jean Gorinchteyn, also brought the deadlock to the public this week during a press conference and demanded answers from the Ministry of Health. According to him, only 11.4% of the Covid-19 ICU beds maintained by the federal government last year in São Paulo are still registered with and funded by the federal government. “Until last year we had almost 5,000 beds in the public system, they were registered. At the start of the year, abruptly, we have only 11% of this figure. That is, a total of 564 beds registered and funded by the Ministry of Health,” he said.

“The absence of a response means that states and municipalities will have to spend, overnight, R$210 million per month to fund these beds which the Ministry suddenly ceases to support,” said Eduardo Ribeiro, São Paulo Health Secretariat’s executive secretary. Gorinchteyn said he has sent several letters to the Ministry on this matter and a request to send syringes and needles, but with no effective replies. “The pandemic is not over, and the Federal Government has to fulfill its part,” he said.

A palliative proposal submitted by Health administration officials to the Ministry included the creation of a central field hospital in Brasilia to be maintained by the federal government, mainly due to the situation faced by states in Brazil’s Northern region, such as Amazonas and Pará. Hundreds of Covid-19 patients are being transferred to other states to be assisted, which involves high costs in flight logistics. “It would have already receive these patients. As it is in the Central region, it would be easier to solve supplies. It would be more rational,” argues Carlos Lula. “This would be a palliative solution, particularly considering the situation in the Northern region.”

For the president of CONASS, cuts in ICU beds financed by the Ministry are “extremely worrisome,” particularly when the curve of infections is growing in the country and the pace of vaccination is still very slow. The available doses so far are scarce and directed to a small group within the population. According to him, the government has signaled that it will buy vaccines endorsed by the Brazilian Health Regulatory Agency for use in the country. However, until mass vaccination becomes a reality in Brazil, assistance to Covid-19 patients must be guaranteed. “Several states have already closed beds because they are unable to afford them. It is a paradox. At the time we need them the most, we are closing them,” he says.

The Ministry of Health did not comment on the issue.

Source: El Pais