Paraná Capital City’s Public Health System Could Collapse in Seven Days

RIO DE JANEIRO, BRAZIL – The surge in new Covid-19 cases in Curitiba and the Metropolitan Region is pushing the city’s medical care structure to its limits. Four physicians who chose to remain anonymous were heard by the reporter, two from the SUS (Brazil’s National Health System), and two from private hospitals. The professionals estimate that Curitiba’s ICU and ward beds could be used up within a range of seven to 14 days.

One of the doctors said that taking into account the new cases, the expected number of hospitalizations alone (about 10% of the total number of patients) would in itself push the system to its limits. Curitiba confirmed 1,597 new cases on Wednesday, November 25th, which would represent a potential new 159 hospitalizations, among ICUs and wards.

This calculation does not consider the possibility that people from this group have already been hospitalized, hence included in the 93% ICU beds occupancy.

Engineer Murilo Linzmayer designed a projection on the data of the past 21 days. “Considering the trend in this period, we have on average an increase in bed occupancy of four ICU hospitalizations per day, while in wards, it is at least seven. Based on our maximum capacity of active beds in mid-August, within a period of seven to ten days all beds will be used up”, he explains.

The difference in timing hinges on several factors. The first and most crucial is how many beds the city will be able to deploy within the next few days. In August, when the capital experienced another wave of growth in cases, the Municipal Health Secretariat (SMS) managed to enable a maximum of 355 ICU beds and another 444 ward beds.

The question now, the professionals say, is whether there will be teams of doctors and nurses to attend all the extra beds available. The Municipal Health Secretary herself, Márcia Huçulak, declared in a press conference that the teams are “exhausted” and that it has been more difficult to persuade professionals to work double shifts.

Curitiba currently has 334 Covid-19 ICU beds in operation and 313 occupied (data from the November 25th SMS Bed Census, the most recent available).

Two weeks

In July this year, when the wave of cases began, the recurring assessment was that the city had closed “too soon”. In other words, it  had paid the economic price of keeping trade and services closed for a period (from April to June) in which the city had no major challenges in dealing with the pandemic.

It is conceivable that this perspective is currently driving Mayor Rafael Greca’s initiatives, who has been resistant to taking new measures to restrict non-essential activities.

The problem, the numbers show, is that the city has returned to a “normal” pace without the wave of infection ending. On September 28th, when the current yellow flag was decreed, the city had 80% of its 334 Covid ICU beds filled.

This percentage dropped in the ensuing weeks to 63.3% from 319 beds on October 12th, the lowest occupancy rate reached in the period. On October 27th, when the number of new cases began to rise again, ICU bed occupancy stood at 79%.

This means that Curitiba has moved from a serious situation to an escalation of new cases, reaching the limit faster. And, in practice, it was only two weeks of slack for hospitals and their teams.

And if their beds are exhausted?

If Curitiba reaches the maximum occupancy of its Covid-19 ICUs, some scenarios should unfold. First, the city hall should step up its efforts to open new beds, disabling services, suspending activities, although there are currently plenty of assistance services suspended.

There will also be a line of patients waiting for invasive treatment out of intensive care units. And there will be a dispute over resources and professionals of common use beds for exclusive Covid-19 beds.

Depending on the time it takes for the beds to be exhausted and on the conditions of patient care, it is likely that there will be an increase in Covid-19 patient mortality rate in the capital.