Projecting 460,000 Infected in São Paulo, Brazil Hardens Fight Against Coronavirus

RIO DE JANEIRO, BRAZIL – Although less forcefully than other countries, the Brazilian government stepped up the fight against the coronavirus on Friday, March 13th, and began to recommend that mayors and governors take tougher social distancing actions to curb the incidence of the Covid-19.

If no such actions are taken, health authorities project that the number of infected could double every three days in the country – rapidly increasing the incidence of cases that could evolve into severe conditions and overload the health system.

For now, only 12 of the 98 cases officially confirmed in the federal sphere are being addressed in hospitals, and the SUS (public health service) has been able to meet the demand. However, São Paulo and Rio de Janeiro now have community transmission of the disease, when it is no longer possible to identify the origin of the infection and contagion gains speed.

In Rio, classes are suspended as of next week. In São Paulo, where the state government projects that at least one percent of the population (or 460,000 people) may become infected in the next few months (even if most of them are asymptomatic), the shutdown will be gradual. In both cases, there is a ban or restriction on mass events.

The government estimates that every three days the number of infected individuals (there were 98 officially confirmed cases on Friday) may double if these measures are not implemented, although it recognizes that each municipality should have a differentiated epidemiological curve according to the beginning of local transmission.

Thus, the most widespread restrictions involve actions by local management. “Brazil is very large and we have deep differences. Non-pharmacological measures are recommendations. We are no longer guiding, we are recommending. We haven’t reached the determination stage yet,” said Wanderson de Oliveira, Health Surveillance Secretary.

At the federal level, the most forceful action was to ban tourist cruises indefinitely. And to establish clearer rules on when is the right time for mayors and governors to decree a quarantine in specific locations in order to delay the peak of disease transmission. The guidance is for local officials to issue orders to isolate areas when the available beds to treat severe cases of the disease reach 80 percent occupation.

The aim is to gain time for health systems to recover in a context where critically ill patients spend more time in ICUs. On Friday, there was a change in the way this disease is being addressed. If before, the government only advised a more restrictive type of action, it began to recommend it and said that at any time it may determine mandatory measures, depending on the pandemic’s progression.

In the country’s two largest cities, São Paulo and Rio de Janeiro, this stage has definitely arrived.

The government of São Paulo, the leading state in the number of cases of the disease, recommended that events involving over 500 people be canceled. It has also decided to gradually suspend classes in the public school system starting next Monday. During the next week, classes will still take place, but absences will not be counted.

The aim is for families to have time to plan and prevent children from staying with the elderly, a populace at greater risk of complications in the event of infection. There will also be no holidays for health professionals, a way to keep the health system operating as efficiently as possible.

The country’s most populous state, with 46 million inhabitants, uses other countries’ epidemiological experience with the Covid-19, in addition to the numbers of respiratory epidemics with other viruses, to draw up scenarios.

The most conservative of these is that between one and ten percent of the population will be infected, with twenty percent of them in need of hospital medical assistance. “Scenarios are estimates. It could be one, two, five, ten percent. There’s a new fact we need to learn: how this virus will behave in a tropical country in the summer. In a little while, it’ll be fall. I can’t tell today if it will be one or ten percent,” said David Uip, head of the state’s fight against the disease.

Rio de Janeiro, on the other hand – with one of the most fragile health systems, according to Minister Luiz Henrique Mandetta – also decided to suspend classes from both the public and private school systems. Mayor Marcelo Crivella canceled classes on the municipal schools for a week, while Governor Wilson Witzel decided to anticipate school vacations and suspend classes in state and private schools for 15 days.

He also banned mass events and made a controversial statement that if there is a large crowd on the beaches, the State Police could act. “Although the beaches are a federal area, in a situation like this the State Police, the firemen, the municipal guard can act to prevent crowds,” he said. Witzel also suspended visits to prisoners.

Social distancing actions have also been determined by the Federal District in recent days, although it has not yet had cases of sustained transmission of the disease. In some states, governments are starting to limit activities in public bodies and avoid work trips by civil servants.

Ceará and Pernambuco have decided, for example, to ban tourist cruises already underway from docking in their territories after the Federal Government prohibited new cruises (whether national or international) from starting activities in the country.

“Tourist cruises are traditionally confined spaces. Many of them carry international tourists,” says Wanderson de Oliveira, mentioning Japan’s dramatic case. In Brazil, there are at least two suspected cases involving a cruise ship in Pernambuco, whose tourists are in isolation.

There are general recommendations from the Ministry of Health regarding the measures that should be implemented to stop the coronavirus from spreading, but it is up to the states and municipalities to determine their own specific actions.

In areas of sustained transmission, the Federal Government recommends actions that involve reducing the urban flow with alternative schedules for workers, encouraging the home office and daily monitoring of ICU beds.

There is greater concern over the progression of coronavirus in the country with the onset of fall next Friday when temperatures drop in several regions of the country and seasonal viruses that had previously circulated in Brazil also return.

Source: El Pais