São Paulo Faces High ICU Occupancy Rate, Will Increase Testing

SÃO PAULO, BRAZIL – The state of São Paulo, the epicenter of the coronavirus pandemic in Brazil, plans to clear the backlog of tests for the disease by April 24th. The announcement was made by Governor João Doria at a press conference on Wednesday, April 15th, and detailed throughout the day by the State Health Secretariat team. In short, the promise to clear away the waiting list is due to the purchase of 1.3 million rapid tests from South Korea, 725,000 of which arrived this week.

The state administration is pending 13,397 coronavirus tests. On Wednesday, 1,451 tests were released and another 2,370 were awaiting release, while in parallel, the system received 1,319 new tests. The same day the state government confirmed 11,043 cases of Covid-19 and 778 deaths from the disease.

Currently, an average of 2,000 tests are processed daily, but the processing capacity is expected to increase to 5,000 next week and 8,000 the following week, as the laboratories are certifying their devices, according to Health Secretary José Henrique Germann. In order for this productivity increase to occur, 34 new centers have been accredited, while another ten are finalizing this stage.

So far, RT-PCR (real time polymerase chain reaction) is the principle test available in São Paulo and elsewhere in the country. It detects the virus’ RNA in a blood sample or nasopharyngeal secretion – collected by a swab through the nose or mouth. Given the limited amount of these tests, the Ministry of Health’s guideline is that only people with severe symptoms of the disease should be tested.

“There is a lack of notification, because 80 percent of the cases are asymptomatic and individuals don’t even go to a health center,” explained infectologist David Uip, coordinator of the technical team fighting the coronavirus in São Paulo. Furthermore, as there is a waiting list for testing, it is believed that the picture reported daily reflects the pandemic of the previous days.

The rapid test kits from South Korea will help not only to detect which patients have been infected by Covid-19, but also to assess the progression of the epidemic in the state by conducting seroepidemiological surveys. However, Uip ponders the effectiveness of the new test, which identifies the virus from the production of antibodies. As these take time to be produced by the human body, the test may produce what specialists call a false negative.

“The PCR test tells us if the virus is circulating in a person’s body. The rapid test does not have a good name, as it only has that name because it takes only 10 minutes to be performed. But it only works after the individual has had contact with the virus for a long time and his or her body has already produced the antibodies to fight it,” he explained. “So the test isn’t fast, it’s slow. We have to wait at least eight or ten days to get a result. It can be very useful to assess population immunity,” he concluded.

“Stress” in the public system

The São Paulo Government team also provided data showing a near capacity of ICU and ward beds in state hospitals. The Emílio Ribas Infectology Institute, a benchmark state unit, has all its 30 ICU beds occupied, but Uip ensures that another 20 will be opened in the next two weeks. In the same center, 80 percent of the infirmary beds are occupied.

The Clínicas Hospital of the University of São Paulo saw an increase from 77 to 83 percent of the ICU beds occupied. The public hospitals Geral de Pedreira and Vila Nova Cachoeirinha have 87 and 86 percent occupancy of beds, respectively. “There is now pressure on the public health system”, said Uip. He adds that the stress in the public network should occur in late May, when ICU bed occupation should reach up to 95 percent.

Considering that a patient’s length of stay in ICU beds is up to 15 days, Germann says that a “first reserve” of more than 2,000 vacancies – now available and with all the resources allocated – should be filled in May should the rate of isolation of people not exceed the current 50 percent.

A second reserve of vacancies, with another 2,000 beds – still lacking allocated resources and which will be activated as the pandemic progresses in São Paulo- would succeed in deferring the “stress” on the state health system to July. Currently, there are 1,143 patients hospitalized in ICUs across the state, which has also recorded an 81.7 percent increase in coronavirus death reports in the past week.

Source: El País