With ICUs at full capacity, Brazil’s South adopts restrictive measures and strict enforcement policies

RIO DE JANEIRO, BRAZIL – A group violating curfew was dispersed by the Paraná state police, where the governor is aligned to Bolsonaro. “Not even if beds were infinite would there be capacity for care,” alerts health manager.

Paraná dawned last Saturday, February 27th under a lockdown. Only essential services are allowed, and circulation on the streets between 8 PM and 5 AM is banned until March 8th. Next door, neighboring Santa Catarina followed a similar measure, although only over weekends, and determined that non-essential services close between 11 PM and 6 AM.

In Rio Grande do Sul, the so-called “black flag” is now in force: until March 2nd, there are also restrictions on traffic and activities between 8 PM and 5 AM. These stricter measures were decided due to the surge in the number of covid-19 cases in recent weeks in Brazil’s 3 southern states and the concern with the situation of hospital beds, which are becoming increasingly scarce.

This reality is now spreading throughout the country, where the healthcare network in 17 states is currently overwhelmed and may collapse at the same time this month.

The ICU situation in the southern states is critical. In all 3, the occupancy rate exceeds 90% “We have never had as many hospitalized patients as we do today. Clinical beds alone [for less critical patients] record over 70% occupancy. The new strains are hitting the population hard,” said the Health Management director of the Paraná Health Secretariat (SESA), Vinicius Filipak, at the press conference announcing the restrictions last Friday.

The State registers 578 patients waiting for hospitalization, either in wards or ICUs, and plans to open 258 new beds by Monday. But the director states that the situation is so critical that “not even if beds were infinite” would there be capacity to attend all. In Paraná, the two new Manaus and UK strains are currently in circulation.

In the western region of the state, where tourist cities such as Foz do Iguaçu are located, there is a 97% ICU bed occupancy for critical patients – there are only eight beds available. With a little more than 35,000 inhabitants, the city of Matinhos, on the coast, recorded 672 cases of covid-19 in the first two months of 2021 alone (an average of 11 per day), in addition to 9 deaths, according to a SESA report.

The figure at the beginning of this year is not far short of the accumulated number over the full 12 months of 2020: the city had registered 894 cases last year. Faced with this scenario, Mayor Zé da Écler announced local restrictions last Wednesday, February 24th, even before the state government decreed the lockdown.

The mounting pressure on the Paraná healthcare system led health secretariat officials to win an internal battle within the Paraná government, which was reluctant to restrict people’s movement. Health officials who chose to remain anonymous said that the state health secretary, Beto Preto, wanted to “soften” decree 6.983/2021, which determined the lockdown. The ties of governor Carlos Massa Ratinho Júnior (PSD) with president Jair Bolsonaro, himself a critic of the lockdown measures, is another relevant aspect.

“The technical area prevailed, but they didn’t believe in the restriction. There was a more serious and heavy discussion. The fact is that the Government of Paraná has never been a protagonist, of stepping up measures in relation to the pandemic, much because of this alignment with the Presidency,” said a servant.

On February 25th, Bolsonaro met with Ratinho Jr. at an event at the Itaipu Power Plant, where both were photographed together, without masks. At the press conference in which the new measures were announced, Health Secretary Beto Preto, however, called on the Ministry of Health for greater speed in the delivery of vaccines (so far, about 300,000 people have been immunized in Paraná). “We have been urging the Ministry of Health, with all due respect, for greater access to vaccines. We have teams prepared to immunize,” he said.

Given this alignment with the federal rhetoric, the adoption of a harder measure in Paraná was surprising. The governor pointed out in the press conference that the state is “in the worst moment of its fight against this pandemic “, but that there is an effort among the city halls for the need of tougher measures, said Ratinho Jr.

The governor also emphasized that the state police command will conduct intense inspection activities. “We will not accept violations through illegal and deliberate meetings and parties. We will impose fines and imprisonment. We will be extremely strict with those who do not comply with the decree,” he said, in a tone different from that used by the Bolsonaro family on social networks. In Curitiba, in the early hours of Friday to Saturday, a large group of people had to be dispersed with tear gas bombs in a region that concentrates several bars, as the clients refused to go home.

Facing the crisis, Rio Grande do Sul state also suspended co-management (where cities had autonomy in relation to activities), and Governor Eduardo Leite PSDB imposed the same level of restriction throughout the state. Non-essential trade operates only in the delivery model and circulation is banned between 8 PM and 5 AM until March 7th. In the South, the state has recorded the highest number of deaths to date: 12,343 in the first year of the pandemic. The situation in February posted a record rolling average of deaths: 84, according to the State Health Secretariat. There was a 54% in the last 14 days alone.

Santa Catarina is the only state that resisted the extension of rules and governor Carlos Moisés enforced a “weekend lockdown”; non-essential services are suspended from 11 PM on Friday, February 26th to 6 AM this Monday, March 1st, and circulation on the beaches is banned. The measure extends to next weekend. Despite the rules, there are records of violation on the beaches, and the state police was forced to disperse beach-goers in points such as Jurerê Internacional. Data from the media outlet consortium show a surge in deaths in the past 14 days, following the pattern of Rio Grande do Sul and Paraná. On February 17th, 26 covid-19 deaths were registered. On Saturday, February 27th, there were 72, an increase of over 60%.

Younger patients

“We wonder if this is a new wave or a new peak of the same wave. In something like two, three days, hospitals are taking many patients at the same time needing hospitalization. The covid-19 patient’s length of stay is two to three weeks, which greatly saturates the system,” says Viviane Hessel , infectologist and coordinator of the Epidemiology and Hospital Infection Center at Marcelino Champagnat Hospital. The profile of patients has also changed, according to the doctor: they are younger, in their 40s, and many are hospitalized in serious condition.

Another aspect that worries health managers is the high mortality of patients with the disease in Intensive Care Units. It stands at approximately 40% in the state, according to Filipak, SESA’s director of Health Management. “It’s extremely serious.” Overall, explains Viviane Hessel, covid-19 mortality in ICUs ranges from 35% to 45%. “It doesn’t mean that patients in the ICU will die, but the chance of a fatal outcome is higher. And despite the learning in treating the disease, some people respond well, and others don’t.”

Healthcare professionals are also exhausted – Curitiba’s city hall launched last week a campaign with reports that show the feelings of front-line healthcare workers in relation to denialism of the pandemic. Among these professionals is physician Carlos Eduardo Valim. Besides the logistical complexity in the opening and closing of beds, and anxiety, the numbers of deaths published every day are very familiar to them. “When I see in the city hall report that 10 people died, I know who these people are. Many of us work in more than one health services, and we know which hospital they are from, how the death occurred. And that is very complex to deal with on a daily basis.”

Source: El Pais