Lacking ICU Beds and Tests, Minas Gerais Pays Price for Underestimating Pandemic

RIO DE JANEIRO, BRAZIL – The trip to the Caribbean occurred smoothly. Although Brazil had started issuing faint warnings about the coronavirus pandemic in early March, the travel agent assured Gilberto Loiola’s family that there would be no problems in keeping their itinerary. However, on his return to Poços de Caldas, in southern Minas Gerais, Gilberto felt unwell.

On three occasions he sought assistance in public healthcare units, but with no constant fever or major symptoms, he was sent back home. As he was still feeling unwell, he decided to visit a private clinic. An X-ray found that his lungs had been virtually consumed.

Gilberto died on April 13th. The death certificate listed respiratory failure as the cause. Only 26 days later did the State Health Secretariat confirm that the death of the retired commercial trader had been caused by Covid-19. “We had to take matters into our own hands, chase reports from the hospital and secretariat to amend the cause of death. We only got the correct certificate in early June,” says Carina Loiola, Gilberto’s daughter, who also lost her 67-year-old father-in-law to a Covid-19 infection.

He was on the Caribbean trip and, like Gilberto, had no prior risk conditions. Currently, Poços de Caldas, with 165,000 inhabitants, counts 302 confirmed cases and eight deaths by Covid-19. In the same region, Pouso Alegre counts over 479 infections and 11 deaths, six of which were reported over a period of four days.

The picture of the southern region of the state symbolizes a shift in perspective about the pandemic in Minas Gerais, where, until May, the authorities boasted of having the “situation under control” based on official data: fewer than 7,000 cases and 250 deaths. However, underreporting and insufficient testing proved decisive for the exponential increase in the number of cases between June and July, raising the figures to 78,643 infections and 1,688 deaths, with more than half (56 percent) of the total cases in the country’s second-most populous state confirmed during the past two weeks.

According to data from the Health Secretariat, there was a 930 percent increase in the number of hospitalizations for Severe Acute Respiratory Syndrome (SARS) between January and June, compared to the same period in 2019. The percentage is similar to that found in a study by a group of scientists from the Federal University of Uberlândia (UFU), which shows an increase of 750 percent in deaths by SARS in the state compared to the average of the preceding three years.

Deaths from pneumonia and respiratory failure, as initially attributed in Gilberto Loiola’s certificate, also increased, but in a much smaller proportion, by five percent.

“The numbers suggest underreporting of cases related to Covid-19 and are a reflection of low testing in the state,” explains professor and epidemiologist Stefan Vilges de Oliveira, from the Faculty of Medicine (Famed/UFU). “Many deaths are being misreported, mainly due to the unavailability of laboratory diagnosis. Brazil already tests little, and Minas tests far below the national average and that recommended by the World Health Organization (W.H.O.). This safety message conveyed by the authorities at the start of the pandemic, signaling that the situation in the state was comfortable, may have exacerbated the spread of the disease.”

Minas Gerais closed the first semester as the state that tested least for coronavirus in Brazil: 170 tests per 100,000 inhabitants, an index one-fifth of the national average (845). In São Paulo, the most populous state, 1,300 tests are conducted per 100,000 inhabitants.

Due to a shortage of diagnostic material, 73 percent of the nearly 3,000 deaths from SARS were ultimately recorded as “undefined cause” -when detecting the virus is not possible- more than twice the national average (30 percent, according to the latest balance released by the Ministry of Health). “In 2020, we had a higher number of notifications [of SARS deaths], but this increase was not reflected in the public healthcare system’s overload,” the health secretariat justified in late May when it had run just over 20,000 tests for coronavirus.

Low testing is the result of a Minas Gerais government strategy, led by Romeu Zema. The governor even stated in an address that “ICUs save lives, not tests“. In the first three months of the pandemic, the data that guided the state authorities’ actions were limited to the bed occupancy by patients with Covid-19, until then restricted to four percent of the public hospitals’ capacity, which led the state government to propose a plan to reopen the cities already in April.

Named ‘Minas Consciente’, the protocol drawn up by the state secretariat established guidelines to direct mayors to ease social isolation measures. In two months, 165 municipalities adopted the plan, but the boom in new infections forced most of them to reverse the reopening schedule.

In the capital Belo Horizonte, which was one of the least impacted by the pandemic, Mayor Alexandre Kalil implemented actions independently of the state government. One month after authorizing the reopening of trade, coronavirus cases and deaths doubled. In late June, the municipal government of Belo Horizonte accepted the need for a new closure of non-essential activities.

“Minas Gerais has basically used the number of beds as an indicator of the severity of the pandemic. Had there been more testing, in addition to other more reliable indicators, the state would have been able to pre-empt actions to prevent the growth in the number of cases. Testing little is very worrying because the data serve as a justification for relaxing quarantine,” Oliveira says.

Currently, 25 percent of ICUs in the state are occupied by people infected with the coronavirus, which sounded the alarm for a change in the government’s stance. Despite having created over 1,000 new ICU beds in the public hospital system, compared to the number available at the start of the year, the state is concerned with the risk of the 3,300 existing beds being insufficient should the pandemic continue to spread at the same rate as last month.

More than half of these beds are located in large cities, which need to attend to the cases recorded in inland municipalities. In Belo Horizonte, the ICU bed occupancy rate has reached 90 percent. Cities such as Guaxupé and Lavras, in southern Minas Gerais, announced they have reached their full capacity in beds reserved for Covid-19 patients.

With almost 350,000 tests conducted, the state now plans to increase its testing and hospitalization capacity. Last Thursday, the Ministry of Health released R$17 million for the opening of 118 ICU beds in Minas Gerais, in addition to providing 500,000 testing kits. The government of Minas Gerais states that “it is focusing all its efforts on increasing its testing capacity, with the purchase of supplies and serological tests, in addition to expanding the network of partner laboratories” for coronavirus diagnosis.

While authorities are banging their heads, the virus is ‘traveling’ across the state

One of the obstacles in tackling the pandemic in Minas Gerais is the poor coordination between the state government and municipalities. In his first term as an elected government official, Zema struggles to consolidate political unity during the crisis. A loyal supporter of Jair Bolsonaro, the governor refused to sign a letter from the National Forum of Governors criticizing the President’s behavior in the pandemic. He thus reflects the tense relations of Bolsonarism with local leaders in the state of Minas Gerais.

Since the start of quarantine, he has been on a collision course with the mayor of Belo Horizonte, who chose to adopt a more rigid stance regarding social isolation measures. According to the governor, Kalil was forced to retreat from the relaxation because he failed to increase the bed supply in the capital.

For his part, the mayor accused the state government of failing to provide resources to Belo Horizonte or expedite the operation of the city’s field hospital, which was structured for 740 infirmary beds and 28 stabilization beds installed in late April, but remained closed until Monday, when the facility was partially inaugurated with 30 beds available – none of which in the ICU.

In addition to his differences with the capital’s mayor, Zema is still trying to reverse the low adherence – only 20 percent of the state’s 853 municipalities – to the ‘Minas Consciente’ plan. Unlike other states, such as São Paulo, which is organizing the reopening of the city in five phases and 17 regions, the Minas Gerais government has decided to grant mayors autonomy.

Many were annoyed by the governor’s statement, when he implied that local managers would be closing cities “just for the sake of closing, without doing anything to structure hospitals”. The disruption contributed to the unbridled spread of the pandemic throughout the interior of the state.

In early April, when fewer than 100 Minas Gerais municipalities were reporting cases of the disease, the governor, voicing criticism of mayors for closing down businesses despite low numbers of infections, argued that Covid-19 should spread across the state, in order to prevent a second, more intense wave.

“We need the virus to travel a little,” he said. Today, the coronavirus has reached 757 cities, the equivalent of 89 percent of those in the state, and has claimed lives in 305 of them. “We have observed that the disease has spread extensively. Given that small municipalities do not have beds or hospitals, this internalization of Covid-19 becomes an even more complex issue,” says epidemiologist Stefan Vilges de Oliveira.

The governor maintains his serene discourse and advocates that the population of Minas Gerais should coexist with the virus, following the health guidelines of the city halls, in what he refers to as the “new normality”. In a video published on social media, Zema warned that this must be the most sensitive week of the pandemic in the state.

“On the one hand, it’s bad because it’s a period of stress for the healthcare system, but on the other, it’s good because it’s beginning to mean that the peak could be behind us.”

However, for those who have lost friends and family, the explosion of cases in Minas confirms the urgency of firmer actions to fight the pandemic. “I was dejected and outraged. Now it’s over,” says Carina Loiola as she recalls the mourning of her father and father-in-law’s death.

“I try to advise the people of my city as much as I can, but to no avail. Many people still don’t believe in this, they walk on the streets without masks. It’s sad to see a society that doesn’t take such a serious illness seriously.”

Source: El País