Thousands of patients with Covid-19 complications, and the pent-up demand for elective surgeries that have been canceled in the epidemic, have had a negative impact on the treatment of diseases such as cancer and slow vaccination amid new waves of infection. BBC News Brazil details four important public health challenges for the country in the coming months and years, in addition to a lack of funds.
the end of Corona Virus It is not yet on the horizon, but it is already clear to many people that the effects will be felt for many years even when the spread of the virus in the world is controlled.
In the area of public health, this critical scenario should last for at least a decade, estimates Susanna Lobo, President and Director of the Brazilian Society of Intensive Care Medicine (Amib), in an interview with BBC News Brasil. The problem, she says, is worse due to inequality in access to health care in Brazil, both regionally and socially and economically.
“The urgency and emergency service will suffer from a lot of pressure because of the previous problems of this unequal distribution of the family and what we see in the future, which will have other waves, will exacerbate the diseases associated with Covid survivors, and the lack of assistance has caused by restricting access to patients who did not go to the hospital. Because they were fearful, psychosomatic diseases, acute chronic conditions … Brazil’s challenges for the next decade are enormous, “Lobo recounts.
In his estimation, many rich countries were also not prepared for the epidemic, but “what makes the difference is after you turn the key and start doing the right things.” In the short term, Lobo advocates controlling the spread of the disease in the population, through measures such as restrictions on the movement of people “at the right time and in the right place, where the beds are saturated” and the mandatory use of the mask.
In the medium and long term, the exits go through points such as reducing inequality and increasing the number of professionals trained to meet the new requirements of the pandemic, according to the diagnosis that she and other colleagues provided to Health Minister Marcelo Quiroga.
The main obstacle is clearly financial. The shortage of health resources will double in the face of growing demand due to the widening gap in the public accounts and the constitutional amendment of the spending ceiling, which has limited the increase in public spending until 2030.
A year before the pandemic broke out, a study published in the journal BMC Medicine already indicated that financial restrictions in primary care programs could lead to nearly 30,000 preventable deaths in the country.
BBC News Brasil lists four important public health challenges for the country in the coming months and years, in addition to a lack of funds.
– Thousands of patients with Covid-19 disease;
Demand for elective surgeries that were canceled due to the pandemic has decreased.
Negative effect in treating diseases such as cancer.
Slow vaccination and new waves of infection.
1. Covid sequelae and myth “Recovered“
At a certain moment in the epidemic, when the number of deaths due to Covid in the country was already more than 100 thousand (today there are 365 thousand), the government Jair Bolsonaro I decided to increase the number of “people recovering” from the disease daily.
The aim of the strategy, which experts saw as no, was to counter “widespread coverage of negative facts,” as the Cabinet Secretary, Reserve General Luis Eduardo Ramos once said.
The concept of recovery includes people who have been diagnosed with the disease but who have not died. However, many of them cannot even be considered to have recovered, let alone cured, due to the so-called prolonged virus.
This persistent health condition has affected hundreds of thousands of people around the world with symptoms that last for weeks or months, some of which may be permanent.
Over the course of the year of the pandemic, scientists and health professionals around the world found that COVID-19 was linked to more than 50 health manifestations related to different parts of the body. Neuropsychiatric, pulmonary, immune, kidney, cardiac, and motor damage have been identified, among many others.
There are dozens of them, such as extreme fatigue, shortness of breath, loss of smell, joint pain, memory problems, depression, joint pain, and a rash.
According to researchers from universities in the United States, Mexico and Sweden, who analyzed dozens of studies on this topic with 48,000 patients in total, the five most common symptoms of prolonged periods were fatigue (58%), headache (44%) and difficulty. In attention (27%), hair loss (25%) and shortness of breath (24%).
There is no data available on the number of people affected by this condition in Brazil, but it is possible to obtain the dimension from other countries. In the United Kingdom, for example, a country of one-third of the population of Brazil, it is estimated that 300,000 people face the so-called long-term virus.
According to the World Health Organization, 1 in 10 people infected with the virus remains sick three months after the first symptoms appear.
The effect of this prolonged condition, still shrouded in suspicion and lack of understanding, must be felt for years in the lives of these patients and in the health system, due to the increased demand for treatments, professionals, medicines and rehabilitation, for example.
“The burden is real and huge,” said Hans Kluge, WHO director for Europe.
2. The explosion of the elective surgery queue
“The incentive (R $ 250 million) for municipalities is to cancel the waiting list for elective surgeries of moderate complexity and reduce the waiting time for those awaiting scheduled procedures.” The announcement in January 2020 of additional funding from the Brazilian Ministry of Health cannot wait for the queue to start exploding a few months later, with the spread of the Covid-19 pandemic.
Elective surgeries are necessary but not urgent and can be scheduled. Among the most sought-after are ophthalmology (treating cataracts, for example), hernia repair and cholecystectomy.
Since the beginning of 2020, countries, states and municipalities have halted many measures of this nature due to the overburdening of the health system (family, professionals, and supplies) and the risk of infection by covid-19. In England, for example, the lineup of these patients went from 1,600 to nearly 388,000 in the year of the pandemic, the worst sign since 2008.
There is no updated data on the size of the Brazilian queue. In 2018, the Federal Board of Medicine spoke with 900,000 people in the field of public health. According to current data from the Unified Health System (SUS), in 2020 there was a decrease of 1 million elective surgeries compared to the previous year, an amount adding to the historical waiting list.
From 2018 to 2019, Brazil managed to expand these measures by approximately 10%. If the country reaches the same level as of 2021, it will only take nearly five years to clear that demand, which the pandemic has reduced.
This is without looking at other factors that may lead to an increase in demand, such as the consequences left by the Corona virus itself.
Countries like Mato Grosso do Sol have already announced measures to try to clear the line, such as additional resources and joint efforts. But demand is expected to explode further when the pandemic loses momentum.
In the private sector, there was also a significant financial impact. The decrease in elective procedures has caused many hospitals to turn to the red because revenues are down, but costs have remained flat, according to a survey by the National Association of Private Hospitals.
3. More than 50% of cancer patients experience delay in treatment
The effects of the epidemic appeared in Brazil and other countries, as well as in the treatment and diagnosis of other diseases, such as cancer.
Kluge, Director of the World Health Organization in Europe, Hans Kluge, said the impact of the epidemic on cancer treatment was “catastrophic”. In the region, the tumor region has experienced partial or complete discontinuities in a third of European countries.
For Sarah Bainbridge of the UK charity Macmillan Cancer Support, 2020 has been devastating for many people with cancer who have faced “painful delays or interruptions in treatment or diagnosis.” It is estimated that tens of thousands of people in the country did not receive their first diagnosis of the disease and therefore began treatment.
About half of the world’s cancer patients have experienced treatment delays, including delays in radiotherapy or chemotherapy, canceled appointments and biopsies, according to a survey conducted by Rachel Riera, a professor at the Federal University of Sao Paulo (Unifesp) and coordinator at Sírio Libanês in partnership with the organization. Global Health Review of dozens of studies on this topic.
The effect of Covid on the treatment, diagnosis and health of cancer patients can increase the number of cancer deaths. A study led by researchers at University College London, UK, estimated that there could be approximately 18,000 cancer-related deaths over a 12-month period.
4. New waves of Covid and immunization
And as if the aforementioned problems weren’t enough, the epidemic is not over yet. This means that the Brazilian health system will be under stress for months (or years) with people infected with the same virus.
Data collected by the Oswaldo Cruz Foundation (Fucruz) shows that 1.8 million people in Brazil were hospitalized in 2020 and 2021 with suspected or confirmed cases of severe corona virus. The health system has collapsed or is on the brink of collapse in nearly every state in the country.
Despite some positive signs of an improvement in the chaotic and tragic situation, the virus continues to spread vigorously in the country and vaccination is proceeding at a slow pace. That is, as long as the vast majority of the population is not immune, Brazil will continue to face the waves of disease that are filling hospitals, killing more and more young people and exacerbating the country’s economic situation.
In the health field, a survey conducted by the Federal Senate indicates that the Brazilian confrontation with the epidemic that required the Union to provide another 63 billion Brazilian reals in the form of direct measures, such as the purchase of equipment, tests and medicines.
As long as the disease is not controlled, thousands of people will continue to fall ill and massive spending will dominate the national health budget, which was already facing restrictions before the pandemic.
Each ICU bed costs from R $ 2,500 to R $ 3,000 per day, according to data from Unicamp State University. In other words, a 30-bed ICU unit costs at least R $ 2.3 million per month. The country increased the supply of intensive care units by a third in the pandemic, and each bed transplant is estimated, according to basic criteria, at R $ 180,000.
In addition to the saturation of hospitals, another major challenge is the vaccination program, which is the main outlet for the epidemic.
On paper, the Ministry of Health’s current schedule projects 563 million doses, with 154 million of them delivered in the first half of 2021, considering only the vaccines approved by Anvisa: Coronavac, AstraZeneca-Oxford, and Pfizer.
That would be enough to immunize the entire priority group, but doesn’t that mean that all of the 78 million people will be vaccinated before July? Brazil was able to implement about half of the available doses and there is a period of weeks between the first dose and the second dose.
But the constant delay in importing inputs and vaccines, combined with production problems in the national territory and the lack of approval by the National Health Supervision Agency (Anvisa) for other immunization devices, make achieving this timetable increasingly difficult.
The trend, so far, is that the start of vaccination of non-priority adults should happen at least in the middle of the second half of 2021, while vaccination for young people under the age of 25 should only happen in 2022. Even more is uncertain.
A recent study by UFJF (Federal University of Guiz de Fora) indicated that Brazil needs to vaccinate 2 million vaccinations per day to control the epidemic within a year. But since the start of the vaccination, it has not exceeded three times the one million mark.