Brazil has reported over a thousand COVID-19 deaths daily for 40 days
The warning was given by epidemiologist Diego Xavier, a researcher at the Health Communication and Information Institute, of the Oswaldo Cruz Foundation (Fiocruz), who says he has no doubts that the country is experiencing its worst moment of the pandemic so far.
«Before, we had different epidemic stages [in each state], and now we have a single big wave throughout the country at once. And, when we have that, we can’t rearrange [founds and patients] from one region to another, from one state to another.»
The moving average of deaths is based on the sum of fatalities confirmed in the last seven days divided by seven. The indicator in considered the most important as it reduces the daily fluctuation in notifications and is believed to be closer to the pandemic’s actual trend. In addition, deaths are considered by specialists less subject to sub-notification than infections, since they are investigated more carefully. Infections, in turn, often are not tested, or take place asymptomatically.
On January 23 this year, the moving average of deaths from COVID-19 in the country once again surpassed a daily 1 thousand victims, according to Fiocruz’s Monitora COVID-19 dashboard, and has been at this level for an uninterrupted 41 days. Last year, the longest period with an average above 1 thousand deaths a day lasted 36 days, from July 3 through August 7.
ICU occupancy
Diego Xavier describes the current figures as «a delayed portrait» of a moment when the ICU bed occupancy rate had not reached the situation it is in today. «This number [the moving average of deaths] has a delay of up to three weeks, depending on the place where reports are made, as it hinges on the reporting system,» he pointed out.
«If someone who can’t be hospitalized passes away, first the death is reported. The COVID diagnosis in this case is queued for typing [onto the system] and only after that does the number go through. What we’re looking at right now is a reflection of the past. The volume of fatalities is likely to increase.»
The ICU occupancy for COVID-19 in Brazil’s unified public health network, or SUS, has entered critical alert state in 28 states plus the Federal District, according to Fiocruz’s COVID-19 Observatory report published on March 1. Classified thus are the areas where the proportion of occupied beds exceed 80 percent. Santa Catarina state had the country’s bleakest plight, with 99 percent occupied.
Xavier argues that the scenario comes as a result of a combination of factors going from gatherings at year-end events and carnival to the premature security sensation after the vaccination started, in addition to the rising of the P.1 variant of the coronavirus, considered more contagious.
Since vacations, summer, and holidays are common to all Brazilian states, and the disease had already spread in the countryside, the gatherings led to a generalized increase in the number of cases, which was even further aggravated by the absence of measures to curb the dissemination of the variant from Manaus city, capital of Amazonas.
«Such dynamics, with movements branching out everywhere at once, led the disease to grow both in and outside of state capitals,» Xavier stated.
Restrictive measures
The epidemiologist recommends that restrictive measures be adopted with coordinated efforts by all levels of the government. Decision makers should not wait until ICU occupancy rates reach a critical levels to take action, he warns.
«In the ICU network, a central municipality and its satellite municipalities depend on this network. If one municipality within this network implement restrictive measures and the others don’t, beds will be occupied just the same,» he said.
Even the capacity to create beds itself, he goes on to mention, is limited, and not only due to financial constraints. «We have a limit for health care teams, because they can get sick too. You can build a bed overnight, but not a professional trained for an ICU overnight.»
Chrystina Barros, health researcher at the Federal University of Rio de Janeiro (UFRJ), states that the difficulties in advancing vaccination efforts and the lack of control over the circulation and surveillance of the new variants may further aggravate concerns over the current landscape. She argues that the new restriction measures are welcome, but they must continue for at least 14 days so that it can have any effect on the circulation of the virus.
«We’re witnessing a situation where the circulation of people among municipalities and states have no epidemiological surveillance control—and that’s the biggest problem. We have no exact information on the impact of that these variants are bringing in the increase in the case load.»