I recently wrote a story about the sad mark of 200,000 deaths caused by Covid-19 in Brazil, and although the text was long, a lot was left out. I take the opportunity to publish here at least some of the material from my research that I could not use. And I’ll start with the well-thought-out comments from Renato Pereira de Souza, a researcher at the Adolfo Lutz Institute in Taubaté (SP). Give it a try – well worth reading, in my humble opinion.
“First of all, I think that epidemiologically, we never correctly described the pandemic in Brazil. The real impact has yet to be clearly demonstrated.
We couldn’t do extensive testing at first, so there was a lot of underreporting.
This undermined real perceptions of the disease’s progression and its real impact on the population. Complicated by the negligence of some political authorities, a perfect scenario for refusal and low compliance with safeguards was created.
In fact, we never managed to solve the problem of underreporting, but in the future cases increased and expanded to new areas, and after at least a month of diffusion the scenario began, although incomplete, at least expected to outline the pattern.
That means more or less. Another thing that caught my attention is how the lethality of the disease was higher in the beginning.
This is normal during an outbreak of a new disease. Ultimately, medical teams are expected to be caught unprepared, but organized and employing new, more efficient protocols, increasing the frequency of favorable outcomes. This also occurred, but much of the greater mortality is due to the fact that we could not properly define the denominator “number of cases” due to the large number of asymptomatic infections and unreported cases.
This ability to transmit through asymptomatic patients is a relatively under-addressed issue, especially given the important role it plays. Although it has been talked about in the media, I think the general public did not understand this information and never understood the gravity of the situation.
The arrival of new variants is expected. I am a virologist who specializes in zoonotic viruses [transmitidos de animais para pessoas] and my PhD was in the field of molecular epidemiology. I see that with concern. I find it very unlikely that variants that are resistant to the vaccine would be effectively selected, especially since the immune response is usually associated with highly conserved regions. [sem alterações] of the viral genome, associated with the process of entry of the virus into the cell. However, it is very likely that there will be variants with different degrees of transmissibility that we are already observing, or more or less virulent variants that do not appear to have emerged yet.
Understanding that both transmission and virulence are characteristics that also depend on the host and its response to infection, these changes and their effects are sometimes difficult to perceive and may take a few months to occur.
Geographically, what I think is being overlooked is the importance of spreading the virus between cities and how this will allow the epidemic to continue.
The control measures are unfortunately scattered, and each community makes its contribution. However, the virus does not know the concept of borders. Connectivity between cities is a very important factor and has been largely ignored.
I’m part of the Scientific Committee here in Paraíba Valley, and we’ve done some studies that show exactly how the spread of the virus in larger, more circulating cities is affecting what happens in smaller cities. Cities like São José dos Campos, Taubaté and the north coast have a huge impact on the surrounding cities, suggesting the need for a common and synergistic response … but it’s difficult. They are also not joining the São Paulo plan.
After all, we have argued a lot here in our region about the fact that we are not experiencing a second wave, but that we are still in the first wave of the disease, which has received a “push”. [impulso] Due to the low compliance with protective measures, the flexibility in the economy became irresponsible and the contact increased due to the reduction in social distance.
It is clear that the entry of the state of São Paulo into the green phase of the plan facilitated this process and had a negative impact. This made it possible to resume transmission and to reverse the curve, which fell and, in the phase of rising cases, was very close to the values observed at the beginning of the pandemic. Then the holiday season came and now we’ll still see the effects of it all.
In my opinion, we are experiencing an even more serious moment because there is less adhesion of the population, the economy is traumatized and it is an unlikely political moment for me to have someone take the lead and do what I think is right, one Declare suspension for a few weeks, at least two or three, to slow down the transmission. I don’t think our leaders have the courage to take on the burden that comes from taking this action, but I honestly think that if they don’t do this, the consequence will be even greater … but they all pay for it, to see it.
I worked hard during the pandemic. My laboratory was not accredited to perform the diagnosis because the equipment we used was not suitable for the protocol used. To compensate for this, I supported the regional surveillance in creating epidemiological models and describing the standards. And we have a very active scientific committee. “
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