- Rafael Barifouse
- BBC News Brasil in São Paulo
O infectologist Jaime Rocha has decided to make a video in the last 30 days, hoping to expand with WhatsApp groups in Curitiba to raise awareness among the population.
He started by not wanting to talk more about covid-19 or the importance of washing hands or wearing a mask. “I’m sure you already know all this,” he said.
The doctor wanted to warn that he was starting to miss beds for patients who fell ill due to a new coronavirus in the capital Paraná, where he works.
“We’re opening more beds, we’re opening more beds … But people’s behavior makes the number of cases so large that we’re not aware of it.”
Rocha then warned: if the population did not cooperate, follow coronavirus control measures and avoid accumulation, the health care system would not support demand, and people could die from lack of care.
He ended by appeal, “I’m not alarming, I’m realistic and I’m asking for everyone’s contribution again.”
At the time, the covid-19 pandemic in Paraná was spiraling out of control.
The disease grew again
The virus transmission rate, which has been below the most dangerous level since mid-August, has risen again.
This index indicates how many people are infected with patients on average. If it falls below 1, the focus will gradually end. In addition, it is gaining more and more strength and the number of patients is growing on a geometric scale.
The moving average of the baud rate takes into account the previous 14 days of the index. Epidemiologists consider it the most appropriate value for measuring the severity of a pandemic because it corrects specific data biases caused by delays and other failures in publishing test results that confirm these cases.
In Paraná, this index returned above 1 on November 6 and did not stop growing until November 19, when it peaked at 1.36.
At that time, 100 people infected 136 others, who again infected 185 others, etc.
It didn’t take long for this to be reflected in the number of people seeking medical attention.
The cases exploded
Increased transmission in healthcare facilities and hospitals has been felt for some time due to the nature of coronavirus.
It takes an average of seven days for an infected person to develop the first symptoms. The experience of healthcare professionals shows that it usually takes patients a few days to see a doctor.
But the most intense infection will inevitably turn into further emergency visits, which is reflected in official statistics.
This was the case in Paraná on November 12. On that day, the moving average of confirmed cases was still 1,233, which is the same level as in previous weeks. Eight days later, however, it almost tripled to 3,569.
Another nine days passed and a new peak came: 3,612. This is still the pandemic state of the state and 75% higher than the highest rate recorded before the beginning of November (2056 cases, August 6).
The hospitals were full
Just as the most intense infection turns into more cases, the largest number of cases per hour leaves hospitals overcrowded. This is happening in Paraná.
“Patients take six to eight hours of emergency care and stay in the wards for one to two days until they can be admitted,” said Jaime Rocha, who works at two private hospitals in Curitiba.
The number of patients with covid-19 or suspected disease waiting for a vacancy in an infirmary or in the ICU at public hospitals in Curitiba or the metropolitan area of the city is growing.
According to the government of Ratinho Jr. (PSD), the front reached 120 people last Wednesday (2/11).
The State Ministry of Health states that they receive medical assistance in other medical units while they are waiting, and that this expands the total number of beds in the network.
The average occupancy rate in the state was 89% on Friday (4/11), but in the capital, where hospitals already announce service restrictions, they reached 96% because they did not meet demand.
“We already expected an increase in cases,” says Rocha, “but not so soon and not so fast.”
Did it close too soon?
“Paraná closed it all too soon,” says epidemiologist Nelson Arns, who is the international coordinator of Pastoral da Criança and lives in Campo Largo in the Curitiba metropolitan area and works in the capital.
The first infections in the state were confirmed on March 12, when there were 200 cases in Brazil. The Paraná government took social isolation measures a few days later.
Classes were suspended at public schools and universities and the same was recommended for the private network. Theaters, cinemas, libraries and museums were closed. Cultural events could no longer be organized.
The servers started working from home and the population was asked not to take to the streets, including measures to curb the epidemic.
“There has been no community transmission in the state so far,” said Arns, a public health physician. An epidemiologist refers to a term that defines when a virus circulates freely among humans.
When this happens, the infection no longer occurs only when there is contact between people who already live together, such as family and friends, but also in ordinary everyday situations, between strangers.
Arns believes that social isolation measures should not have been applied at first, but a distance that is less restrictive.
“The burden was too heavy and in a way unbearable, especially for young people,” he says.
“Tested well, but not enough”
The Minister of Health in Paraná, Beto Preto, says that the state was not the only one to take measures of this type at the time, and states that the government considered it best to take the lead in this process.
“City halls began to function in a disorganized way and made individual decisions. We understand that the measures had to be generalized, “says Preto.
The secretary also says the state is one of the most tested in Brazil. “We’re first or second in PCR tests,” says Preto.
This type of test detects the presence of a virus in the body to confirm a person’s illness and should be used in large-scale tests, according to the World Health Organization (WHO), to identify cases and disrupt the transmission of the virus.
Official figures on the number of tests performed per 100,000 inhabitants show that Paraná tested significantly above the Brazilian average. In some months, the local index was twice the national index.
However, the state still has rates 70% to 85% lower than in the countries that test the most in the world, such as France, Germany, Great Britain, the USA and Russia.
“In reality, the country tested Paraná well, but in relation to what should be done, it was not enough, according to the WHO,” says Arns.
Long pandemic, exhausted population
“You will find all sorts of opinions about what happened, but so far we have managed the pandemic,” says Secretary Beto Preto.
Epidemiologist Nelson Arns agrees that the early quarantine of the state has had a positive impact.
This initially managed to contain an explosion of cases and prevent the collapse of the health system. Paraná has become one of the least affected in the country of coronaviruses.
The lower intensity of the local epidemic and the deterioration in other parts of the country resulted in only the 22nd highest number of cases out of 27 states and the federal district in mid-June. But then the number of cases began to increase.
At the same time, the crisis has cooled in other countries and Paraná will move upwards in Brazil’s pandemic position, despite a temporary tightening of isolation measures for 14 days in July.
In August, it was already the 14th state with the largest number of cases. Two months later it was the tenth. Today it is in 8th place and more than 294,000 infections have been confirmed.
“It all led to exhaustion,” says Arns. One of the consequences is that non-compliance with pandemic control measures is increasing, says the epidemiologist.
“There is a part of the population that has complied, but there are also deniers and those to whom you explain the care, and that will not help. Then you call the patient’s house to give a positive test result and find that he is on the street. Or call to see who’s sick and hear that the person went to see his parents because they thought it was okay because they didn’t feel bad. “
Paranaense did not stay at home
In Loco’s data, which monitors social isolation across the country based on geolocation data from mobile phones, suggests that paranaense has not stayed at home before.
The highest rate recorded in the state has never exceeded 45% for the entire pandemic and has been below 40% since June. In September and October it reached its lowest level, 36%. In November, it rose slightly again to 38%.
“If that were enough, we wouldn’t be in this chaos,” says Viviane Hessel, a consultant to the Brazilian Infectious Diseases Society in Paraná.
He says he always hears stories of patients with covid-19 who have left home or thinks that because they are young or have no other illnesses, they may catch that everything will be fine.
“They forget that they can spread the disease to other people,” said Hessel, president of the Brazilian Association of Infection Control and Hospital Epidemiology Experts.
In addition, the positive factor for Paraná is now turning against the state. Because it used to be less affected, the number of people who have already been infected is still low.
This index reaches a maximum of 20%, Hessel points out. As a result, fewer people have immunity to coronavirus, which is easily spread.
A number of holidays in October and November and municipal elections contributed to the easing of measures in Curitiba at the end of September, when the trend of cases had been declining until then.
“Governments have become more flexible. Cinemas and museums even reopened. All this gave the feeling that the crisis was over, “says Nelson Arns.
“People relaxed,” Hessel agrees, “and we saw much more movement than we expected.”
Stricter measures to prevent the worst
The town hall suspended the operation of bars, nightclubs and parties. Restaurants, shopping malls and shops on the street are still open, but with limited working hours.
A curfew was also adopted throughout the state, between 11:00 pm and 5:00 am, until the next 17. The government is studying closing squares and parks. He also recommended that civil servants start working from home.
“We are trying to reduce the spread of the virus and, in particular, to prevent the operation of bars and clubs, because 30% of new cases are among the youngest,” says Secretary Beto Preto.
However, it acknowledges that the implementation of these measures is becoming increasingly difficult as the pandemic lengthens.
“Yes, she has been exhausted. It’s been nine months, isn’t it? People want to regain their normal lives. But we are expanding awareness-raising events. “
Dr. Viviane Hessel says experience to date shows that a pandemic does not end in social isolation. “But without it, it will be even more difficult,” he says.
Infectologist Jaime Rocha explains that pandemic measures usually reduce the number of cases by two to three weeks. “We will not be able to stop this runaway train overnight.”
Meanwhile, he works and hopes that the measures have been taken in time and that the warnings of him and his colleagues will come into force so that Paraná avoids the worst.
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