“Brazil: A Major epicenter of the COVID-19 pandemic” – July 2020

July 14, 2020  

Stephen Stefani, MD,

Head of Oncology, Unimed RS

ISPOR Brazil Chapter president.

The COVID19 pandemic in Brazil began in late February 2020. Since then, on July 1, more than 1.4 million cases have been confirmed, most of them in the state of São Paulo, causing around 60,000 deaths. Proportionally, considering the size of the population, Brazil occupies the 15th position in the ranking of deaths (1). With new confirmed cases and consequently social isolation, the pandemic affected the country’s economy, which had been recovering from the 2014 economic crisis. On March 30, for the first time, a contraction in the Gross Domestic Product (GDP) was forecast for the year, further delaying the end of the crisis. As a measure to face the crisis, the National Congress approved emergency aid, later sanctioned by President Jair Bolsonaro, offering monthly financial aid to more than 50 million Brazilians who were left without income at that time. In April, the health system collapsed in some cities, like Manaus, and then the funerary system, also. In the following month, the states of Maranhão, Pará and Ceará opted for lockdown in some of their municipalities as a more rigid measure to prevent the progress of the coronavirus, with the population being able to leave home only for essential activities. Later, the same measure was adopted by Rio de Janeiro and São Paulo. Physical distancing and hygiene recommendations are major challenge to follow in favelas — many of them have organized themselves to implement measures as their best possibilities. About 13 million Brazilians live in favelas often with more than three people per room.

In May, according to data from the Ministry of Health, COVID19 killed more than H1N1, dengue and measles throughout 2019. During the pandemic, the Ministry of Health through Luiz Henrique Mandetta , positioned itself according to the guidelines of the World Health Organization (WHO) when adopting social isolation with the objective of “flattening the curve”, although in disagreement with President Bolsonaro who advocated isolation only for the risk group. The political turmoil has not stopped. So far, 2 ministers of health left the position for disagreements about isolation and protocol for the use of chloroquine and hydroxychloroquine to treat the disease.

An excellent study from the Federal University of Pelotas, with epidemiological intelligence, was started and evaluates the prevalence and immunity behavior for COVID-19. While in the north of the country, cities had their health system collapse with 10% positivity, the south of the country began to see occupation grow only later and continue with low rates (<1%) of positivity. Good news: lethality is low and only a small fraction will need complex care. Bad news: lack of ventilators and health professionals are likely to happen. But we are moving forward. Brazil is the first country outside of Great Britain to test the University of Oxford-developed vaccine for the deadly virus. The federal government, Oxford University and AstraZeneca signed a cooperation agreement on technological development and Brazil’s access to the COVID-19 vaccine. The agreement provides for the purchase of lots of vaccine and technology transfer (3). In Brazil, the technology will be developed by Fiocruz (Fundação Oswaldo Cruz). If demonstrated to be effective, 100 million doses will be available to the Brazilian population.

References: 

1.        https://www.worldometers.info/coronavirus/country/brazil/

2.        Editorial. The Lancet, 395( May 9), 2020 : 1461 3.   

3.        http://www.ox.ac.uk/news/2020-06-28-trial-oxford-covid-19-vaccine-starts-brazil