The report on Treatment of Smoking in SUS during the Covid-19 Pandemic, released today (25) by the José Alencar Gomes da Silva National Cancer Institute (Inca), in celebration of the National Day to Combat Smoking, shows a drop of 66%, on average, the number of smokers under treatment in the Unified Health System (SUS) in 2020 compared to 2019.
The research was based on data collected by the National Program for Tobacco Control (PNCT), coordinated by Inca, and found that the Southeast was the region where there was the greatest decrease, followed by the Northeast (66%), Midwest (63%), South (62%) and North (59%).
The medical epidemiologist Liz Almeida, head of the Inca’s Prevention and Surveillance Coordination, told the Brazil Agency that several factors contributed to the retraction, including the recommendations of the Ministry of Health for people to stay at home and only leave in case of need, not to look for a health unit unless they were feeling unwell with more severe symptoms of covid- 19, in addition to the closing of the trade.
“This actually affected all appointments and, in particular, outpatient appointments. It greatly reduced demand and, on the supply side, there was a serious problem in the units, because it was necessary to remove elderly health professionals, with comorbidities, pregnant women, breastfeeding women. Reduced workforce. There were people who also got sick”, said the specialist.
She also remembers that many health professionals took covid-19, as well as their families, which caused a large absence of employees in hospitals. “In practice, on the one hand, patients reduced their search for health facilities, some were warned that they should not look because that type of care had been suspended. In the end, we imagined that this would only last a few months, but the pandemic turned the year around”.
Smoking treatment is prolonged; it lasts around 12 months and is done by more than one health professional. Anticipating the return of treatment within the SUS, Inca is already getting in touch with patients. According to Liz, however, due to the Delta variant, the part of the treatment that is done in groups will have to be postponed, favoring individual care, which increases the burden of health professionals.
Despite the significant drop in the number of smokers in care at SUS units last year, around 68 thousand smokers sought care at the beginning of last year, reveals the Inca report.
“People were confined at home, nervous, watching on television the rather dramatic situation around the world. So, very stressed, people started smoking more, drinking more, eating more, not doing physical activity. All the factors combined for our most serious diseases, which are cardiovascular disease, chronic respiratory diseases and also types of cancer,” says Liz.
The number of smokers and SUS assistance for this public varies according to the Federation unit and the infrastructure available in the municipalities. Not everyone is prepared to offer treatment.
In some cities, health units were directed to the exclusive care of covid-19. In this case, the recommendation is that the smoker has to look for the municipal office to find out which health units are treating smokers.
According to Liz, the complete treatment offered by SUS is rare in the world. “Most places charge for this type of service. At SUS, we are able to offer the complete treatment, including medications, which do not have a negligible price. It is important for the smoker to know this”. The doctor also says that relapses are normal and are part of any addiction treatment.
Training and campaign
Given this situation, Inca started to issue alerts, distributed materials, made virtual broadcasts, to show the population that smoking and covid are an explosive combination, because smoking directly affects the lung, an organ that is also a target of the virus that causes covid -19 (Sars-CoV-2), in addition to affecting the immune system and the cardiovascular system. “It’s a complete bomb.”
Even during the pandemic, Inca remotely trained 5,800 health professionals, already thinking about resuming care for smokers. “We will prepare ourselves for when we fully return to normal, because there will be a lot of people looking for it and we will have to be prepared to receive this group and resume activities”.
This Wednesday, Inca launched the campaign The Best Choice is Not Smoking, developed in partnership with the Pan American Health Organization (PAHO). The institute has prepared booklets for health professionals, which include a basic questionnaire to be answered by patients with questions related to the smoking habit.
The booklets of the anti-smoking program have audio description thanks to a partnership with the Federal Center for Technological Education Celso Suckow (Cefet) and with the Fluminense Federal University (UFF). They will be launched on September 2, closing the celebrations for the National Anti-Smoking Day, celebrated next Sunday (29).
In Brazil, smoking kills 162,000 people a year and has an annual cost of R$125 billion to public coffers to cover expenses with diseases caused by cigarettes. This cost is equivalent to 23% of what Brazil spent, in 2020, with the fight against covid-19, informed the Inca, through its press office. The high cost of smoking does not include SUS expenses to treat nicotine dependence, considered one of the most effective medical measures when compared to the treatment of diseases caused by the use of tobacco products.
The specialist also highlights an increase in tobacco consumption among adolescents. “This is very worrying. The new generations are no longer being alerted”. Recent studies prove that teenagers start smoking electronic cigarettes and then migrate to regular cigarettes.
While in several countries lung cancer is the one that kills the most, in Brazil, the disease ranks fourth in deaths from types of cancer. “We only achieved this feat due to the drop in smoking in the country. So, we cannot lose all the effort that has been made”.
According to Liz, it is essential to include the new generations as a target audience for campaigns, “warning and preventing them from starting to use products, especially now, electronic products, which have nicotine and make people dependent.”
The program of events related to the National Day to Combat Tobacco Use includes the seminar online Minimum Approach to Smoking Cessation. Promoted by INCA and the Associação Médica Brasileira (AMB), the event will take place next Tuesday (31), at 9:30 am, and will be broadcast by the Inca TV channel, on YouTube.