- André Biernath – @andre_biernath
- From BBC News Brasil in São Paulo
The State of Rio de Janeiro has been in a unique situation since the pandemic began.
On the one hand, there is optimism with the advance of vaccination: many cities have already applied the first dose against covid-19 in practically the entire adult population.
On the other hand, there is concern about the arrival and rapid spread of the Delta variant of the coronavirus and the growth in the number of hospitalizations for respiratory infections, which triggers the warning signal from authorities and threatens the reopening plans.
“The data show a recent increase in hospitalizations among older groups. This is happening elsewhere, but in Rio de Janeiro, the situation is worse”, evaluates researcher Leonardo Bastos, from the Oswaldo Cruz Foundation (FioCruz).
“The latest statistics suggest that something different is happening in the state, but we still don’t know exactly what it is,” he adds.
The infectious disease specialist Alberto Chebabo, medical director of the Clementino Fraga Filho University Hospital, at the Federal University of Rio de Janeiro, sees this change of scenario happening in practice.
“Recently, there has been an increase in the demand for hospitalization for covid-19, especially among the elderly and health professionals”, he reports.
“This was something we hadn’t seen with this frequency for a long time,” adds the specialist, who is also vice president of the Brazilian Society of Infectious Diseases (SBI).
But what is behind this worsening? And can the same be repeated over the next few months in other states and regions of the country?
Rio de Janeiro crisis
After a very complicated first half of 2021, marked by a second devastating wave, Rio de Janeiro experienced, between May and July, a downward trend in the numbers of the pandemic.
A similar scenario, in fact, occurred in the rest of the country, with a considerable reduction in diagnoses, hospitalizations and deaths from the disease in the same period.
But there are two important details in this story, which apply both to the state of Rio de Janeiro and to Brazil as a whole. First, notifications remained very high, even in the recent lull, with tens of thousands of cases and hundreds of deaths every day.
The second point is that, according to the InfoGripe Bulletin, published periodically by FioCruz, the rate of transmission of respiratory viruses remained extremely high in a large part of the Brazilian territory, even at a time of greater tranquility.
This placed us in a delicate situation, in which a new worsening could break out at any moment.
And that is exactly what seems to be happening now in Rio de Janeiro, with a resumption of covid-19 growth.
Let’s analyze what happened with the cases of the disease there, following the records compiled by the National Council of Health Secretaries, Conass.
In the first week of May, more than 39,000 diagnoses of the infection were made, a record so far.
In the last week of June, that number dropped to 14,000, the lowest level since the peak of the second wave.
In the first seven days of August, however, 27 thousand new cases were detected.
And what about hospitalizations?
“At the worst moment of the pandemic, we had around 1,400 patients admitted to hospitals in the region and, now, we are at around 700”, calculates Chebabo.
“It is possible that, at some point near, we will need to suspend elective surgeries and readjust the beds to meet the demand of covid-19 once again”, says the vice president of SBI.
The doctor explains that this new increase in diagnoses and hospitalizations has not yet impacted death rates.
“We will only be able to analyze whether there is an increase in deaths in a few weeks, even because the worsening comes in waves. First, people get infected, then they get sick, are hospitalized and take a while to recover or die”, he explains Chebabo.
The ingredients behind the worsening
According to experts interviewed by BBC News Brasil, it is not possible to single out a single factor behind the rise in Rio de Janeiro.
“There are some hypotheses that help to understand what is happening, but they are not exclusive”, explains Bastos.
“It is necessary to consider the arrival of the Delta variant of the coronavirus, the relaxation of the population and the restrictive measures and even a possible loss of effectiveness of the vaccines over time”, lists the researcher.
Let’s start with Delta: the lineage that emerged in India was identified in Brazil in May 2021 and, since then, surveillance teams have been following how it spreads across the country.
And Rio de Janeiro is perfect for understanding the progression of this variant. This is because the state has the Rede Corona-Ômica RJ, a project that brings together researchers from various institutions and aims to monitor the different strains of the coronavirus, detect the emergence of mutations and understand how these genetic alterations influence the progress of the pandemic.
“Every 15 days, we randomly collect about 380 samples from infected patients from various municipalities in Rio de Janeiro, which are sequences”, says geneticist Ana Tereza Vasconcelos, from the National Laboratory of Scientific Computing, one of the institutions that do part of the initiative.
And the evolution of variants in Rio de Janeiro is quite clear: between January and July 2021, Gama (originally detected in Manaus) was the most frequent strain, with a large advantage over other competitors.
“In parallel to the growth of Delta, we cannot ignore what happens with the other variants either. Gamma has undergone mutations and we have already found nine sublines of it here”, warns Vasconcelos.
“The coronavirus is constantly changing to continue circulating among us,” he says.
The worst (not yet) is over
Although Delta is more transmissible than previous versions, it cannot be seen as the only one to blame for the situation in Rio de Janeiro – not least because the preventive measures, such as physical distance, the use of masks and ventilation of the environments, continue to work against this and the other variants.
That’s why experts also point to the relaxation of restriction policies as another factor that helps explain the recent worsening.
“People think that, after vaccination, everything is cleared and we can go back to normal, but that’s not quite the case. We are not at the moment to leave the masks aside”, advises Vasconcelos.
In this sense, the announcements made by municipalities in Rio de Janeiro about the realization of mega-events, such as New Year’s Eve and Carnival, do not help at all, according to experts.
“It is clear that the public manager needs to plan and plan things, but speaking openly at parties now, at this moment, conveys a sense of normality that does not exist in practice. The pandemic is not over,” criticizes Chebabo.
“We don’t know what will happen in the coming months. The scenario changes very quickly,” he adds.
Who needs backup?
Speaking of vaccines, there is currently a lot of discussion about a possible loss of effectiveness.
Studies indicate that they remain important in protecting severe cases, hospitalizations and deaths, but some vulnerable groups appear to suffer from diminished immunity six months after taking the two doses.
This drop in vaccine protection would also help explain the recent increase in hospitalizations of older individuals in Rio de Janeiro, as shown by reports collected by BBC News Brasil and the latest editions of the Infogripe Bulletin.
It was precisely to deal with this that, like countries like Israel, the United States and Chile, the Ministry of Health announced that the elderly and immunosuppressed (HIV carriers, individuals undergoing cancer treatment, newly transplanted, among others) will take a third dose of the immunizing agent from September 15th.
In parallel with the reinforcement for the most vulnerable groups, scientists consider it essential that everyone who has already received the first dose returns to the health post on the date stipulated for the second application.
Is the Rio de Janeiro of today the Brazil of tomorrow?
Finally, it is natural to question whether the worsening of the pandemic in one state can be repeated or spread to the rest of the country by the end of the year.
For Bastos, the local situation should represent, yes, a concern.
“Rio de Janeiro is a point of confluence and has a great connection with other Brazilian regions, especially with São Paulo”, analyzes the FioCruz researcher.
“And we know that when the worsening arrives in São Paulo, it spreads more easily to other places”, he concludes.
For Vasconcelos, everything indicates that the Delta variant is also spreading across several states in the country and the data from Rio de Janeiro draw attention precisely because there is genomic surveillance of the coronavirus there, unlike what happens in other places.
“It’s the popular ‘those who look for it, find it’. As we have structured a network of laboratories with the capacity to carry out this genomic follow-up, we ended up observing in detail the presence of this and other variants”, he says.
To contain the advance of the problem in Rio de Janeiro or in the rest of Brazil, Chebabo says it is time to speed up vaccination.
“We need to expand our vaccination coverage, with the guarantee of the second dose to everyone, the offer of the third to those who need it and the advancement of protection among adolescents”, he points out.
“In parallel, we would need to do everything that has not been done so far to contain viral transmission, such as reducing the circulation of people and creating testing, tracking and case isolation programs”, recalls Bastos.
According to the latest information from Conass, Rio de Janeiro has officially registered 1.1 million cases and 61,900 deaths by covid-19 since the pandemic began.
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