Covid is on the way to being a new neglected disease in Brazil

Towards the end of the Public Health Emergency of National Importance, as announced this week by the Ministry of Health, covid-19 is heading towards being a neglected disease in Brazil in the near future.

Experts heard by the column say that it is not time for the country to let its guard down and lower the level of importance of covid-19 and say that this will especially impact people who depend only on SUS (Unified Health System). They also fear that social and regional inequalities will impact people’s prevention, testing and health care.

According to a definition by Fiocruz (Fundação Oswaldo Cruz), neglected diseases “are those caused by infectious agents or parasites and are considered endemic in low-income populations”.

The list of neglected diseases in Brazil is long, according to the PAHO (Pan American Health Organization), an arm of the WHO (World Health Organization) in the Americas.

According to the institution, diseases such as leprosy, dengue, schistosomiasis and Chagas disease, for example, are on the list of at least 20 neglected infectious diseases that kill in the country.

“Neglected infectious diseases are a diverse group of conditions widespread in the poorest regions of the world, where water security, sanitation and access to health care are precarious”, explains PAHO.

For Isaac Schrarstzhaupt, coordinator at the Covid-19 Analysis Network, the term neglected disease is used for diseases “whose combat is not profitable” for private health systems and laboratories — in which case, technically, covid-19 might not fit.

“But, at the same time, when we see states and countries with low vaccination coverage and coincidentally those with the lowest income, it lets us make that use of the term”, he says.

The biggest example is the idea of ​​ending the emergency in Brazil without taking into account, for example, regional particularities.

“The moment the big centers realize that they can ‘live’ with the disease, they end up having decrees to end the emergency. The problem is that the decree is valid for the country, and then those who do not have good vaccination coverage end up having their increased risk,” he says.

When explaining the end of the emergency, the Minister of Health, Marcelo Queiroga, said this Monday that the covid “has not ended and will not end, and we need to live with this disease and this virus. Fortunately, it seems that the virus has lost its strength, it has lost its lethality, and every day we see a post-pandemic period closer to everyone”.

Deaths in the country from neglected diseases (2016-20):

  • Dengue – 1,682
  • Malaria – 213
  • Leishmaniasis – 1,621
  • Chagas disease – 21,847
  • Leprosy – 735
  • Schistosomiasis – 2,538
  • Anger – 18

Microbiologist Átila Iamarino says that covid-19 already has several interactions that are consistent with neglected diseases. “They already permeate this situation of inequality, which makes the disease have different impacts on different types of population”, he says.

We already have a layer of the population that has less access to health care, less trust in the health system, less opportunity to get vaccinated, less opportunity to take care of children — so children need to go to day care, people need to keep working and they will have more covid.
attila Iamarino, microbiologist

One of the examples of inequality can be seen in the markers of ICUs (intensive care units) that treated patients with covid-19.

According to data from the UTis Brasileiras project, from Amib (Association of Brazilian Intensive Medicine), the mortality of covid victims who needed intensive care during the pandemic was 29.2% in private beds, a rate that rises to 50.2% in hospitals. public. The project evaluated the hospitalization of 210 thousand patients until the last day 19.

8.jun.2021 - Medical work at the covid-19 ICU of the Vila Alpina State Hospital, in the east side of São Paulo - Mister Shadow/ASI/Estadão Content - Mister Shadow/ASI/Estadão Content

8.jun.2021 – Medical work at the covid-19 ICU of the Vila Alpina State Hospital, in the east side of São Paulo

Image: Mister Shadow/ASI/Estadão Content

For Iamarino, however, it is still early for the disease to be considered neglected in the country, given the impact it still causes on public health.

“Covid still generates too great a disturbance in the health system and in people’s lives to be as neglected as other diseases. And this dynamic should continue to happen in the near future, at least”, he says.

But as time goes on, he says he believes there should be even more privileges, the higher the social class. “The trend is for people who have more access to healthcare and more money to have more boosters. [da vacina], more access to antivirals and treatments. People in the poorest and most uninformed regions will suffer the most. So, covid is heading towards this [ser negligenciada]”, complete.

Is being endemic good?

Epidemiologist Anaclaudia Fassa, who is director of Abrasco (Brazilian Association of Collective Health) and professor at the Department of Social Medicine at UFPel (Federal University of Pelotas), says that people misunderstand when talking about covid-19 turning an endemic.

“There were improvements in the health situation, in vaccination coverage, yes. However, we have a very high number of deaths. People think that the epidemic evolving into endemic is a good thing, but it depends”, he reports.

Endemic is when you have a stabilization. She is good when the death toll is low, which is not the case. We now have an average of 100 deaths a day. If you multiply it to a year, three times more people would die from covid than from HIV, twice as many as breast cancer, the same number as traffic accidents.
Anaclaudia Fassa, epidemiologist

For her, the way in which covid-19 will be treated in the country depends on the regulations and rules that will be edited by the government after the end of the emergency – which has not yet occurred.

“The impact depends on what is done in the review of these measures. We have to see what these frameworks are like”, he says.

Faso says he has no doubt that, despite historical problems, the SUS responded “super well” to the pandemic. But with the end of the emergency and loss of funds, she fears there will be underfunding at a time when the country will have a series of challenges ahead.

“We have the long covid, the need for vaccine campaigns, the search for procedures that were not done in the pandemic, an advance of chronic diseases”, he explains.

One of the biggest problems that the country may face, he says, is that Brazil has not structured a network capable of noticing an increase in cases as soon as they begin to occur.

“One thing I should have learned was the importance of epidemiological surveillance. We had an increase in this period, but it was not a structure that came to stay. This is very worrying. We need to identify outbreaks and new epidemics”, he reports.

19.jam.22 - Testing center in Manaus had high demand this year - Rodrigo Santos/Secretariat of Health of Amazonas - Rodrigo Santos/Secretary of Health of Amazonas

19.jam.22 – Testing center in Manaus had high demand this year

Image: Rodrigo Santos/Secretariat of Health of Amazonas

Pandemic scenario still uncertain

As covid-19 is a new disease, the professor of tropical diseases at UFPE (Federal University of Pernambuco) Vera Magalhães, says that it is still impossible to predict a scenario for the country and the world in the next few years. “We don’t know what’s going to happen,” she admits.

“We don’t know if the covid is now in that interepidemic period. There were those peaks in cases, then it was on a plateau, then a new peak. Now, we don’t know if we are now facing this or if we really have a lasting cooling . Only time will tell”, he points out.

She considers, however, that the withdrawal of the emergency situation should hit the SUS in full, in case of a possible need to increase the number of visits and beds.

An example of the impact of this occurred in January, when the country faced a double epidemic of influenza and covid caused by the Ômicron, the SUS faced initial difficulty in meeting the demand, which generated a rush to open beds in an emergency (which was only possible thanks to the state of emergency).

“And now we will have funds that should be destined to combat covid that end the end of the emergency. This impacts even more the possibilities of SUS [Sistema Único de Saúde] to face the pandemic, which is not over yet”, he reports.

Vaccination coverage

For Magalhães, the country still has a very high number of unvaccinated people or people with incomplete cycles, who are susceptible to infections if viral circulation occurs again with force.

“I’m afraid because children from zero to four years old have not been vaccinated yet. In addition, only 38% of Brazilians had the booster dose. This is very little”, he laments.

Today, in the country, there is a great difference in vaccination coverage between states. The worst rates are in the North, where states like Roraima and Amapá have only 12% of the population vaccinated with a booster dose. In São Paulo, the leading state, this percentage already exceeds 45%.

Biomedical and neuroscientist Melanie Fontes-Dutra agrees that one of the biggest problems is the lack of vaccine coverage.

“This is insecurity. With the lack of equity in vaccination coverage, for example, we run the risk of having regions that will continue with a higher transmission than others, generating impacts on them and their health system”, he says.

The fight for greater equity in vaccination coverage in different locations, inside and outside Brazil, is to have greater protection for these societies and generate a lesser impact of the disease and the circulation of the infectious agent that causes it.
Melanie Fontes-Dutra, biomedical and neuroscientist

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