September 20, 2021

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Covid: worsening pandemic in Rio de Janeiro serves as a warning for the whole of Brazil, say scientists - 28/08/2021

Covid: worsening pandemic in Rio de Janeiro serves as a warning for the whole of Brazil, say scientists – 28/08/2021

The state of Rio de Janeiro has been in a unique situation since the pandemic began. On the other hand, there is optimism about the progress of vaccination: many cities have already applied the first dose against Covid-19 in almost the general adult population.

On the other hand, there are concerns about the rapid arrival and spread of delta variable Act Corona Virus And the increasing number of hospitalizations from respiratory infections, which sends the warning signal from the authorities and threatens to reopen 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,” assesses researcher Leonardo Bastos, from WireCross (Oswaldo Cruz Foundation).

“The latest statistics suggest that something different is happening in the state, but we still don’t know what exactly it is,” he adds.

Infectious disease specialist Alberto Chapoo, medical director of the University Hospital Clementino Fraga Filho, 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 hospitalizations for covid-19, especially among the elderly and health professionals, he says.

“This was something we had not seen with this frequency for a long time,” adds the specialist, who is also vice president of the SBI (Brazilian Society of Infectology).

But what is behind this deterioration? Can the same be repeated over the next few months in other states and regions of the country?

Rio de Janeiro crisis

After the very complicated first half of 2021, which was marked by a second devastating wave, Rio de Janeiro, between May and July, experienced a downward trend in epidemic numbers.

In fact, a similar scenario occurred in the rest of the country, with a significant decrease in diagnoses, hospitalizations, and deaths from the disease in the same period.

But there are two important details in this story, which apply to both the state of Rio de Janeiro and Brazil as a whole. First, notifications have remained very loud, even in the recent lull, with tens of thousands of cases and hundreds of deaths each day.

The second point is According to InfoGripe, published periodically by FioCruz, transmission of respiratory viruses has remained very high in much of the Brazilian territory, even at a time of greater calm.

This has put us in an awkward position in which a new downturn could erupt at any moment. And that is exactly what appears to be happening now in Rio de Janeiro, with the growth of COVID-19 resuming.

Let’s analyze what happened to the disease cases there, following the records I collected Kunas (National Council of Health Trustees).

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In the first week of May, more than 39,000 cases were diagnosed, a record number so far. In the last week of June, that number fell to 14,000, the lowest since the height of the second wave.

But in the first seven days of August, 27 thousand new cases were discovered.

And what about hospitalization?

According to Shababou, “At the worst moment of the epidemic, we admitted about 1,400 patients to hospitals in the area, and now our number is about 700.”

Although the household occupancy rate in the state is 69% of capacity, What is considered the average alert level in the InfoGripe Bulletin, The situation in the capital is critical: currently, 96% of the vacant positions available for the treatment of COVID-19 are filled in the institutions of Rio de Janeiro.

“It is possible, sometime soon, that we will need to suspend elective surgeries and reset beds to meet covid-19 demand again,” says the SBI vice chair.

The doctor explains that this new increase in diagnoses and hospitalizations has not yet affected mortality rates.

“We will only be able to analyze if there is an increase in deaths in a few weeks, even because the deterioration comes in waves. First, people get infected, then they get sick, they are hospitalized and take some time to recover or die,” Shababou explains.

The ingredients behind the degradation

According to experts interviewed by BBC News Brasil, it is not possible to shed light on a single factor behind the flumine boom.

“There are some hypotheses that help to understand what’s going on, but they are not exhaustive,” Bastos explains.

“It is necessary to consider the arrival of the delta variant of the coronavirus, population mitigation and restrictive measures and even the potential for loss of efficacy of vaccines over time,” the researcher states.

Let’s start with Delta: The strain that emerged in India was identified in Brazil in May 2021, and since then, monitoring teams have been following up on how it spreads across the country.

And Rio de Janeiro is ideal for understanding the evolution of this alternative. This is because the state has RJ Corona-omic . NetworkIt is a project that brings together researchers from different institutions and aims to monitor different strains of the Corona virus, detect the emergence of mutations, and understand how these genetic modifications affect the progress of the epidemic.

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Says geneticist Anna Teresa Vasconcelos, of the National Scientific Computing Laboratory, one of the institutions doing part of the initiator.

And the evolution of variants in Rio de Janeiro is quite clear: between January and July 2021, the Gama (originally discovered in Manaus) was the most common breed, with a significant advantage over other competitors.

In August, however, deltas became prevalent and, According to the latest Corona-Ômica RJ . network technical noteIt is already present in 61% of samples analyzed by partner laboratories.

“In parallel with delta growth, we can’t ignore what’s happening with the other variables as well. Gamma has undergone mutations and we’ve already found nine sublines of it here,” Vasconcelos warns.

“The coronavirus is constantly changing to keep spreading among us,” he says.

The worst (not yet) is over

Although Delta is more transferable than previous versions, can’t it be considered the only one responsible for the situation in Rio de Janeiro? Even because prevention measures, such as physical distance, use of masks and ventilation of environments, continue to work against this and other variables.

That’s why experts also point to the easing of restrictive policies as another factor that helps explain the recent deterioration.

“People think that after vaccination, everything clears up and we can go back to normal, but that’s not quite the case. We are not at the moment to leave masks aside,” Vasconcelos advises.

In this sense, the declarations made by municipalities in Rio de Janeiro regarding the realization of major events, such as New Year’s Eve and Eid carnival, does not help at all, according to experts.

“Obviously the general manager needs to plan and plan things, but speaking frankly at parties now, at this moment, conveys a sense of normalcy that is practically non-existent. The epidemic is not yet over,” Shababou criticizes.

“We don’t know what will happen in the coming months,” he says. “The scenario is changing very quickly.”

Who needs backup?

When talking about vaccines, there is currently a lot of discussion about the possibility of losing their efficacy.

Studies show that it remains important in protecting severe cases, hospitalization and mortality, but some vulnerable groups appear to have compromised immunity six months after taking both doses.

This drop in protection from vaccines will also help explain the recent increase in hospitalizations for older individuals in Rio de Janeiro, as evidenced by reports compiled by BBC News Brasil and the latest editions of the Infogripe Bulletin.

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To deal with this precisely, the Ministry of Health, like countries such as Israel, the United States and Chile, have announced that the elderly and those with immunodeficiency (carriers human immunodeficiency virus, individuals undergoing cancer treatment, newly transplanted, among others) a third dose of the immunizing agent as of September 15.

In parallel with strengthening the most vulnerable groups, scientists consider it necessary that everyone who has already received the first dose should return to the health center on the date set for the second application.

Is Rio de Janeiro today the Brazil of tomorrow?

Finally, it is natural to wonder whether an exacerbation of the epidemic in one state could recur or spread to the rest of the country by the end of the year.

For Bastos, the local situation should indeed be a concern.

“Rio de Janeiro is a meeting point and has a great connection with other Brazilian regions, especially with São Paulo,” researcher FioCruz analyzes.

He concludes, “We know that when the degradation reaches São Paulo, it easily spreads to other places.”

For Vasconcelos, everything indicates that the delta variant is also spreading across several states in the country and the data from Rio de Janeiro draws attention precisely because there is genetic monitoring of the coronavirus there, unlike in other places.

“It’s the famous people ‘those who look for it, they find it.’ Because we’ve built a network of labs with the capacity to carry out this genetic tracking, we end up with detailed monitoring for the presence of this variant and others,” he says.

To contain the problem’s progress in Rio de Janeiro or in the rest of Brazil, Chapo says it’s time to speed up vaccination.

He pointed to the need to expand the coverage of our vaccinations, while ensuring the second dose for all, offering the third to those who need it, and promoting prevention among adolescents.

“In parallel, we will need to do everything that has not yet been done to contain the transmission of the virus, such as limiting the circulation of people and establishing testing and tracing programs and isolating cases,” Bastos recalls.

According to the latest information from Kunas, Rio de Janeiro has officially recorded 1.1 million cases and 61,900 deaths due to COVID-19 since the pandemic began.