Tuesday, October 19

Coronavirus in Brazil: São Paulo is experiencing a “war” health situation, without beds or drugs against covid-19 | Society

A patient with coronavirus is transferred to the intensive care area in a São Paulo hospital, this Tuesday.
A patient with coronavirus is transferred to the intensive care area in a São Paulo hospital, this Tuesday.AMANDA PEROBELLI / Reuters

In São Paulo, the richest city in the country and with the most solid health system, private hospitals are experiencing a “war situation” and reflect the chaotic scenario of the pandemic in Brazil. The outlook is dramatic and some centers have already reached the limit of hospital pressure, without ICU beds and queues of patients waiting to be transferred to other hospitals. If this sector already had difficulties to increase the number of beds, this week a worrying problem has been added even for those that already exist: the shortage of drugs to intubate patients with covid-19, without which it is not feasible to put them on invasive mechanical ventilation for help them breathe.

In public health, the outlook is no better. There are only medications for the next 20 days, a problem that several governors have alerted to the Ministry of Health in a letter requesting that the necessary drugs be urgently imported. The Brazilian Association of Medical Insurers denounces the same situation in São Paulo and, together with other associations, is pressing for the importation to be facilitated. Private hospitals and health companies say that they work daily with concern about the increase in demand and infections. There were more than 680,000 cases until last Wednesday, and more than 20,000 deaths from covid in the city of 12.3 million inhabitants. “If the rate of infections remains the same, even if we increase thousands of beds a day [no daríamos abasto]… The only solution is to raise awareness among the population ”, says Marcos Novais, executive superintendent of the association.

The collapse scenes that were seen in Manaus or the northeast of Brazil last year, which a priori have fewer resources, are now being repeated in São Paulo. It is no use being rich and paying for good health insurance, although the poorest population is the one that has been most affected by the pandemic since the beginning of the crisis. Now, even private hospitals – serving people with greater purchasing power – are beginning to show signs of collapse. “It is a war situation”, defines the president of the Union of Hospitals, Clinics and Laboratories (SindHosp), Francisco Balestrin. He assures that private centers are acting “as if they were field hospitals” due to the considerable increase in patients in the last 10 days and some admit that they are close to or have already reached the maximum occupancy capacity of the ICUs.

“It is a very complex situation. The fact that all the beds are occupied becomes more important because we have a high number of daily cases. We do not have the pandemic under control, quite the opposite. This generates more demand and, with the beds occupied, this new demand cannot be accommodated. Today ICU beds remain occupied for longer than before ”, he adds. On March 16, there were 240 deaths from covid-19 in the city, more than double the previous day. The first official death from the ICU waiting list, announced by Mayor Bruno Covas, became an emblem of the situation in the city. A 22-year-old young man who entered the hospital with respiratory problems from covid on the 11th, but could not get a bed. He died the next day without the ventilation he needed.

The Municipal Health Secretariat confirms having received, over four days, 30 requests for ICU and nursing beds for patients with covid-19 from private hospitals, but ponders that this “does not yet indicate the exhaustion of the private network ”, Although it reflects the pressure of the pandemic on health. He admits, however, that it is “unprecedented.” This Thursday, Mayor Bruno Covas recounted a line of 475 people waiting for an ICU bed in the city.

Even the transfer of patients between private hospitals is problematic, due to the difficulty in increasing the number of beds while the demand increases. A study carried out by SindHosp in 25% of the private hospitals affiliated with the union (93 centers) shows that only half say they have the capacity to increase the number of beds and 82% already have more than 91% of their places occupied. There are problems even in guaranteeing care for patients who already have one: there are difficulties in guaranteeing drugs to intubate patients, in addition to teams with specialized professionals. Health insurers have already converted infirmaries and even operating rooms into ICUs, but even so the beds fill up quickly.

“It is not just a question of beds. An ICU infrastructure and specialized professionals are also needed. Intubation drugs have become the main concern. We are working to increase the number of beds, but we will not cope if people do not take care of themselves, ”says Novais. A bed is only free when someone is discharged or dies and, according to Balestrin, hospitalization time is longer at this time, marked by the growth in the number of young people hospitalized, even in ICU beds. “They are more resistant, but for some reason this disease has become more violent and they end up staying longer. We have more beds and also many more patients ”.

In the Nipo-Brasileiro Hospital, for example, all ICU beds for covid-19 and for other diseases are occupied. Last Wednesday, there were 25 patients in the emergency room waiting for a bed. The Nipo-Brasileiro says that every day it looks for vacancies in other hospitals in the city because it has reached the occupancy limit. The hospital was on the list of the 15 private centers that would have referred patients to public hospitals, but explains that it did so because the patients did not have health insurance and could not afford the costs as individuals.

Private healthcare admits to having limitations both to expand and to maintain the existing structure. It also has difficulties in guaranteeing the stock of drugs to sedate intubated patients and of drugs that function as neuromuscular blockers, necessary so that the patient does not “fight with the ventilator” and breathes at the rate of mechanical ventilation. “There are drugs that have increased almost 900%. Refueling is difficult, ”says Balestrin. He mentions the global dispute over these drugs, which, despite being produced in Brazil, depend on the importation of raw material from India and China. Another problem is the difficulty in guaranteeing specialized intensive care equipment. “More and more hospitals say they have reached their limit of expansion,” says the president of Sindhosp.

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