Low testing casts doubt over Covid-19 reality in Brazil

side of <a href="https://brazilian.report/power/2020/03/25/rock-hard-place-bolsonaro-favors-economy-over-health/">getting Brazilians back to work</a> are President Jair Bolsonaro and conservative business owners. They are opposed by Congress and the vast majority of the country&#8217;s state governors. Twenty-three of Brazil&#8217;s 27 state governors have upheld broad isolation measures, dismissing the view of President Bolsonaro.</p> <p>However, before any informed decisions can be made, there is a pressing need to discover the real impact of the pandemic on Brazilian society.</p> <p>Over one month since the first confirmed case of Covid-19 in Brazil, no one knows exactly how many people have been infected, while suspicions loom about the underreporting of cases and deaths.</p> <p>There have been numerous reports of overcrowded morgues in the city of São Paulo — the epicenter of the epidemic in Brazil — while renowned medical research institution Fiocruz has reported an &#8220;explosion&#8221; of hospitalizations for respiratory problems nationwide, many of which could be undiagnosed cases of Covid-19.</p> <p>A <a href="https://cmmid.github.io/topics/covid19/severity/global_cfr_estimates.html">study</a> by the London School of Hygiene and Tropical Medicine raised suspicion that Brazil has registered only 12 percent of its actual total of Covid-19 cases. On Friday afternoon, the Health Ministry declared 3,417 coronavirus infections in the country, and 92 deaths.</p> <p>The ministry itself has said numbers may rise as they try to determine accurate causes of death in a number of patients. According to secretary Wanderson Oliveira, these responses will still take some time.</p> <p>Meanwhile, on a completely different tangent to any major political leaders in the world, President Jair Bolsonaro suggested during a rambling Friday afternoon interview that the number of deaths may be being <em>inflated</em>.</p> <h2>Tests, tests, and more tests</h2> <p>While no country can hope to know how many Covid-19 cases are within its borders with 100 percent accuracy, increasing the number of tests performed can help give a much more reliable estimate. According to the Health Ministry, this has been the case in countries such as the U.S. and <a href="https://www.washingtonpost.com/world/asia_pacific/japan-targets-coronavirus-testing-while-south-korea-goes-big-the-us-faces-which-path-to-take/2020/03/28/97e81b44-6eb6-11ea-a156-0048b62cdb51_story.html">South Korea</a>. Both have high rates of infection primarily because many more of their citizens are being tested.</p> <p>The situation in Brazil, however, is a world away. A <a href="https://ourworldindata.org/coronavirus-testing-source-data">survey</a> from the Our World in Data project showed that Brazil is one of the nations with the smallest amount of tests performed, ranking 53rd out of 59 countries. While the UK and South Korea, for example, have tested 960 and 6,148 people for every 1 million inhabitants, Brazil registered just under 14 tests per million. The Health Ministry has ordered 45 million new tests for Covid-19 that will be delivered by the end of April.</p> <div class="flourish-embed flourish-chart" data-src="visualisation/1705059"><script src="https://public.flourish.studio/resources/embed.js"></script></div> <p>If the numbers of severe cases increase, the Brazilian healthcare system looks set to collapse. A calculation made by researchers Gustavo Kay, Lucas Amorim, and Gonzalo Vecina Neto detailed that Brazil has 48 intensive care beds for every 100,000 inhabitants on the private health system. In the public system, this proportion drops to 10 for every 100,000. The proportion of respirators — essential equipment to treat those with severe cases of Covid-19 — is 84 for every 100,000 in the private system and 12 for every 100,000 in public healthcare.</p> <p>To compensate for the lack of ICU beds, the federal government issued a decree on Friday allowing small hospitals that have long-term care beds to register to receive federal aid and thus receive patients from other health institutions.</p> <h2>Panama case study: more cases mean more effectiveness</h2> <p>Panama, the country of 4 million people that divides Central and South America, accounts for the highest rate of Covid-19 infections per capita in the region. Sixteen of every 100,000 Panamanians are infected with the virus, and nine have died.&nbsp;</p> <p>Pan American Health Organization representative Gerardo Alfaro said during an <a href="https://news.un.org/es/story/2020/03/1471462">interview with UN news</a> that the tiny state “has always been one step ahead,” mentioning President Nito Cortizo’s quick response to the pandemic, allocating financial resources and quickly imposing quarantines. The head of epidemiology of the Panamanian health ministry, Lourdes Moreno, said at least 4,856 Covid-19 detection tests have been carried out since the outbreak reached Panama, with 608 during a 24-hour-period. In Panama’s case, more detected patients have led to increased effectiveness.&nbsp;</p> <p>The Panamanian government explained that the country is massifying the coronavirus detection tests to isolate as many infected people as possible. The numbers presented by Panama, which added 391 cases by last Friday, “are not surprising” and are within the previous projections. Mr. Alfaro said the country’s quick reaction will be crucial to the results “that will begin to be seen in two weeks.”</p> <div class="flourish-embed flourish-chart" data-src="visualisation/1722928"><script src="https://public.flourish.studio/resources/embed.js"></script></div> <h2>Covid-19 in Brazil: what is ahead</h2> <p>Brazil is in its second week of social isolation, and expectations about the growth of the virus pandemic are encouraging. Projections indicate that the country has a growth curve close to Italy, and the federal government expects a situation that is not encouraging.</p> <p>In an interview with the newspaper <em>Folha de S.Paulo</em> on March 16, Economy Minister Paulo Guedes said that <a href="https://www1.folha.uol.com.br/mercado/2020/03/dados-do-bc-mostram-que-contagio-e-mais-rapido-no-brasil-diz-paulo-guedes.shtml">projections</a> made by the Central Bank and the Health Ministry showed that contagion could be faster than in other countries.</p> <p>&#8220;The U.S. and Brazil could have a faster rate of contagion than we saw in China and Italy. It was alarming. It was something like this: in Italy there was a forecast of 60 percent contagion and here, 80 percent. But everything will depend on prevention,&#8221; said Mr. Guedes.</p> <p>Analyses carried out by the Health Intelligence Laboratory (LIS) at the Ribeirão Preto Medical School indicated that the cities of São Paulo, Rio de Janeiro and Brasilia are the hotspots for the spread of the virus. According to experts, the three municipalities could reach 16,000 cases next week without social isolation measures.</p> <p>Brazilian scientists had already shown that Covid-19 has mutated since it arrived in the country. The experts also detailed that the virus spreading around Brazil is closer to the one ravaging Italy, as opposed to the strain found in China.</p> <p>The joint study carried out by the Bioinformatics Laboratory of the National Laboratory for Scientific Computing — which brings together scientists from different federal universities and research foundations — analyzed 19 patients admitted to hospitals in Minas Gerais, Rio de Janeiro, Goiás, Rio Grande do Sul and São Paulo.</p> <p>This result, according to scientists, only reinforces the argument that Covid-19 is already transmitted in a community way. This finding, they claim, shows the need for social isolation to stem the spread of the pandemic.