Brazil’s Health Minister Luiz Henrique Mandetta declared this week that Brazil is entering the stage of having local transmission of the novel coronavirus, predicting “some harsh 20 weeks ahead.” During that stretch, infection numbers will balloon and, according to projections based on the novel coronavirus’ path in countries such as China, Italy, or Spain, they could go from around 150 to 30,000 by April 1. And within the next four months, the state of São Paulo alone could have over 45,000 people infected. When addressing the nation on Thursday night, President Jair Bolsonaro said the number of Covid-19 cases would rise fast—and that the public healthcare system had a limit of patients it could help at any given moment.
Created in 1988 and fully implemented in 1996, the Unified National Health System (SUS) reaches about 70 percent of the Brazilian population. Now, the public healthcare apparatus faces perhaps its biggest challenge to date. The Brazilian Association of Intensive Care Medicine, however, says SUS meets World Health Organization (WHO) standards—of 1 to 3 beds per 10,000 inhabitants.
Data shows, however, that this is hardly the case in every state—especially without throwing the private healthcare network into the mix. Only in the states of Minas Gerais and Paraná does the public system meet the WHO standards of ICU beds for every 10,000 citizens. Meanwhile, in the North and Northeast regions, the rate can be as low as 0.14 beds per 10,000 people.
“The Brazilian system includes several parts of the protection chain. The units are often community references in poorer areas and even very close to people’s homes. This first phase of diagnosis, when done well, can reduce the inevitable future stage of the pandemic. If the first exams are expensive, hospitals that receive patients showing advanced symptoms become real transmission sites,” the expert said.
Adapting the healthcare system to the Covid-19 outbreak
Since last week, the federal administration has passed several measures trying to anticipate the steps of the outbreak. One of the first moves was including tests for Covid-19 in the list of exams health insurance companies are forced to cover—as long as the patient is considered a “suspected case” by a physician.
Other measures can be considered more controversial. They include allowing doctors to force treatment and tests on reluctant patients, and granting state administrations the power to impose lockdowns—as long as they are properly reported, giving people time to adapt.
But the most draconian measure, so to speak, involves the appropriation of assets of companies and individuals to assist in combating Covid-19, in return for “fair compensation.” While this initially appears to be a reference to private hospitals, with the government being able to use their facilities in a potential overflow of patients, the mention of individual assets leaves the door open to a number of extreme measures, such as using privately owned land or property to house patients.
“We understand that the administration is trying to avoid bureaucratic delays that could be an obstacle to treating patients—causing unnecessary deaths. But once this ’emergency status’ is lifted, these decrees could be challenged,” says lawyer Aureane Pinese, from law firm Dagoberto Advogados.
Will Brazil repeat Italy and the U.S.?
The novel coronavirus has only recently reached Brazil. Two weeks ago, there were only three confirmed Covid-19 infections—but the number is now at least 50 times higher. Some infectious disease experts say the country could face similar curves to the ones observed in Italy or the U.S.
Italy has become the new epicenter of the Covid-19 outbreak in the space of just three weeks. So far, 22,000 cases have been confirmed, with 2,000 deaths—only China and Iran have reported more casualties. Public hospitals were quickly overloaded, making doctors and nurses have to triage patients to decide who would be treated and who would not. In many facilities, patients were admitted according to their chances of survival.
This week, the Italian government placed the country on lockdown—which generated some dystopian situations. In one such report, actor Luca Franzese, of TV series Gomorra fame, was forced to stay with his sister’s dead body inside their family home for 24 hours—to prevent other people from exposure to her corpse. “Italy has abandoned us,” he posted.
To avoid a similar situation in Brazil, the Health Ministry launched a smartphone app with information about Covid-19, including a self-triage tool consisting of a questionnaire that will inform patients, based on the symptoms they describe, whether or not they should go to the hospital or stay home in self-isolation. The app is available in Portuguese for iOS and Android.
The U.S., where President Donald Trump declared a national emergency, faces different challenges. Business Insider reported that at least 27 million people are not covered by health insurance, which forces them to pay up to USD 1,100 for a simple coronavirus blood test, including subsequent control exams.
In a tweet—latched on to by Brazilians as a reason to praise their public healthcare service—HuffPost journalist Michael Hobbes posted that he went to a Medical Center in Washington University and heard people were charging between USD 100 to 500 for coronavirus tests if they had insurance, versus USD 1,600 if they didn’t.
With Brazil’s health authorities and state governments taking quick measures against the outbreak, banning public gatherings and in some cases closing schools, there is a sense that the conscientiousness of the population may help avoid a crisis on Italian levels.
Whether that is the case, however, will become clear in the coming weeks.
Data in this piece gathered by data editor Marcelo Soares.
Update: This text has been updated on March 15, 2020, at 12:00 pm.