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Covid-19 spreads to small towns, where patients are far from care

. Jun 01, 2020
Covid-19 spreads to small towns, where patients are far from care Health unit in the Greater Belém Area. Photo: Cícero Pedrosa Neto/Amazônia Real

A report from the Oswaldo Cruz Foundation (Fiocruz) shows that Covid-19 has now spread to small Brazilian towns, leaving patients far away from intensive care units. More and more people will be forced to travel long distances in order to seek treatment in large urban centers, according to the study, published on May 20. But this is not the only problem: even for those who live near hospitals, the lack of access to privately held ICU beds prevents many from receiving adequate health care. 

Fiocruz is one of Brazil’s leading references on public health issues. Its study was based on the Monitora Covid-19 database, which collects data about the pandemic in Brazil.

By the end of April, all municipalities with over 500,000 people had recorded at least one death. Now, the coronavirus is rapidly making inroads in smaller towns: five percent of municipalities with fewer than 10,000 inhabitants have recorded at least one death; one-third have recorded confirmed cases of Covid-19.</p> <p>The Fiocruz report highlights that the spread of the disease is &#8220;expanding uncontrollably, and it is almost certain that it will arrive in most of [Brazil&#8217;s] municipalities&#8221;. Once this happens, the volume of cases increases rapidly and severe patients must seek specialized treatment, which is nowhere to be found in most of the country&#8217;s cities. As a result, a growing number of Brazilians will be forced to travel for hours to hospitals in bigger cities.</p> <p>This migration is already happening. As of May 4, half of Covid-19 patients were in hospitals outside of their cities of residence. The report stresses that this makes it harder to know how the coronavirus is spreading in smaller cities, as cases and deaths may be added to the tally of the city where they are receiving treatment, but not necessarily where they contracted the virus.</p> <h2>7 million Brazilians over 4 hours away from intensive care</h2> <p>For many Brazilians, simply reaching a large urban center is a major challenge. Cross-referencing information on medical infrastructure with populational data from the Brazilian Institute for Geography and Statistics, the study shows that more than 7 million people are at least a four-hour car ride from a city with ICU units and specialized personnel —&nbsp;essential to treat respiratory diseases such as Covid-19.&nbsp;</p> <p>In the states of Mato Grosso, Pará, and Amazonas, as much as 20 percent of the population is four hours or more from their nearest ICUs.</p> <p>But even if people manage to make the journey to major urban centers, access to healthcare on arrival is not a given. In Amazonas, state capital Manaus is the <em>only</em> city with <a href="https://gauchazh.clicrbs.com.br/saude/noticia/2020/04/a-beira-do-colapso-por-coronavirus-amazonas-tem-95-de-ocupacao-de-utis-e-respiradores-ck8rgdjvf01n801llyttnn4cu.html">public intensive care beds</a>. As of May 25, around <a href="https://noticias.uol.com.br/saude/ultimas-noticias/estado/2020/05/25/apos-brasil-bater-recordes-cinco-estados-se-aproximam-do-colapso-na-saude.htm">87 percent</a> of them were occupied.&nbsp;</p> <h2>Not enough beds for everybody</h2> <p>The situation in Brazil&#8217;s urban favelas is particularly troubling, as these areas lack infrastructure and are densely populated, making social isolation virtually impossible.&nbsp;</p> <p>One <a href="https://agenciadenoticias.ibge.gov.br/media/com_mediaibge/arquivos/1d84b79d30c50c71e372ede086cb516c.pdf">study</a> led by the country&#8217;s official statistics agency and published on May 19 estimated the distance between favelas and medical facilities. It shows that 65 percent of favelas are less than two kilometers from the nearest hospital, while 80 percent are less than 1 km from a basic health center.</p> <hr class="wp-block-separator"/> <iframe title="Percentage of households located in favelas" aria-label="Map" id="datawrapper-chart-FzXq7" src="https://datawrapper.dwcdn.net/FzXq7/1/" scrolling="no" frameborder="0" style="width: 0; min-width: 100% !important; border: none;" height="610"></iframe><script type="text/javascript">!function(){"use strict";window.addEventListener("message",(function(a){if(void 0!==a.data["datawrapper-height"])for(var e in a.data["datawrapper-height"]){var t=document.getElementById("datawrapper-chart-"+e)||document.querySelector("iframe[src*='"+e+"']");t&&(t.style.height=a.data["datawrapper-height"][e]+"px")}}))}(); </script> <hr class="wp-block-separator"/> <p>At first glance, the data would suggest that a great deal of the country&#8217;s poorest people have easy access to medical assistance without having to travel large distances. However, the survey does not convey any specific information in regards to infrastructure. It fails to indicate if these hospitals or basic healthcare units have areas where they can isolate and test Covid-19 patients, or intensive care beds where severe cases can be treated.</p> <p>The study also doesn&#8217;t distinguish between public and private hospitals. <strong>The Brazilian Report</strong> showed in an April 27 article that there are <a href="https://brazilian.report/business/2020/04/27/brazil-unify-public-private-healthcare-systems/">14,876 public intensive care beds</a> on the public healthcare network, and another 15,898 are owned by private hospitals.</p> <p>In other words, 52 percent of Brazil&#8217;s hospital beds are exclusively for <a href="https://www.ans.gov.br/perfil-do-setor/dados-gerais">22 percent</a> of the Brazilian population that can afford a health insurance plan.&nbsp;</p> <p>A movement called <em>Leitos para Todos</em> (&#8220;Hospital beds for all&#8221;) advocates that privately-held intensive healthcare beds should be controlled by the government during the pandemic, and several legal mechanisms could make such a policy viable.&nbsp;</p> <p>Citizens are turning to the courts to try and gain access to private beds when public treatment is no longer available, but there is no legal consensus over the issue. On May 27, the Senate passed a bill stating that vacant private beds <a href="https://www12.senado.leg.br/noticias/materias/2020/05/26/senado-aprova-uso-de-leitos-de-uti-particulares-por-pacientes-do-sus">must be handed over to the public system</a>, with hospitals receiving compensation from the government. The bill still needs to pass through the lower house —&nbsp;and then the president.

 
André Cabette Fábio

André Cabette Fábio is an award-winning journalist who has previously been published by Folha de S.Paulo, UOL, Nexo, Estadão, and Die Zeit Online. He has mainly written about human rights, inequality, macroeconomics, and violence.

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