RIO DE JANEIRO, BRAZIL – After a controversial week in which the transparency of coronavirus data was threatened, a climate of mistrust still hovers over official information from the Bolsonaro government.
The country, which now counts 40,919 deaths and 802,828 Covid-19 cases and is on track to become the main epicenter of the pandemic by the end of next month, has not been provided with complete data on the disease by the Ministry of Health for three days and has been casually advised by the President about plans for a change in methodology that would impact the statistics, pushing the numbers down.
After an injunction by the Supreme Court, the government had to re-release the total number of deaths from the disease. Interim Health Minister Eduardo Pazuello, summoned to provide explanations to congressional deputies, said that everything was merely a “proposal” and that soon a new platform would be launched, with complete and detailed data; however, when disclosed on Friday, it included only data previously known.
However, the brief change had already moved the press and experts, who rushed to get their own counting platforms online. And it triggered an alert among researchers, who continue to focus on checking official figures and advocate greater transparency.
The Bolsonaro government plan, which has downplayed the pandemic in the country since the first cases, was to release daily only the deaths that occurred in the past 24 hours rather than everything that was recorded over that same period by the states.
The data would be much less, since the country is unable to quickly test the suspected cases and the confirmations sometimes come days after the death – Friday’s Folha de S.Paulo report points out that 44 percent of the victims would be excluded from the daily statistics using this new method. Currently, 3,608 deaths due to respiratory syndrome, i.e., occurring with symptoms compatible with Covid-19, are still awaiting results.
For medical professor Domingos Alves, head of the Health Intelligence Laboratory (LIS) at Ribeirão Preto Medical School, the government’s attempt to change the method of data disclosure is related to the fact that the country is on its way to becoming the greatest epicenter of the pandemic in the world.
“We are the only country in the world that after the 50th day was accelerating in the number of cases and deaths. We have projections that suggest we could reach 5,000 deaths per day in July,” he says. “Brazil so far hasn’t managed the epidemic because we only test patients who are hospitalized and, therefore, already in isolation. We are not isolating those who are spreading the disease because we don’t test en masse. There hasn’t been any policy of isolating contacts,” he criticizes.
The Ministry claimed the new records of old deaths would be accounted in retroactive dates, but by removing the total number of deaths since the start of the pandemic from disclosure, it would preclude follow-up. This prompted a sharp reaction from the scientific community, which feared the use of incomplete data to produce a distorted picture of the epidemic in the country.
Currently, epidemiologists analyzing the behavior of the novel coronavirus in Brazil are considering in their studies the dates of death, with projections that also take into account the delay in testing. By analyzing these data, the Covid-19 BR Observatory reached the statistic that 61 percent of deaths take more than ten days to enter the system and that only 0.7 percent of those deaths are counted on the same day of occurrence.
Now, the Ministry is discussing with state and municipal Health Secretaries the unification of information systems in which professionals report hospitalizations for severe acute respiratory syndrome (SARS), a complication of Covid-19 and also of other flu syndromes.
In a scenario of few tests and delays in results, SARS hospitalizations have been an important metric for observing the progress of the epidemic. In recent days, Minister Pazuello himself talked about simplifying registration forms for these cases. Without detailing what this unification would mean, he sounded new warnings amid the noise already caused by last week’s attempt to release only partial data.
Brazil uses important public databases to analyze the behavior of several diseases, such as swine flu, dengue and, more recently, Covid-19. The country’s legislation requires all hospitals to report a high range of diseases.
The country also has a National Health System (SUS) that allows widespread access to hospitals and, consequently, greater notification. One such system is Sivep-Gripe, through which researchers have also been able to collect a number of SARS-related microdata that include information such as location, race, age and co-morbidities of patients.
“Brazil’s health monitoring system is one of the best in the world. We have one of the largest compulsorily reported disease charts. The fact that Brazil has the SUS and a broad range of diseases that must be reported renders our data highly reliable,” explains scientist Vítor Sudbrack, a physicist who is part of the Covid-19 BR Observatory.
He explains that the system presents technical issues – such as allowing ratings in observation fields that can hinder reading in programming language – but that it is rich in data reliability.
The issue with the recent changes announced by the Ministry, he explains, is not the disclosure of untrue data, but instead the potential for its use in a narrative that might not represent the reality of the epidemic in the country. Reliable data are critical to controlling the disease while there is still no vaccine or proven effective treatment. They help managers make decisions and show the population why isolation needs to be sustained in the most affected regions, for instance.
“What we can see is that our resources are ultimately unused, discarded or misused,” says Sudbrack. If the Ministry of Health provides what it pledged in the new platform – that is, include the numbers of deaths by date of occurrence and also the accumulated deaths – he considers the reform to be positive.
For now, the Observatory continues to analyze the national database, cross-checking the figures with those submitted by states that access the same systems. “The reform, when done correctly, clearly, transparently and debated, is welcome,” he says.
In May, the federal government extended the transparency of Covid-19 data. It started to provide microdata in OpenDataSUS, a platform that introduced improvements in stratified information. In the first days, it even included the Postal (Zip) Code of those infected and people who died from Covid-19. The LabCidade, from the USP (University of São Paulo), even developed a platform to monitor cases by street in São Paulo, but this data was then removed from the Ministry’s database.
“In the case of the Postal Code variable, the data is considered sensitive since it allows for easier identification of the individual. Therefore, in compliance with the General Data Protection Law – LGPD (Law no. 13.709/2018), it was removed. This action contributes to ensuring and preserving the citizens’ privacy”, explains the portfolio. The data should not recur even with the STF’s decision last Monday, June 8th, as since June 2nd (before the change in disclosure) it was no longer available to the public.
In any event, experts point out that providing a large volume of information in open databases is not enough. Transparency also needs to match the platform created by the government to communicate with the population.
“The panel they publish is a very different beast. They process data with a methodology that is not widely disclosed,” explains Sudbrack. The researcher says that recent attempts to change the disclosure of data undermine transparency. “We hope the data will still be reliable. The point is that you can provide reliable data that doesn’t reflect reality. That’s what would happen if they disclosed only the deaths that occurred that day,” he points out.
Epidemiologist Ana Ribeiro, who works in the surveillance service at Emílio Ribas Hospital and is a member of the Observatory, also supports greater clarity about the Ministry’s methodologies to consolidate the data and inform the population.
“The source needs to be very clear, from where they are using the data collection (when they release the deaths within 24 hours),” she says. On the platform with processed data, SARS cases have been outdated for about three weeks.
The transparency of the states also leaves something to be desired. The most recent Covid-19 Transparency Index Report, conducted by Open Knowledge Brasil, points out that there has been progress in the disclosure of data in recent months, but a third of states still do not release the microdata that could be used by scientists for more in-depth analysis. Information on the occupancy of hospital beds, where infected patients with the most severe forms of the disease are treated, is also poor.
End of isolation
Pandemic data are crucial to guide public policy and the actions of governments when it comes to relaxing social isolation. Several Brazilian states are already starting to implement their plans to reopen the economy despite the fact that the country is still unable to test the population en masse. Interim Minister Pazuello said that the country is working to extend testing, but has already conceded that there is no way to reach the 40 million tests pledged by his predecessor, Nelson Teich.
In São Paulo, scientists say they haven’t had time to analyze the risk of the business reopening that occurred during the holiday, given the haste in the decision. And they criticize the government’s use of record data rather than date of occurrence for this analysis.
Source: El País