Is Brazil a threat to global health security? What Science magazine says

RIO DE JANEIRO, BRAZIL – Understanding the behavior of SARS-CoV-2 and how its mutations test the management of the pandemic and even the efficacy of the vaccines developed in record time is undoubtedly of great interest to the women and men of science.

Prestigious cardiologist Eric J. Topol is a professor of molecular medicine at the Scripps Research Institute in California and on his Twitter account he highlighted two articles published in Science journal on Covid-19 in Brazil, which document what triggered the emergence of the P1 variant in Manaus and analyze its high transmissibility, potential increase in lethality and incomplete protection of previous Covid infection.

It is in the nature of viruses to mutate. To expect them not to do so is to ask them to cease to exist. Thus, viruses mutate frequently, both within infected individuals and when they travel from one person to another.

The central challenge today is that SARS-CoV-2 continues to mutate and circulate, with the potential risk of it becoming another virus.

“We need to redouble public health measures. The less a virus spreads, the less it will mutate.” For Anthony S. Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases, “we need to vaccinate as many people as possible with the current vaccines available and prepare for the potential eventuality that they may need to be updated in the future.”

The recent publication of the prestigious scientific journal highlights “the rapid spread of both cases and deaths from Covid-19 in Brazil, with different patterns and burden by state.” According to the researchers, what is happening in that country “demonstrates that no single narrative explains the spread of the virus among Brazilian states. Instead, layers of complex scenarios intertwine, resulting in concurrent and varied Covid-19 epidemics across the country.”

In analyzing the relentless advance of the Manaus variant in the country, experts deployed five causal factors.

“First, Brazil is large and unequal, with disparities in the quantity and quality of health resources, such as hospital beds, physicians and income,” they elaborated. “Second, a dense urban network connecting and influencing municipalities through transportation, services and businesses, which was not completely disrupted during peaks in cases or deaths.”

Third, they noted, “political alignment between governors and the president played a role in the timing and intensity of distancing measures, and polarization politicized the pandemic with consequences for adherence to control actions.” Fourth, “SARS-CoV-2 circulated undetected in Brazil for more than a month, as a result of the lack of a well-structured genomic surveillance.”

Finally, “fifth, cities imposed and relaxed measures at different times, based on different criteria, facilitating the spread.” “Our findings address these problems, but also show that some states were resistant, such as Ceará, while others with comparatively more resources were unable to contain the spread of Covid-19, such as Rio de Janeiro,” the publication outlined.

The P1 variant emerged in the city of Manaus, capital of the state of Amazonas, but was only identified as a new mutation in January, in Japan, in travelers returning from the region of northern Brazil.

However, the emergence of the variant that had already been detected in several South American countries, such as Argentina, Chile, Uruguay, Bolivia, Peru and Venezuela had occurred much earlier.

“We show that P1 likely emerged in Manaus in mid-November, where high attack rates had previously been reported. High rates of mutation accumulation over short periods of time have been reported in chronically infected or immunosuppressed patients. Given a sustained generalized epidemic in Manaus, we believe this is a potential scenario for P1 emergence. Genomic surveillance and early data sharing by teams around the world has led to rapid detection and characterization of SARS-CoV-2 and new variants of concern, but such surveillance is still limited in many settings,” highlights another Science publication distinguished by Topol.

In such a scenario, rapid and equitable, federally coordinated responses are imperative to prevent a rapid spread of the virus and disparities in outcomes. However, the response to Covid-19 in Brazil was neither rapid nor equitable.

Brazil is currently facing the worst moment of the pandemic, with a record number of cases and deaths, and near collapse of the hospital system. Vaccination has begun, but at a slow pace due to the limited availability of doses. The new variant of concern that emerged in Manaus is estimated to be 1.4 to 2.2 times more transmissible and capable of evading the immunity of a previous non-P1 infection.

That variant is spreading throughout the country. It became the most prevalent in circulation in 6 of the 8 states where investigations were conducted. By March 11th, 2021, Brazil reported 40% of the total deaths from Covid-19 occurred in 2020. Manaus recorded 39.8% more Covid-19 deaths in 2021 than in all of 2020.

“Without immediate containment, coordinated epidemiological and genomic surveillance measures, and an effort to vaccinate as many people as possible in the shortest possible time, the spread of P1 will likely result in unimaginable loss of life. Failure to prevent this new round of spread will facilitate the emergence of new VOCs, isolate Brazil as a threat to global health security, and lead to an entirely avoidable humanitarian crisis,” the experts concluded.

Source: Infobae

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