São Paulo registers collapse in 32 cities; state may restrict circulation even more

RIO DE JANEIRO, BRAZIL – The São Paulo state Health Secretary says that the state is unable to open beds as fast as Covid-19 transmission causes need for them. The government maintains all municipalities in the red phase and is discussing an increase in restrictions. The situation in the wealthiest state mirrors Brazil, which passed the mark of 2.000 deaths recorded in one day for the first time.

In a scenario in which the health systems of 32 cities in São Paulo have collapsed because of the pandemic, the state government is considering increasing the quarantine restrictions in an attempt to contain the crisis.

The health authorities point out that they have been unable to open beds as fast as the surge in infections and hospitalizations. There is a daily demand for 130 intensive care beds, and Governor Doria accepts that the situation is critical. Since January experts have been alerting to the situation and criticizing the sluggish pace in increasing restrictive measures taken by the government to curb contagion.

Currently, the whole state is in the red phase, the most restrictive of the relaxation plan; however, rules for that phase have been eased, and the now allow in-person religious services and the opening of schools. Doria says that decisions on quarantine are based on his Contingency Center’s guidelines, either through consensus among the members or a majority vote.

For weeks the group has been discussing the creation of a new phase in the pandemic containment plan, which would involve more stringent measures, but it is still divided. A position could be announced this Thursday.

“If this is the case, the governor will announce new measures. Everything suggests that he will,” said the group’s coordinator, Paulo Menezes, during a press conference on Wednesday, March 10th. He said that the state entered the red phase a week ago and that it will take at least 2 more weeks for the results to be reflected in the pandemic figures, but he advocated the need to improve isolation rates in the state at this critical moment.

For the first time in the health crisis, there are patients waiting for ICU beds in several cities in São Paulo. At least 30 people have already died while waiting. “What we need is to reduce contact between people, and this is done by staying home. We had a positive result this first week with increased isolation,” Menezes pointed out.

According to the government, São Paulo’s isolation rates increased between 3% and 4% this week, but they still need to be improved.

A lower court decision on Tuesday, March 9th, blocked the summoning of teachers and employees for in-person activities in schools during the São Paulo Plan’s orange and red phases, but an appeal should still be filed. On the same day, state prosecutor general Mario Sarrubbo recommended the suspension of sporting events, such as soccer matches, due to the severity of the pandemic. The government says it will not rule out implementing such measures, which are on the Contingency Center’s discussion table.

However, the main measures announced on Wednesday are directed to the opening of additional medical and ICU beds – there will be 338 new beds, 167 of which in intensive care. With no success in slowing down infections, this is an attempt to alleviate a health system that, according to authorities, is on the verge of collapse.

The state expects to reach a total of 9,200 beds by April, close to triple the 3,500 beds it had before the pandemic. Some of these new beds are being set up in temporary structures such as emergency units and hospital extensions.

However, the measure is limited. “We are increasing the number of beds as best we can. When I mention increasing the number of beds, it is not simply a mattress, a bed, and a ventilator. It is also a team that will attend the patient. That’s why opening ICU beds doesn’t happen overnight. We are doing our best to open them,” says state Health Secretary Jean Gorinchteyn.

Patient demand is so high that São Paulo health authorities accept that the wealthiest state in the country is in danger of seeing its health system collapse. “We are unable to open this number of beds as fast as the disease. But we must provide as much assistance as possible to everyone,” Gorinchteyn concedes.

New variants and vaccine

According to the secretary, São Paulo has been experiencing “a new pandemic” since January, referring to the presence of new strains of the coronavirus, potentially more transmissible. At the time, the Butantan Institute’s president, Dimas Covas announced that the Coronavac is effective against the new variants, but failed to present data. He only said that the results of studies showing the production of neutralizing antibodies to the variants of concern will be released “soon.”

Both he and Gorinchteyn said that the Brazilian P1 variant is more transmissible and severe and that it is impacting this critical moment of the pandemic. The secretary said that the state still has ICU beds – the occupancy rate stands at 82% -, but demand has greatly increased: “32 municipalities have already seen their healthcare collapse and have been helped by other locations,” he said, without providing details.

Gorinchteyn also points out that the Central Office for the Regulation of Health Supply and Services (Cross) on Wednesday received 1,930 applications for bed transfers and other procedures related to Covid-19, a demand much higher than the 150 average observed in early December. “Of those, 35% are for ICUs.”

Governor João Doria again complained that the federal government has not been renewing the funding of intensive care beds in São Paulo and other states, even after a Supreme Court ruling ordering resumption. “Only 13% of beds are qualified [i.e., paid by the Federal Government], and it is no different in Bahia, Maranhão, Ceará, this is disobeying the country’s highest court,” he criticized. Urged by the governor to comment on the issue, Gorinchteyn added that the government failed to invest over R$1 billion in hospital beds in the state.

Last Tuesday, São Paulo registered a record 517 deaths in one day. Nineteen state hospitals in São Paulo have reached 100% ICU bed occupancy for covid-19, and another 6 register rates above 95%.

“We are unable to take in everyone at the same time. We are at our limit. Don’t let us collapse, help us help them,” urges Eloisa Bonfá, clinical director of the Clínicas Hospital. The governor and other health officials also appealed to the population’s cooperation in order to reduce contact and consequently infections.

But so far they are only considering the creation of a new decree with tougher restrictions to save lives when vaccines are still scarce.

Source: El Pais