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One day after the state secretary of health Rio de JaneiroEdmar Santos admits that, with the increasing number of cases of Covid-19, there will not be respirators Sufficient for all critically ill patients, the State is already studying criteria to choose which patients will be entitled to a place in the ICU. In accordance with the technical protocol under analysis, which will remove the weight of the “Sofia choice” from the shoulders of the doctors, the conditions of six organs will be analyzed and scores will be given, from 0 (good) to 24 (terrible). the lower the score, the more likely the patient will have to lie down. On Thursday, more than 1,000 patients with suspected or confirmed cases of the new coronavirus were waiting for a place in the ICU or ward in the state. Of this total, 361 were in serious condition.
The first element analyzed will be the functioning of six organs, such as the lungs, kidneys, and heart. Doctors will assign a rating to the patient based on whether or not pre-existing conditions exist. Whoever has a problem that can be fatal, regardless of Covid-19, in up to a year, will earn 4 points and will be in the queue of those who are not sick (0 points) or who have a comorbidity that allows a longer survival than one year (2 points)
The document also provides tiebreak criteria, if there are identical scores. The first is whether the patient is on mechanical ventilation, already connected to a respirator. The second is the age of the patient. Younger people, up to 60 years old, will win a seat before people between 61 and 80 years old. Those over 80 will be the last in the dispute for the bed. According to the proposal, professionals who work directly in the fight against the coronavirus will have priority, if they need a CTI bed, and will be ahead of everyone. Finally, the location will be decided in the order in which the vacancy is requested.
The document, which has already been signed by Renata Carnevale de Miranda, undersecretary of Regulation and Own Units of the state, and which only awaits the approval of the Secretary of Health, Edmar Santos, to be published in the Official Gazette, was developed by the members of the secretariat along with other entities, such as the Regional Council of Medicine of Rio and the National Academy of Palliative Care, say that there will be a choice because there will be “an inevitable overload of health teams when the peak of infection is reached, with a need immediate. ” promoting solutions that avoid the collapse of the state network ”.
According to the text, the working group took into account the “Principles of detection in disaster situations” of the Brazilian Association of Intensive Medicine, the resolution of the Federal Council of Medicine that establishes the criteria for admission and discharge in intensive care units , in addition to a protocol published in the “Journal of the American Medical Association”.
Alarming numbers
This Thursday, Rio de Janeiro confirmed 9,453 cases of the new coronavirus in 78 of its 92 municipalities. Altogether, the state already accounts for 854 deaths from Covid-19. Another 294 suspicious deaths are still under investigation. According to the bulletin published by the State Department of Health, 60 new deaths and 584 new people were registered in just 24 hours, from Wednesday to Thursday. The capital of Rio de Janeiro remains the epicenter of the pandemic in the state, registering 39 deaths between Wednesday and Thursday. In total, the city has 5,903 confirmed infections, with 535 deaths.
Doctor suggests joining public and private networks
For the former head of cardiology at Hospital dos Servidores, Luis Maurino Abreu, who has worked in the ICU for more than 35 years, the protocol can leave many patients unattended. He argues that it is better to create more beds in the ICU than to choose who is most likely to survive or not.
– With the score, we will always have patients with recovery potential that will not be covered. If the situation worsens, only ICU patients will have access to a more favorable score. The best alternative is to look for more beds in the ICU, which can be achieved, as was done in Spain, with the unification of the queue in public and private institutions, says Abreu, and also affirms that the decision to choose who can or not wearing a respirator will mark the lives of all doctors who are at the forefront of the fight against the new coronavirus: – We are sending everyone to war, even young people who are not so prepared to face a pandemic like this.
This Thursday, the Legislative Assembly (Alerj) approved a bill that alters the rules of the Alerj Special Fund. In practice, the measure will allow Alerj to transfer R $ 5 million to UFRJ to manufacture 1,000 respirators, in thirty days, to help patients affected by the new coronavirus. The text will be forwarded for sanction or veto by Governor Wilson Witzel, who, once received, on Monday, will have up to 15 business days to make the decision.
“We have already reached our ceiling”, says the secretary
Hoping for the health system in Rio, field hospitals are still awaiting the inauguration of teams and professionals. The structures of most of these units are ready. But the problem is the inner emptiness. The government faced the difficulty of securing respirators, in addition to medical ones, to meet the initial opening deadline of late April.
According to Edmar Santos, there will be approximately 3.4 additional beds, of which two thousand will be initiated by the state government and the rest by municipalities or the federal government. The secretary promised that at least six of the state’s nine field hospitals will be ready in the coming weeks.
This Thursday, to “RJTV”, the Secretary of Health declared: “We will open Maracanã, São Gonçalo, Nova Iguaçu, Jacarepaguá, Caxias and we will finish Leblon in the next 15 days. The other three (Casimiro de Abreu, Campos and Freiburg) will take a little more. We are on the verge of collapse. Later, we will need more beds, but we have reached the roof. Even if you build more, there are not enough professionals or teams. When the curve is out of control, it is impossible for the system to follow it ” .
Of the nine field hospitals in the state, only Leblon, in partnership with Rede D’or, was opened, but still with operations far below what was promised. Of 200 beds, 100 in ICU, only 30 were opened. According to the schedule, the next inauguration would be the Maracanã, with 320 nursing beds and 80 ICUs, the second largest field hospital in the state, after Nova Iguaçu, whose structure for 500 beds has been completely ready for almost two weeks. , but still no signs of operation.
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