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São Luís Agency
City council inspection found crowded streets and fairs during shutdown
Crowded fairs. Crowds on the streets. Heavy traffic The scenes seen in recent days in some parts of São Luís are not what one would expect from the country’s first capital to enter a blockade.
To avoid the collapse of the local health system, where the occupation of intensive care units in the state network reached 100% at the end of April, the Justice determined that the city and three other municipalities in its metropolitan region should adopt last Tuesday (5/5), for ten days, stricter measures to reduce the spread of the coronavirus.
Among them, the prohibition of the circulation of private vehicles, except to buy food or medical care, the entry and exit of vehicles from the island and the closure of any non-essential trade.
However, the data on monitoring social isolation in São Luís show that, although more people stayed at home, this is still not enough to control the epidemic in the city, where 3,745 of the 5,909 confirmed cases in Maranhão were registered. until last Thursday, according to the Secretary of State Health.
Adherence to insulation was 55.4% on the first day of closing and since then it fell to 54.1% on the second day and to 53% on the third, according to the company In Loco, which created an index based on the data. Geolocation of 60 million cell phones in the country.
This is more than the 47.1% average the city posted on business days in the week immediately preceding. São Luís also reached, for the first time during the week, a level of isolation that the city could only achieve on Sundays and holidays.
But the first two days of the closure did not break the accession records registered by the capital of Maranhão since the state government enacted the first isolation measures on March 21. Since then, seven days with better rates have passed, between 55.8% and 57.6%.
And the current level is not enough to control the epidemic, says epidemiologist Antonio Augusto Moura da Silva, professor at the Department of Public Health at the Federal University of Maranhão (UFMA).
“Any profit is a profit, but it is not what we wanted. It is not ideal,” says Silva.
The epidemiologist explains that the rate would have to be around 70% to prevent the number of new cases from growing and starting to decrease.
This is because the contagion rate, which indicates how many people an infected person can infect, was 3 at the start of the pandemic in Maranhão, according to a study by Imperial College London.
For the number of new cases to decrease, this rate must be less than 1. In the case of Maranhão, this means that the rate should be reduced by more than two-thirds and, to achieve this, the reduction of social contact must occur in the same proportion. In other words, the insulation should be 70% or more, says Silva.
Virologist Anderson Brito, from the department of epidemiology at Yale University School of Public Health, in the United States, points out that a study by the University of Sydney, in Australia, complies with the numbers cited by Silva.
This survey calculated the impact of isolation on the local epidemic and indicated that for the prevalence of covid-19 to begin to drop in the country, it would require 80% adherence.
“Taking due account of the differences between Brazil and Australia, this is the level indicated by the scientific evidence. Therefore, São Luís would need greater adherence to really eliminate the transmission chains,” says Brito.
BBC News Brazil contacted state and municipal health departments to comment on the closure results, but received no response until the publication of this report.
Uneven insulation
Fernando Spilki, president of the Brazilian Society of Virology (SBV), says that the São Luís index with the closure is a “victory”, because it will have some effect.
But he considers that they are insufficient, because the scientific literature indicates that until now it is necessary to have at least 70% isolation.
“This 15% difference between what the city has achieved and the ideal may seem small, but it has a great impact because we are dealing with a highly contagious pathogen.”
The virologist also explains that, in addition to the overall average isolation, it is also necessary to analyze how this happened in different parts of a city.
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EPA
The central region of São Luís became emptier than the periphery
In São Luís, the central regions became emptier and the peripheries filled up. If membership is very uneven in different regions of the city, this can compromise the effort to close.
“Blocking turned out to be a very appropriate strategy and perhaps the only fully effective one to prevent the spread of the virus today, but if only part of the population is isolated, the virus continues to circulate and create outbreaks of contagion,” says Spilki.
People in these regions where the coronavirus continues to spread will go to other areas and carry the disease away, causing further waves of contagion after a while.
Anderson Brito says that one of the worst possible scenarios is to do a blockade, but there is no massive adherence from the population.
“This creates the feeling that something is being done, but it is not working. But it will only work if people come together,” says the virologist.
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São Luís Agency
The regions of the capital of Maranhão had a lot of traffic
Also, he explains, it is too early to know if the blockade will produce the expected result, because it takes up to 14 days for a person infected with the new coronavirus to have symptoms and the hospitalized person stays in the hospital for an average of 18 days.
Then, it will only be possible to see the results of the new levels of isolation in the rates of cases, deaths and occupation of beds in at least three or four weeks.
“Therefore, it is necessary not only to have the support of the population, but also the confidence of the population that this is working,” says Brito.
Social vulnerability
Epidemiologist Antonio Augusto Moura da Silva says that one of the biggest obstacles for the city to have higher levels of isolation is the social vulnerability of the Maranhão population.
The state has the highest proportion of the population living in poverty, according to data from the Brazilian Institute of Geography and Statistics (IBGE): 54.1% of the 6.8 million people in Maranhão live on less than R $ 406 per month.
In addition, Maranhão has the highest percentage of informal workers in the country: 64.9% of employed workers, according to 2018 data.
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São Luís Agency
Social vulnerability is an obstacle to isolation in Maranhão
“We already suspected that we would not be able to keep everyone at home. Not because people do not want to join. But because they find it difficult to do so because they need to leave the house every day to earn money. To do the closure, they would have to expand the program emergency government aid to reach as many people as possible. Without one thing or another, they will go hungry, “says Silva.
This is the case of the domestic employee María Barros, 51 years old. She has been out of a job for almost a month and has spent all of her last previous salary to pay the rent and bills and fill the pantry.
Her son also doesn’t get a job as a bricklayer and he doesn’t know if he will be able to earn money to spend next month.
Socorro is in the same situation. He was on trial at the house where he works and he doesn’t have a formal contract. Therefore, you have no guarantee that you will receive your next salary.
“I want to stay home, but if my boss doesn’t pay me, I will have to go. I need to get at least R $ 100 to buy food.”
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