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The new Minister of Health, Dr. Marcelo Queiroga, said on Wednesday (17) that he will unify the medical procedures used in the treatment of hospitalized cases of Covid-19 throughout the country.
“We are going to work to homogenize healthcare behavior in the country as a whole,” said Queiroga during an event in Rio de Janeiro with Eduardo Pazuello.
“(…) our ICUs, we have to have standardized care protocols, we have to transfer the experience from the large centers to the intensive care units that are in the most distant cities, in the smallest states.” – Marcelo Queiroga
Queiroga’s comment was made two days after Dr. Ludhmilla Hajjar, who rejected the position of Minister of Health, defended that it is the role of the Ministry of Health to guide medical teams on the best way to care for patients with Covid -19. Ludhmilla highlighted the need to create a “national reference protocol”.
“Brazil needs protocols, and this is for yesterday. (…) We are discussing azithromycin, ivermectin, chloroquine. It is a thing of the past. Science has already given that answer. Where is a treatment protocol? (…) A was wasted a lot of time arguing about drugs that don’t work. “- Ludhmilla Hajjar, doctor
As the G1 found that, unlike the United States and the European Union and even after a year of pandemic, Brazil still does not have a detailed national protocol that unifies the non-pharmacological procedures to be performed on patients in Covid-19.
Justification for the delay
However, Queiroga pointed to the ignorance of Covid-19 as a justification for the delay in the development of a unified protocol by the Ministry of Health. “We are facing a new disease. When these cases began, we did not have this knowledge.”, Justified the new minister.
Despite this, he argued that proper care can save lives. “It is necessary to guarantee a faster service to the patient, faster, to prevent the disease from progressing,” said Queiroga.
G1 in 1 minute: doctors criticize the lack of a national protocol to treat patients with Covid
No protocols
On the website of the Ministry of Health, there are only technical notes on clinical management and case treatment, with general information on tests, diagnosis of the disease and forms of notification of cases and deaths due to respiratory syndrome.
In one of them, there is a controversial recommendation to administer doses of azithromycin with chloroquine or hydroxychloroquine in both severe, moderate and mild cases, and in all patients, whether pediatric, adult or even pregnant.
Such drugs are not effective against the infection caused by Covid-19 and can have serious side effects, according to the World Health Organization (WHO), but still they are strongly defended by President Jair Bolsonaro.
Directors of medical societies also detailed to the G1 the non-existence of this protocol in the country. They defend the creation and constant updating of the document by the Ministry of Health and propose that it focus on patient management practices and practices, such as:
- When to the hospital
- How to handle or inpatient moderate cases
- When to use mechanical ventilation
- When to intubate the patient
- How and when to use blood thinners and corticosteroids
- How to manage the patient in the ICU
The Brazilian Society of Cardiology (SBC), an entity chaired until this month by the new Minister of Health, cardiologist Marcelo Queiroga, is in favor of creating a protocol to standardize Covi-19 care in hospitals.
“We are in favor of a national service protocol, approved by the main specialty societies, which would standardize patient care, in the different phases of Covid. Mainly in the approach to hospitalized patients, where we have more solid scientific evidence on the treatments. “. said Fernando Bacal, scientific director of the SBC.
The president of the Brazilian Society of Pulmonology and Tisiology (SBPT), Irma de Godoy, details which are the protocols established at that time and which were pointed out by Hajjar.
“I understand that Ludhmilla Hajjar has proposed a document that indicates when the evolution of Covid should, for example, apply or not some treatments, which are neither prevention nor ‘early treatment’, but protocols for the disease that the virus installs”, Godoy says.
“At what point do I offer oxygen to the patient; when should I probe this patient; Should corticosteroids be administered? And the anticoagulant? (…) In this sense, it is very important that we have a unified document. that meets these guidelines “- Irma de Godoy, president of the Brazilian Society of Pulmonology and Tisiology.
The pulmonologist José Antonio Martínez, scientific director of SBPT, maintains that, unlike the technical notes that the Ministry of Health has made so far, a Covid management protocol should focus on procedures, not medications.
“Everyone would benefit from a protocol to carry out the care of patients with Covid-19. However, it must be done based on solid scientific evidence. In this context, the use of drugs without a proof of effectiveness would not be instead, “Martinez says.
The Brazilian Society of Infectious Diseases (SBi) also advocates the creation of a protocol that unifies procedures in the treatment of infection caused by the virus.
“We need a protocol (…) based on what science says and with guidance in the smallest details, which can be carried out by all municipalities with the coordination of the states”, says Leonardo Weissmann, member of the board of directors by SBi.
Without a procedural protocol for Covid cases at different stages of the disease, the medical societies heard by the report say they advise their associates to consult the protocols of the Center for Disease Control and Prevention (CDC), the agency Healthcare of the United States. the Agency, the European Medicines Agency (EMA) and the World Health Organization (WHO).
“Covid’s procedural protocols are well established and are frequently updated based on the results of clinical studies. The last update to the WHO protocol, for example, occurred in late January,” Godoy says.
