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Public health agents in various regions of Brazil warn of a “third wave” that will overcome the two biggest problems the system is already facing: the increase in the number of critically ill patients and the lack of personnel and equipment for security, which affects most professionals.
With millions of consultations and surgeries canceled due to coronavirus, the Brazilian Society of Family and Community Medicine (SBMFC), with 47,700 teams in the country, foresees a new stress on the system in the coming weeks due to the lack of monitoring of chronic patients , especially hypertensive / cardiac and diabetic patients.
These diseases, which affect up to 40% and 20% of the population, respectively, are two of the main comorbidities associated with deaths from Covid-19. Alone, they are already at the top of the main causes of death in the country.
“It is one thing to leave patients unattended for 15 days. Another is a month or two, ”says Rita Borret, president of the Association of Family and Community Medicine of Rio de Janeiro.
Away from work on suspicion of coronavirus infection, Borret says that normal consultations in many health units in Rio have been “destroyed to zero”, and that the municipality has not equipped health posts with cell phones so that professionals can try to provide patient care. distance.
“In the epidemic, community agents also fail to circulate as much in communities, losing control of chronic cases,” he says.
According to her, only cases of prenatal care, tuberculosis and leprosy have been treated more frequently.
In Uberlândia (MG), Dr. Natália Madureira, responsible for an audience of 5,000 people in a basic unit, affirms that the priority in the attention of Covid-19 cases has been causing interruptions in many units due to the lack of personnel and safety equipment.
Just before talking to Sheet, Madureira had sent home a patient with bipolar disorder, in the midst of a psychotic crisis, who for days had been unable to receive care at the city’s Psychosocial Care Centers (CAPS).
“The operation of the units depends on the structure, but almost everything that is not an urgent demand is being closed or directed to Covid-19,” she says.
In Recife, Dr. Bruno Pessoa reported at least three cases of critically ill patients, without the coronavirus, who were unable to continue treatment or investigate problems in his health unit, which cares for some 4,000 people.
In one of them, a patient with a very enlarged thyroid cannot have an endocrinological examination and is at imminent risk of having exponentially high blood pressure. She has already lost 7 kg and has not slept well for a week.
Another patient, with tuberculosis, does not have access to an infectious disease specialist to evaluate the necessary medication.
“The system was already congested before, with lines of months to attend. With Covid, many serious cases are sent home, “he says.
According to Pessoa, the test kits available for coronaviruses in the capital of Pernambuco still do not meet half of the demand.
One of the solutions sought in some cities and states is the adoption of “two doors” in the system: one for Covid-19 and the other to return to the care of chronic patients. This, however, has not always been possible due to a lack of personnel and structure.
According to Denize Ornellas, communication director at SBMFC, teams in hospitals were already working to the limit before the epidemic, limiting the possibility of division of staff. Now many also get sick on the job.
In many states, teams have tried to expand services through social media and video apps, which is not always due to limited access to phones and the Internet or patients’ unfamiliarity with these media.
Another difficulty is that chronic patients themselves, especially the elderly, have avoided visiting health facilities for fear of being contaminated by the coronavirus.
According to the doctor Rodrigo Lima, from the Federal District, while the consultations in his health unit were reduced to 20% of the normal, more than half of the patients seeking daily care disappeared.
“Diabetic and hypertensive patients without medication adjustments are a kind of snowball for the system,” says Lima.
In addition to this concern, officers continue to report a large underreport of probable Covid-19 cases.
Not all states and municipalities report cases of the so-called SG (Flu Syndrome) to the Ministry of Health, which, in addition to fever, includes another symptom, such as cough, and there is no evidence to confirm whether it is Covid-19. . Therefore, they only report the so-called SARS (Severe Acute Respiratory Syndrome), generally related to the coronavirus.
In addition to the lack of personal protective equipment (PPE) and delays in the arrival of test kits, there are reports that the release of their results, when they exist, can take almost three weeks.
At the Rodrigo Lima unit in Brasilia, which serves 25,000 people with other equipment, so far only two test kits have arrived.
On Monday (21), the Governor of the Federal District, Ibaneis Rocha (MDB), announced that the plan is to resume most economic activities by May 4.
Despite the reduction in outpatient clinic visits, in states where the number of infected people is lower and the system is still free in ICUs, an effort is being made to maintain monitoring of chronic patients.
“Patients with cancer, heart disease, diabetes and even orthopedic problems have been treated,” says Sandro Rodrigues, head of the Superintendence of Comprehensive Health Care in Goiás.
In the state, the orientation is that the so-called “responsible return” of commerce will start soon.
In Florianópolis, which has already resumed several activities, the care of patients without coronavirus is practically normal, according to Dr. Livia Hinz Caliço, who cares for some 15,000 people in four teams located on the mainland of the municipality.
“Santa Catarina began the isolation early, on March 16, and has no problems with the lack of beds in the ICU. We will see what happens now that things are working again, “he says.
