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CWith a seventh of the Chinese population, Brazil surpassed China in the number of deaths from Covid-19 and in one week it should have double the deaths registered in that country, according to a mathematical projection from Imperial College London. As deaths increase, social distance measures have relaxed and the street movement has grown since the end of March. For a group of mathematicians and researchers at the University of São Paulo (USP), there is an explanation for this: the Brazilian quarantine was poorly planned and, in some regions, early. The price paid for this is the pressure to cool the insulation on the eve of the most critical moment of the epidemic.
Quarantine is the indispensable measure to contain the pandemic, recommended by the World Health Organization (WHO) and by most scientific studies. In Brazil, the main problem pointed out by the researchers is the way it was implemented. Mathematicians, most of them linked to the Institute of Mathematical and Computer Sciences (ICMC), located in the city of São Carlos, in the interior of São Paulo, have been joining since the end of March to analyze mathematical models that can be applied to the policies. related to quarantine. Some teachers from Unicamp and Impa (Institute of Pure and Applied Mathematics) also participate in the initiative.
While the President of the Republic played against the need for isolation, it was up to the states and municipalities, since the arrival of the pandemic, to decide to decree their own quarantines. Instead of imposing a confinement stricter in the most affected cities, like the Chinese did in Hubei province, state governments issued soft and simultaneous decrees for regions that were in completely different stages of contamination. In the researchers’ evaluation, they were wrong about the method and the right time to take these measurements. The cost of an early quarantine is that the wear and tear caused by it also occurs faster than it should. And people begin to disrespect isolation at the worst possible time.
This can be explained by a simple analogy: Coronavirus contamination is like jumping out of an airplane. To survive, you must open the parachute. But it must be done at the right time. If it is too early, the fall stops, but it soon accelerates again and the result is fatal. Brazil opened the parachute too early, and sometimes in states and cities that did not yet have to stop the fall so abruptly.
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The thesis of these researchers is that quarantine, to be truly effective, must be “smart and decentralized”. This means that isolation measures must be planned according to the situation in each city, taking into account a complex network of data, from the number of ICU beds available in the region to the number of buses that circulate in the city, the number of schools and the geographical position of each school. They condensed all this into an algorithm that takes, on average, one day to make hypothetical calculations and try to predict the evolution of the disease in each municipality. It is a tool that can be used by state governments to monitor the situation in different regions and, with that, tighten or slow down quarantine according to the needs, whether epidemiological or economic.
“What we saw in São Paulo was a confinement from across the state. Small towns, with very little flow of people, had to close trade. This generates a very great social and political cost, which will further increase the pressure to loosen the quarantine, ”explains mathematician Tiago Pereira, professor and researcher at the ICMC. “If I quarantine everyone, as was done, the disease is latent for a time and I can protect the health system. But when people return to the streets, everyone will become infected. ” In other words, the parachute drop is accelerating again. The result of this, in practical terms, would be the saturation of the health system, which is the great danger of the pandemic. There is a risk that many people will become infected at the same time, without beds for all. “That is why it is necessary to occupy the health system in an intelligent way, so that the disease is contained in the shortest possible time.”
That is what China has done and it has been worth it. Wuhan, the city where the pandemic began, went into strict quarantine on January 23. Schools were closed, public transportation was suspended, and roads were blocked. A sanitary cord was created covering sixteen other neighboring cities. The measures gradually became more rigid, but were always restricted to Hubei province, where Wuhan is located. Other municipalities began to adopt milder isolation measures. In the week that it was enacted confinement in Wuhan, 87% of all cases in China were concentrated there.
Brazilian Wuhan was São Paulo, the epicenter of the pandemic in Brazil. The two cities have the same number of inhabitants: around 11 million people. On March 25, the day after Governor João Doria (PSDB-SP) decreed quarantine, 84% of cases in São Paulo state were in the capital. “If a confinement Stricter in the city of São Paulo, neighboring municipalities would not need to enter such a strong quarantine. Or maybe they would, but only after weeks, “says Pereira. “The Great ABC Region, for example, would have a relatively normal life.”
The big automakers and industries at ABC, many of which suspended their production lines, could have remained open for at least a few weeks. As a result, the economic cost of quarantine would be lower, as would the social cost of doing so: Fewer workers would be sent home or not sent soon.
In summary, the quarantine carried out in the state of São Paulo was, at the same time, too lenient and exhaustive. It did not sufficiently isolate the epicenter of the pandemic, unlike Wuhan, public transportation continued to operate in the city, while paralyzing life in smaller municipalities that could maintain a normal routine for a period to be defined. And the same happened in other states, such as Rio de Janeiro.
The price paid for this is now increasing pressure to loosen quarantine. Spontaneously, people have abandoned social isolation. On March 23, a Monday, a day before quarantines were decreed in São Paulo and Rio, the isolation rate in Brazil was 55.6%. Thereafter, the isolation fell, reaching a minimum level of 46% on April 23, exactly one month later. The data comes from the company In Loco, which calculates this index based on GPS monitoring of cell phones.
The The Ministry of Health predicts that the peak of transmissibility of the coronavirus in Brazil will occur from mid-May to mid-June. The curve in the number of cases and deaths is getting steeper. One report published by Imperial College London He estimates that by the end of this week, Brazil will have another 4,400 deaths from Covid-19, a total of just over 10,000 deaths since the start of the pandemic.
Among the 48 countries analyzed by the Imperial College, Brazil is the one with the highest contamination rate, called Rt. Today, each infected Brazilian contaminates another 2.8 people, according to this index. In the United States, an infected person contaminates only one person. Considering the ten countries with the highest number of deaths so far, Brazil is the only one that is experiencing an acceleration in the number of infected people. Growth in the United States has already stabilized, while in Italy, France, and Spain it is declining.
Given these circumstances, loosening the quarantine should be out of the question. But it is what has defended not only the president, but also the governors, amid the economic pressure resulting from isolation. João Doria determined that the quarantine in São Paulo should last until May 11. Entrepreneurs such as the president of the Federation of Industries of São Paulo (Fiesp), Paulo Skaf, have proposed models to resume work to try to contain further damage to the economy. Other states discuss flexibilization plans to a greater or lesser extent.
According to Tiago Pereira, there is currently no plausible scenario in which the São Paulo city health system can resist a process of quarantine relief. The maximum occupation that hospital ICUs would support would be if around 1% of the city’s population were contaminated. Today, according to official data, only 0.13% of the population is infected. However, underreporting is estimated to be at least twelve times the official number. This means that, today, the real proportion is 1.6% of those contaminated in the population of São Paulo. Therefore, the ICUs are already overcrowded.
The calculation of the maximum occupancy of beds is based on estimates, since data is lacking in Brazil. “Among people who contracted the virus and were symptomatic, in China, 5% needed to be admitted to the ICU. In Italy, it was around 12% ”, says Pereira. “This is important information, but in Brazil we have no idea what the proportion is. We are working with an estimate that 10% of the contaminated would be here. But if the proportion is equal to that of Italy, the situation is very worrying. “
Therefore, the algorithm’s answer is clear: even in the universe of official data, the only possible way to avoid the collapse of the São Paulo health system is the adoption, as soon as possible, of a confinement it lasted for at least two months. How it was done in Wuhan and how it should have been done from the beginning. Quarantine would be stricter where it should be and smoother where it is not yet needed. The predictions are unequivocal in showing that simultaneous, generic quarantine for multiple cities is never the best option to contain the disease. When one city facilitates isolation, another becomes rigid.
Decreed one confinement In the city of São Paulo, neighboring municipalities could adopt lighter isolation measures, the algorithm points out. In this scenario, during the first month of quarantine in the capital, Sorocaba would only need to avoid crowds of people. Ribeirão Preto would have to close bars or schools. When São Paulo’s isolation declined, both Sorocaba and Ribeirão would need to tighten their measures, but never to the same degree as the capital: crowds would be banned and mayors could choose to close bars or close schools. In the third month, both São Paulo and the two cities would only avoid crowds. This is a hypothetical scenario, which until now is far from being realized. And the longer it takes to tighten the isolation measures in the city of São Paulo, the more distant is the possibility of a slow, gradual and safe opening.
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