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BBC News Brazil gathered key indicators to explain the country’s situation in the pandemic, despite the lack of reports; Today, there are almost no more ICU beds in some states, cases and deaths are on the rise, but at a rate that has decreased or remained constant, more and more small towns are affected and people have fewer respect for social distance.
On May 12, Brazil registered 9,300 new cases of covid-19, totaling 177,000 notifications and 12,400 deaths. But what do these and other data mean and reveal about the reality of the disease in Brazil? And how do they compare with other countries?
BBC News Brazil gathered ten of the main indicators to explain the country’s current situation in the pandemic, despite the paucity of laboratory tests that serve to obtain a more accurate picture of reality: experts use expressions such as “data blackout “and” blind escape “”.
Currently, there are almost no more ICU beds in the public health system by the states, cases and deaths are increasing, but at a rate that has decreased or remained constant, more and more small towns are seeing affected and people have less respected social distance.
Look down.
1. Brazil is the seventh country in number of cases, but the tenth per capita.
The first case of coronavirus in Brazil was launched by the federal government on February 26. The patient had traveled to Italy for work, but at that time it was not known that the virus was already circulating strongly in the European country.
Since then, the volume of newly registered cases has grown exponentially, but at a rate that has either decreased in recent days or has remained constant.
On April 12, it registered 1,388 new cases in 24 hours. On May 12, there were 9,258.
Is this too much or too little compared to other countries? Well, any international comparison runs into limitations. One is that each place in the world is in a particular stage of the pandemic.
So instead of looking at countries on the same calendar, we can avoid some distortions and compare them, for example, from the day the 100th case was recorded in each nation. At this stage, the virus is already circulating among citizens.
In the graph below, on a logarithmic scale, the vertical axis shows the number of cases and the horizontal axis deals with the number of days from the hundredth case. This scale makes it easier to see the progression of cases.
The more vertical the line of daily cases, the faster the pandemic progresses. Currently, the number of cases doubles in Brazil every 5 days, the third worst rate in the world. But in the beginning, when the number of cases was less and there were no measures such as quarantines, it happened every two, three days.
According to physicist Roberto Kraenkel, professor at Unesp (São Paulo State University) and member of the Covid-19 Observatory (an independent initiative of 43 researchers in the country), the rate of Brazilian contagion was close to 3 at the start of the pandemic in the country. That is, each infected person transmitted the disease to 3 others.
Kraenkel currently estimates this rate to be 1 to 1.1. For him, this means that the measures taken have worked, but not enough to keep the number below 1, a level that indicates the withdrawal of the pandemic. At a rate of 0.5, for example, 10 infected people transmit the disease to 5 people.
Staying below level 1 is the condition that Germany has adopted, for example, to make social distancing measures more flexible. If any region has this index again above 1, the quarantine will be adopted again.
The following graph explains the relationship between the contagion rate and the absolute growth in the number of cases.
The country that most quickly adopted this type of distance measure was China, with strict quarantine at the epicenter of the pandemic, Hubei province, just days after the number of cases exceeded 100. All of Italy’s confinement has taken two weeks from the hundredth case.
On day 30 of this chart path, which measures the progress of the disease from case number 100 onward, notifications grew rapidly in the US. USA And less quickly in Brazil. China had already managed to contain the spread of the disease and Italy was beginning to control the situation. The United States and Brazil did not adopt national quarantines, but only in isolated cities or states.
Fifty days after Case 100, the United States and Italy say they have stabilized the pandemic. China has practically no new cases.
The trajectory of Brazil still points upwards, that is, the number of cases is still growing. But this is just a trend and can improve or worsen depending on what happens in Brazil.
But to understand more precisely what is happening, it would be necessary to evaluate the mass population to find out who is infected.
However, Brazil has faced a number of difficulties in expanding its testing capacity, such as management problems and higher demand than the analytical capacity of laboratories.
Another problem is that the Ministry of Health does not know how to adequately report how many tests have been carried out in the country.
As of April 20, according to the folder, only the Brazilian public health network had performed 132,000 tests. Total. That same April 20, the United States carried out 147 thousand tests in 24 hours, accumulating 4 million.
If we compare taking into account the size of the population, on April 20, Brazil had a rate of 0.63 test per thousand inhabitants. United States, 12.2.
But after all, without enough tests, how to calculate how many people are infected in Brazil and have not developed symptoms or have not gotten sick enough to go to the hospital?
Studies are underway to try to answer that. One of them is coordinated by the Federal University of Pelotas and is in the second phase. 4,500 people were chosen by sampling and tested in nine cities.
According to the researchers, for each known case, there are 12 unreported.
2. Brazil has the lowest mortality rate per 100,000 inhabitants among the 10 most affected countries
During the pandemic, the coronavirus killed at least 12,400 people in Brazil (until 05/12). “At least” because experts say identifying the cause of death is also underestimated, but to a lesser extent.
The first one to be officially released was March 17. The 62-year-old man, admitted to the Sancta Maggiore hospital in São Paulo, died six days after the first symptoms appeared. He had diabetes and hypertension, two pre-existing conditions that are considered risk factors for those who get the new coronavirus.
In the past week, 3,877 people died. The daily peak so far has been May 12, with 881 deaths.
The United States is the country with the highest absolute number of deaths in the current pandemic, and Brazil appears in seventh place in this comparison.
Taking into account population size, Brazil appears last in the list of the ten countries most affected by the pandemic prepared by Johns Hopkins University in the United States.
Brazil has 3.5 deaths for every 100,000 inhabitants in a list led by Belgium, with 69.3.
Johns Hopkins also analyzes the so-called mortality rate, the relationship between the number of deaths per total infected. According to the American university, this international comparison faces several distortions. This rate tends to be lower in countries that perform more population tests and tends to be higher when there is a burden on the health system.
Brazil appears in seventh place, with 7 deaths for every 100 infected. Italy is in fourth place, with 14 deaths for every 100 infected. The United States, in ninth, has 6 deaths for every 100 infected.
This rate also varies widely from state to state in Brazil. From 10.4% in Rio de Janeiro to 1.7% in Tocantins, according to data from May 12.
In addition to the problems of lack of evidence and underreporting, experts estimate that the actual death rate of covid-19 is between 1% and 3%.
The increasing number of deaths in the home, which increased during the pandemic, is another indication of underreporting. The total number of deaths in the home increased by an average of 10.4% in the country between March 16 and April 30, according to data published by registry offices.
There were 27,217 deaths in the home environment, which represents 20.1% of the total death records made by the Civil Registry Offices since the first death by covid-19 (March 16), according to the numbers of the Transparency Portal of the Civil registration.
3. The disease kills older people, people with heart disease, and blacks.
The Brazilian Ministry of Health published an analysis of 1,985 deaths in the country. The data indicates something similar to what was seen in other countries. For example, the highest incidence among men. In Brazil, they are 48% of the population, but they are 60% of the patients who died with covid-19.
There is also an imbalance in the ages of the victims. Brazilians under the age of 19 represent 14% of the population, but represent less than 1% of the people who died from covid-19.
People over 60 years represent 13% of the population and 72% of the dead.
There is another point to mention, which is the presence of pre-existing diseases or comorbidities in 70% of the dead. Of these people, 46% had heart disease, 35% had diabetes, and 9% had lung disease.
Data from the Ministry of Health also show disparity in race or skin color. Blacks are almost 1 in 4 hospitalized, but 1 in 3 dead. Experts say this may indicate unequal access to healthcare, but this is still under study.
4. ICU bed occupancy exceeds 90% in 5 states
And not everyone who gets the new coronavirus is hospitalized or dies. Overall, for every 100 infected, 83 recover, 15 need to be hospitalized and 2 die.
But these numbers vary depending on the location and stage of the pandemic.
And they can worsen if too many people get sick at the same time and overload the health care system. To give you an idea, the researchers say that if São Paulo had not adopted any containment measure, the ICU beds would have been full since March 31.
This is important because, although there is no coronavirus treatment or vaccine, you can save a life thanks to an intensive care unit (ICU) bed with a respirator, which provides oxygen and works like a pump.
If we compare it with other countries, Brazil is one of the countries with the most ICU beds per inhabitant in the world, largely due to other epidemics that we face, such as violence and traffic accidents.
The WHO recommends 10 to 30 ICU beds for every 100,000 inhabitants. Brazil has around 20. But this rate varies by region, and the Southeast is three times higher than the North, for example.
There are almost 50,000, half on the private network, half on the public. However, as 7 out of 10 Brazilians depend on SUS, the demand for public beds is much higher.
And how many beds are occupied by covid-19 patients? The Brazilian government does not know, but has been doing a census since mid-April to try to find out.
Very different is the situation in Germany, where anyone can check the occupancy rate in hospitals across the country on a website.
An important indicator to understand what is happening is the number of hospitalizations for severe acute respiratory syndrome (SARS), which is the health condition of a patient hospitalized for having been affected by covid-19 or the flu, for example. This year, the number is 10 times higher.
But it is also possible to understand the situation from the data published by the States on the occupation of ICU beds in the public network.
On May 10, in Piauí, the ICU bed occupancy rate for covid-19 was 43%. In Espírito Santo, 63%. In São Paulo, 69%. In Ceará, Roraima, Maranhão, Pernambuco and Rio de Janeiro, it exceeds 90%.
5. The disease already affects all medium and large cities and is now moving inland
The exact date the new coronavirus landed in Brazil is unknown, but the first case of covid-19, the disease caused by it, was recorded in São Paulo on February 26.
From there, the virus began to spread throughout the country, first by air routes between capitals and major urban centers, then by roads, which interconnect Brazilian cities.
On March 28, cases were registered in 100% of the municipalities with more than 500 thousand inhabitants, in 42% of the municipalities with a population between 100 thousand and 500 thousand people and 15% of those with between 50 thousand and 100 thousand inhabitants.
On April 28, cases were registered in all municipalities with more than 100,000 inhabitants and 86% of those with between 50,000 and 100,000 inhabitants.
In small municipalities, the first case arose on March 14. Since then, 13% of cities with less than 10,000 inhabitants have registered cases.
The data comes from MonitoraCovid-19, a system created on March 30 by researchers from the Oswaldo Cruz Foundation (Fiocruz) and the Brazilian Institute of Geography and Statistics (IBGE).
6. The adherence of Brazilians to social isolation is on a downward trend
Without the vaccine and drugs with proven efficacy, the main strategy that has been adopted worldwide to contain the advance of covid-19 is social distance.
The intensity varies according to the rule, the severity of the situation and the ability to perform mass tests.
At the top is the total and compulsory confinement adopted by the Italian government. Everyone was prohibited from leaving the house, except to go to the market or the pharmacy, for example. On the opposite side is the South Korean government, which did not adopt mass confinements, but isolation only from people who were sick and monitoring those who had contact with them.
In Brazil, there was no national quarantine. President Jair Bolsonaro assesses that such a measure has a more devastating socioeconomic impact than the disease itself, and compares confinement to a drug that ends up killing the patient.
The Federal District was the first unit of the federation to adopt some kind of restriction on the movement of people, on March 11.
However, non-mandatory confinement requires authorities and experts to make frequent recommendations and requests to increase or maintain people’s adherence to social distance.
However, many people continue to go out to work, especially informal workers.
The main way to measure this mobilization is through the location of cell phones. The technology company In Loco monitors the location of 60 million people in Brazil (without identifying them) and has developed a social isolation index, published daily.
The rate is below the recommended level to prevent the spread of the disease, and the trend is a decline in the country.
São Paulo, for example, has a goal of 70% isolation, but did not exceed 62.5% and now revolves around 43.6%.
Of the 5 states that adhere most to isolation, 3 are from the north and 2 from the northeast. During the pandemic, the number of deaths in the Amazon capital Manaus quadrupled from the same period last year.
On the other hand, of the 5 states that adhere the least, 3 are from the Midwest. According to a survey carried out by Google, also based on cell phone data, the movement in the areas of leisure and commerce (except markets and pharmacies) in Goiás fell by 33%. In Amazonas, this same segment fell 50%.
