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For experts, it is very likely that the first case of the new coronavirus occurred before February 25, the date of the first confirmation in the country, but it was not diagnosed.
The first case of the new coronavirus may never be discovered in Brazilian territory. At least that’s what experts heard by BBC News Brazil say. According to doctors and academics investigating the trajectory of Sars-Cov-2 (official name of the virus), it is very likely that there are already cases in the country before the first confirmed patient.
A 61-year-old businessman is considered the first diagnosis in Brazil. He tested positive for covid-19, a disease caused by the new coronavirus, on February 25, at the Israelite Albert Einstein Hospital, in São Paulo (SP). The patient had returned from northern Italy, a region that was beginning to face an explosion of Sars-Cov-2 cases. He had symptoms like fever and a dry cough: Approximately two weeks after diagnosis, the patient recovered, according to the São Paulo government.
But experts say the 61-year-old businessman is unlikely to have been the first person to set foot on Brazilian soil with the new coronavirus, whose cases began in Wuhan, China.
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Amid exponential growth in records in Brazil, academics believe it is difficult to pinpoint the country’s first case. Among the reasons that there may be cases that were not previously discovered are the lack of guidance from the authorities before the first diagnosis, the large number of asymptomatic patients and the fact that the new coronavirus may have been confused with other respiratory problems.
One of the main alternatives to discover cases before the first diagnoses is the antibody test, which allows finding out if the person has had the coronavirus before. This helps to understand how fast the virus spreads and possible undiagnosed cases. These tests, however, are still incipient in Brazil.
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The researchers point out that discovering the first cases of the new coronavirus is essential to chart the path of the pandemic.
Another important method in the study of the origin of the coronavirus in Brazil is the sequencing of the virus genome, which clarifies aspects such as which countries the Brazilian cases come from and the evolution of Sars-Cov-2 here.
While experts are studying the virus’s entry points in different countries, worldwide, there are more than 2 million cases and 150,000 deaths to date, an important question about the origin of the pandemic has yet to be answered: the “zero” patient identity in China.
First case became controversial in Brazil
In early April, information from the Ministry of Health caused controversy about the first case of the new coronavirus in Brazil. This is because the folder revealed that the first death from the virus in the country was registered on January 23, in Minas Gerais, almost two months before the first officially confirmed death.
The next day, however, the ministry rectified the information. The folder stated that the death was registered on March 23 and justified that there was a typing error, for which it had erroneously reported that it would have been in January.
Correcting the information, during a press conference, the then Minister of Health, Luiz Henrique Mandetta, stated that it is possible that the virus was already circulating in the country in December or January. Mandetta argued that China is still uncovering cases that occurred in early December. Because it is a large country, according to the former minister, the virus may have spread to other regions of the world, even when there was no diagnosis.
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BRAZIL AGENCY
Then, the Health Minister, Luiz Henrique Mandetta, said that the first case of the new coronavirus in Brazil could have been in December or January
For the experts, one of the facts that contributes so that the first person with the coronavirus in Brazil has not been diagnosed is the delay of the Brazilian authorities to take the first coping measures, even with the registered Sars-Cov-2 cases. in the worldwide since January.
“There is a lot of air traffic in Brazil. In January, for example, many people may have arrived from abroad without symptoms or with very mild symptoms, such as cough and low fever. There was no control or guideline regarding the coronavirus, so they have not sought medical attention. In a week, they may have recovered, but in that period they may have contaminated many people, “reports virologist Bergmann Morais Ribeiro, from the Department of Cell Biology at the University of Brasilia (UnB).
The health doctor Ana Freitas Ribeiro, from the epidemiology service of the Emílio Ribas Institute, points out that one of the reasons that hinder the discovery of the first cases of infection in Brazil was the orientation of the Ministry of Health, which, at the beginning, indicated that only the Cases of travelers who arrived in Brazil with respiratory symptoms or fever should be investigated.
“The other cases were excluded. It is important to remember that this disease has a broad clinical spectrum, including asymptomatic cases that also transmit,” he notes.
Studies show that the rate of asymptomatic patients can reach 70% at some ages. The number depends, according to the researchers, on the age group. Younger people are the majority among cases without symptoms.
Initial difficulties
Among the indications that there may have been cases of the new coronavirus in the country before the first diagnosis are data from Infogripe, from the Oswaldo Cruz Foundation (Fiocruz). The system indicates that there was a historical increase in the records of Severe Acute Respiratory Syndrome (SARS) in Brazil between February and March.
In previous years, the system registered an average of 250 cases in the months of February and March. However, this year, in the week of February 23-29 alone, 662 people entered the country with symptoms such as fever, cough, sore throat, and difficulty breathing. Notifications refer to public and private hospitals.
The data serves as a warning, experts say. However, scholars emphasize that SARS, which is now highly associated with covid-19, can also be caused by other viruses such as influenza, adenovirus, or the four seasonal coronaviruses that have previously circulated.
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Antibody testing is one of the hopes of academics to identify possible ancient cases of the new coronavirus
For the virologist Davis Ferreira, from the Microbiology Institute of Professor Paulo de Góes (IMPPG), of the Federal University of Rio de Janeiro (UFRJ), the cases of the new coronavirus before the first diagnosis in the country may have been treated like other syndromes respiratory. “Antibody tests can help clarify whether some of these patients in January or early February had the new coronavirus,” he notes.
Experts claim that the fact that the first diagnoses in Brazil were made at Albert Einstein also reinforces that there may be previous cases. This is because the private health unit was already prepared to help said patients, through examinations and medical monitoring.
“Many cases of the new coronavirus across the country may have been treated, in January or February, with diagnoses such as H1N1 or pneumonia, which also cause respiratory problems. During this period, there was no evidence in many places, so this possibility of covid-19 may have had has been discarded many times, “says Bergmann.
Why would it be important to find the first patient?
The diagnosis of coronavirus in Brazil on February 25 is considered an important milestone in the fight against Sars-Cov-2. After that, several local authorities began to take more energetic measures regarding the issue; many expected the exponential growth of cases to work.
Experts emphasize that it is important to find out if there were infected people in Brazil before the 61-year-old businessman, since this could change the trajectory of Sars-Cov-2 in the country. This finding can confirm that there are even more cases than have been found so far, in addition to demonstrating that several covid-19 patients may have been diagnosed with other types of respiratory difficulties.
“Discovering that there really were cases before this first diagnosis is important so that we can evaluate, in a new scenario, the speed of the virus’s spread in Brazil. This helps in the studies, so that we can be better prepared for other pandemics in the future , which may have similarities with this, “says Ferreira.
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Patients’ symptoms before the first case in Brazil may have been associated with other diseases, without doctors suspecting covid-19, experts say.
Because there are many asymptomatic patients worldwide who did not seek medical help, studies on the origin and history of the spread of the new coronavirus in Brazil become even more complex.
Research by scientists at Columbia University’s School of Public Health in New York found that symptom-free patients were responsible for up to two-thirds of infections in Wuhan. The survey was published by the American scientific journal Science.
A deeper study of the origins of Sars-Cov-2 around the world becomes even more complex because one of the main questions on the subject remains open: the identity of the first infected person in Wuhan, the first epicenter of the new coronavirus. .
“This zero patient in Wuhan is very important, because through him we can discover the origin of the infection of the new coronavirus. With this discovery, we could know the location of this first infection and how it occurred. This is fundamental, mainly, to trace the path of the epidemic, “says Ferreira.
Scientists around the world are still searching for answers about the origin of the new coronavirus. The investigation attempts to map the first case.
Research and evidence
The origin of the new coronavirus in Brazil is the objective of the researchers’ investigations. The objective is to find out if there were several introductions of Sars-Cov-2 in Brazil and where they came from. This information can help to cope with the pandemic, since it indicates which mutations are present in the country and measures the progress of the virus.
For the president of the Brazilian Society of Virology, researcher Fernando Spilki, it will be difficult to identify the first case of the new coronavirus in Brazil. “This ‘zero’ patient in Brazil is no longer so relevant,” he says. He notes that investigations into possible cases before the first diagnosis are aimed at investigating which viruses are currently circulating in the country. “We need to know what regions of the world they come from, to assess whether these differences in the genome are related to the severity of covid-19 in the country and also with a higher or lower rate of spread in the population,” he explains.
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The world’s first records of the new coronavirus were in Wuhan, China. However, until today the identity of the first person with the virus is unknown.
In the midst of studies on the origins of the virus in Brazil, one of the ways to discover infected patients before the first diagnosis is through tests that can detect previous antibodies.
“This can be done if there is appropriate evidence. It is possible to evaluate samples for SARS or respiratory syndrome collected before the first case and analyze them for covid-19. Therefore, we can evaluate people with SARS before February, with discharge or death”. , says epidemiologist Ana Freitas.
Antibody testing in Brazil is still in its infancy in Brazil. According to experts, research on the origins of the virus in the country will advance, especially when there are applications of these mass tests.
“These tests can identify, in many cases, even the virus in asymptomatic patients, who had Sars-Cov-2 previously and had no symptoms, but developed antibodies,” says Ferreira.
Through genetic samples from patients who have had or are having Sars-Cov-2, it is possible to carry out the sequencing of the virus genome, an action considered essential to study the origins of the new coronavirus in the country.
“The virus that is infecting today is different from the virus from a week ago. The more it reproduces, the more changes it has. Therefore, in the sequence we discover its origin, to identify what changes it had and if it became more pathogenic or not” . no, “explains Bergmann.
The sequence of the first two diagnoses in Brazil, carried out by researchers from the University of São Paulo and the Adolfo Lutz Institute, indicated that the first case was genetically more similar to the virus sequenced in Germany, while the second was more similar to the one in England.
In Brazil, different researchers try to sequence the virus. There are studies in this direction in states such as São Paulo, Rio Grande do Sul, Brasilia, Rio de Janeiro and Bahia. These surveys, however, face difficulties. The number of cases sequenced so far is considered low and, according to experts, this makes further studies on the origin of the new coronavirus in the country difficult.
“We have several virology laboratories in Brazil that can do these surveys. But we need resources for that,” says Bergmann. The Ministry of Science and Technology recently launched calls for projects to study the new coronavirus. However, the results of the fairs should only be ready from June. “It is a very bureaucratic procedure,” says the virologist.
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