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With the alert on for the Christmas season, the consequences of the next few days will be decisive for Belo Horizonte. In a scenario considered uncomfortable by the health authorities from the epidemiological point of view, the period is announced as a litmus test in the control of COVID-19. If the city passes the test, it even considered the recommendation to reopen schools, closed nine months ago outside of the pandemic, in the first quarter of 2021. Otherwise, the city can put the measures in place. make flexible, with the possibility this time of “surgical” interventions, aimed at specific groups of the population, according to the infectologist Carlos Starling, a member of the scientific committee that is the basis for decision-making in the capital. Among them, it is even considered passing teachers in front of the priority line of vaccination. “We are absolutely aware of the importance of opening (schools), but we are attentive to the dynamics. We can even make mistakes, but never neglect ”, says the doctor in an interview with State of Minas.
Is the situation deteriorating at BH?
We take into account three parameters: the Rt (transmission rate), the number of hospitalizations in intensive care (bed occupancy) and the occupancy of rooms. If we have two of them in red, maximum alert. Rt above 1.2 and bed occupancy above 80% is an unbearable, risky situation that should lead us to decisions that imply restriction of social mobility, the only way to control the epidemic. The situation today should be around 1.1 and it has remained with an upward trend. The occupancy of beds in private hospitals is at the critical limit, increasing progressively, as is the occupancy of wards. the situation is not very comfortable from the epidemiological point of view. Depending on the source of information, we are varying between 100 and 150 cases per 100,000 inhabitants. better than So Paulo or Rio, which have more than 300, 500 boxes. But we had 40 cases per 100,000 inhabitants for about two months and it began to rise gradually, as people began to trivialize care.
Many people think that with summer and heat the virus disappears. What to say about it and what are the recommendations for the Christmas season?
The virus does not go on vacation, whether in summer or winter, it circulates in the same way. There are very vulnerable people among the population and the transmission that occurs in the area and the contact between people is high. The spread of the virus is very fast. In one week (the situation) is fine and in another it accelerates rapidly. There is progress and geometric increase. We (from the scientific council) are emphasizing that holidays are avoided at this time, which is traditionally festive, but this year, no. The recommendation is the opposite: stay at home, with the family. In the year to mix groups.
If after the holidays the sanitary conditions deteriorate, what measures are considered?
Everything that has been done before is planned from the beginning of the pandemic. The novelty that now we can be more “surgical” in the interventions than when we did not have an organized healthcare structure and, therefore, the measures were harsher. In March and April, when we made the first attempt at flexibility, we did not have enough personal protective equipment for health professionals, we did not have pathophysiological knowledge of the disease. But we still don’t have an effective early or antiviral treatment available. Contrary to what certain groups defend, we do not have scientific evidence of effective drugs for prophylaxis or early treatment, although we believe that early follow-up is vital. In the treatment of critically ill patients, the protocols are much tighter. We have a structure to serve adult patients who are working and have the lowest mortality in the country, with a city of more than 1 million inhabitants. These factors allow us to be more objective in the interventions. We have mapped the entire city: we know where the epidemic is more advanced, who obeys and does not obey the rules.
Of how many cases per 100,000 inhabitants can the protocols change?
It does not have a minimum amount, because what counts are the parameters that I spoke about. If we have less than 100 cases, but with overloaded beds and rooms, change. Because both the impact of the increase and the fall occur a few days later in the rooms and beds. When it drops (the transmission rate) in the community, the patient remains in the ICU for 15 days. When the community accelerates, the units become overcrowded, which takes time to empty. a very tenuous balance, sometimes difficult for the population to understand. There is a gap between bed occupancy and epidemiological fluctuation.
And the schools? When do you imagine a reopening?
We consider school a priority. It was not left out of the discussion planning process during the period. We had numerous discussions about return planning and return protocols. Meetings in the House, in the Legislative Assembly, with parents … The great concern, because it is a complex base. The reasoning we had at the beginning of the pandemic was influenza, but the coronavirus behaves differently. We can only conclude that children get little infected over time, with a lot of work. But the epidemiological dynamics within the community and the flow of cases leaving the community, entering the school and returning to the community are being studied. Schools open in different ways around the world, with different strategies, different operating dynamics, which does not necessarily mean that we are capable of doing what is being done in Europe and the United States. And there are places where schools continue to function and places where they close everything again. We are looking very carefully and lovingly and I can say that I have a conflict of interest, because I also have my little daughters. It is a question that I have followed very closely from the beginning.
“We are in favor of vaccinating health professionals and teachers, so that they can return safely, in addition to the priority groups that are at home”
Carlos Starling
How are these studies carried out?
There is a group of researchers who work with me and systematically review the literature on all matters related to the pandemic, in different regions of the world, and nothing looks like us. In South Korea, for example, the recommendation is 5 boxes per corn. If we take them as a base, we will never return. In the US, there are several tracks. It is these risk bands that, with this support group, we analyze here the 853 municipalities of Minas Gerais and pass them on to the Secretariat (de Sade) depending on the situation, whether they are in the low, medium or low risk range. high. We put it in the public power and each municipality will run the risk it is willing to take: outbreaks in the community and in schools, as well as in companies. The decision of the magnitude of the risk that each one wants to assume in politics. We use the banner of the US Center for Disease Control and Prevention and the recommendation to open with low risk: 20 cases per 100,000 inhabitants.
Can you change this parameter?
an open discussion, suggestion and what we have used. We can conclude that it can be changed. In an epidemic, I must say that I want them to open on such a day, to do this or that, it is not possible. A, it has to match the virus. And with the entire population: what is the size of the sacrifice that the population is imposing. When you go to a funk dance, you want to party, it has repercussions: on your health, on attendance costs, which will hit everyone’s pocket, in schools, in the education of your children. Collective responsibility and sadly the worst example in this regard comes from the federal government. What we are trying to do is have as few deaths as possible, open schools sooner, have hospitals capable of caring for people. If they are above the bad example, and below, a significant part behaves like the mirror that has 1. And the responsibilities that fall on the municipalities do not exempt the federal government from taking a position in the face of the pandemic.
So is openness up for discussion?
We are arguing. We cannot set a date, but sometime in the first quarter. We are in favor of vaccinating health professionals and teachers, so that they can return safely, in addition to the priority groups that are at home. I am in favor of skipping the line for teachers and health professionals, if we consider education as a priority.
And close the rest of the city to open a school?
It has also been considered, but in an epidemic, no one is left without suffering. Bars, restaurants, commerce also suffered greatly during the epidemic. But the fact that the schools were closed was, at first, an attitude of protection of the child and the surrounding community. This has clear side effects. Domestic violence increases, everything passes, but there is no way (to avoid it). The whole world suffers. In this war, children are, in a way, protected by the virus, but their parents, grandparents, uncles, all have the opportunity to fight it. It is a priority in a society, but it does not take away the rights of older people. An important attitude and teaching, since our society, always very young, privileges youth, the future. If there is anything we have to learn and teach children and young people respect for life in all age groups. it is a sacrifice made on behalf of those who helped build what we have. an extremely important ethical philosophical discussion. We can even make mistakes, but never neglect them. It must be said that 7.6% of infected children go to intensive care and 0.2% die. About 3,000 children have already died in the United States.
Many people believe that everyone will be vaccinated at the beginning of the year. Could you explain what this scenario is like?
Until we manage to vaccinate a contingent of the population that prevents or obstructs viral circulation, it will take six months to a year. We do not count that the vaccine has arrived and is resolved. The virus did not come to walk, it came to stay. (mission) for marathon runners. You have to work hard to get to the end with less suffering. There is no one who runs a marathon that does not reach the end without suffering, no matter how prepared the athlete is. It is not the first marathon or the last: it is good that we prepare for the next ones, and they will come. We will have new epidemics. Today’s is essential to create a social structure capable of facing similar situations in the future. Asians learned and we didn’t. We are headbanging. And that headache is burying 200,000 Brazilians.
