Government changes rules and Grande SP and five other regions advance to the green phase of the economic flexibility plan | Saint Paul

In addition to the capital city of São Paulo, Greater São Paulo and the regions of Taubaté, Campinas, Piracicaba, Sorocaba and the entire Baixada Santista also went through the least restrictive flexibility phase. The announcement was made by Governor João Doria (PSDB) during a press conference at the Palácio dos Bandeirantes.

The Barretos region, which was in the yellow phase, was the only one that fell back and returned to orange.

The government also announced on Friday that regions that remain in the yellow phase will be able to extend the operation of commercial establishments from 8 a.m. to 10 a.m., including street shops, shopping malls, gyms and service providers. In the green phase, the opening hours of the establishments can be 12 hours.

In the case of the São Paulo capital, Mayor Bruno Covas (PSDB) determined that the opening of the cultural sectors would only occur when the city was in the green phase. So, now the operation of theaters and cinemas, for example. Under the capital’s rules, events for up to 600 people, such as conventions, seminars, conferences and fairs, will also be premiered. The parties, however, are temporarily prohibited.

“Starting tomorrow, therefore, a new classification of the city for the green phase. We not only have changes in schedules and limitations in relation to the activities that are already released, but also the return of activities in the cultural sector. Other activities that can be released in the green phase, within two weeks. The health surveillance of the municipality instructed that the evolution of the pandemic in the city is now expected due to these authorizations of the activities already allowed and also of the cultural sector that returns to work from the beginning in the morning within the protocols and restrictions already signed with the city of São Paulo ”, he said.

Criteria changes made progress possible

If the criteria of the São Paulo Plan in force until last week are considered, the capital would not have indexes to advance to the green phase. The arrival of the municipality and other regions to this phase occurred after the government made new changes to the criteria, published in the Official Gazette on Friday (9).

The main change is that the criteria for hospitalizations, deaths, cases, among others, will be analyzed in a period of 28 days, compared to the previous 28 days. Before, the analysis was for the last 7 days, compared to the previous week. According to the coordinator of the state government’s Coronavirus Contingency Center, this change would eliminate the distortions.

“The committee understood that the evolution of the epidemic analyzed every 7 days brings instability, especially considering the disparity between the date of the event and the notification and, from now on, both in the numerator and in the denominator that we will have, in the numerator the current 28 days and in the denominator the immediately preceding 28 days to determine the evolution of the disease, ”said José Medina.

In addition, the government eliminated the division that existed in Greater São Paulo, which was divided into six subregions. Before, each area of ​​the metropolitan region could be in a phase. Now, everyone should be in the same flexibility stage.

For Medina, the unification of Grande SP is necessary because the capital attracts more serious patients and, therefore, has worse rates.

“There is a distortion in relation to the city of São Paulo that needs to be corrected. The city of São Paulo is a medical reference in Latin America, it is the city where the largest number of critical patients is concentrated and where the largest number of patients is located in the metropolitan region, the interior and other states that seek care when they are in a more serious situation. ”Said José Medina, coordinator of the state government’s Coronavirus Contingency Center, at a press conference this Friday.

“So the mortality rate in the city of São Paulo is higher, the mortality rate in the city of São Paulo is higher than in the entire state, because it concentrates the most serious cases and therefore sacrifices the indicators of the city. That is why the reestablishment of a single Regional Health Directorate, as it was originally, seems quite reasonable to us ”, he added.

Remember changes in the SP Plan

Implemented on June 1, the São Paulo Plan has undergone several changes in its criteria in recent months.

On July 27, the São Paulo government made the first change. The management of João Doria (PSDB) changed the rules for the occupation of ICU beds and created a margin of error in the criteria for the evolution of the epidemic. With that, it allowed the regions to go to the yellow phase more easily. This allowed the entire state to move into the yellow phase, even with regions with more restrictive phase indicators based on the above criteria.

On the other hand, the maximum occupancy rate for ICU beds that allows cities to go from the yellow phase to the green phase went from 60% to a value between 70 and 75%.

The government also determined that the regions could not move forward or backward in phase due to subtle changes, since a safety margin was created for variations. In the case of occupying ICU beds, the margin of error is 2.5 percentage points. The criteria related to the evolution of the pandemic, such as new cases and hospitalizations, the margin is 0.1.

On August 28, the São Paulo government made further changes to the São Paulo Plan. Since then, the regions that reach phases 3 (Yellow) or 4 (Green) remain in these phases as long as they have weekly indicators below 40 hospitalizations for Covid-19 per 100,000 inhabitants and 5 deaths per 100,000 inhabitants.

This new criterion is superimposed on the others, that is, if deaths and hospitalizations are below this level, the regions do not regress to more restricted phases of quarantine.

This change changed the logic of the plan, since two of the main criteria of the São Paulo Plan were the variation in new admissions, compared to the previous week and the variation in new confirmed deaths, compared to the previous week.

The last change was made about a month ago, on September 11. Since then, updates to the São Paulo Plan have started to occur only once a month. The previous rule provided for weekly reviews, in case of deterioration, or fortnightly, due to evolution or regression.

After applying the changes, the tightening of the quarantine in a region can occur at any time, but only if the reclassification is for the red phase, the most restricted and that does not allow to open any trade. In practice, regions that have a worsening in the indices do not recede, unless the worsening is so great that it drives the numbers directly to the high alert stage. This occurred on September 18 with three state health boards: in Franca, Araraquara and Barretos the number of deaths from Covid-19 worsened, but the quarantine continued in the yellow phase.

Main changes in the classification criteria of the São Paulo Plan:

• The maximum UCI occupancy rate for a region to go from the orange phase to the yellow phase went from 70% to 75%.
• The maximum occupancy rate of the UCI for a region to go from the yellow phase to the green phase went from 60% to a percentage between 70% and 75%.
• The regions cannot move forward or backward from phase per percentage point, so the management has developed a margin of error of 0.1 for the criteria for the evolution of the epidemic and 2.5 for the capacity of the health system.
• The criteria of death and hospitalization per 100,000 inhabitants were added so that a region goes from the yellow phase to the green phase.
• Regions must spend 28 consecutive days in the yellow phase before moving to the green phase.
• The regions that reach phases 3 (Yellow) or 4 (Green) will remain in these phases as long as they have weekly indicators below 40 hospitalizations for Covid-19 per 100,000 inhabitants and 5 deaths per 100,000 inhabitants.

The São Paulo Plan, which regulates quarantine throughout the state, classifies the regions of the state in color, determining which places can advance in the measures of reopening the economy.

To begin the reopening of the state on June 1, the government divided the territory according to the 17 Regional Health Divisions (DRS).

The criteria underlying the classification of regions are:

• Occupancy of beds in the Intensive Care Unit (ICU);
• Total beds per 100 thousand inhabitants;
• Variation of new admissions, compared to the previous week;
• Variation of new confirmed cases, compared to the previous week;
• Variation of new confirmed deaths, compared to the previous week.
• In the green phase, deaths and cases are also considered for every 100,000 inhabitants;
• The regions that reach phases 3 (Yellow) or 4 (Green) will remain in these phases as long as they have weekly indicators below 40 hospitalizations for Covid-19 per 100,000 inhabitants and 5 deaths per 100,000 inhabitants.

See the main rules of each phase:

• Red phase: only essential services are allowed to function.
• Orange phase: Real estate agents, dealerships, offices, stores and shopping centers can also reopen, but with restrictions.
• Yellow phase: Beauty salons, bars, restaurants, gyms, parks and cultural activities with a seated public can also reopen, but with restrictions.
• Green phase: Events, conventions and cultural activities with standing public can also be reopened, which can happen again when there is a stability of four weeks of the state of São Paulo in the green phase (4), also with restrictions.

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