ICU bed occupancy exceeds 70% in six states

ICU bed occupancy for coronavirus patients already exceeds 70% in at least six states. The situation is recorded in Espírito Santo, Pará, Ceará, Amazonas, Pernambuco and Río – in the last two, the rate exceeds 90%, considered saturation by specialists. As the disease progresses, governments rush to build field hospitals and expand the number of vacancies. Doctors and managers say the pandemic has not yet peaked in Brazil, which should increase pressure on hospitals.

In 40 days, Pernambuco opened 348 ICU beds for patients with the disease and, according to the state administration, ten new vacancies were offered per day, on average. Still, on Wednesday, the state’s open-bed occupancy rate for covid-19 was already 96%.

Pernambuco’s health secretary, André Longo, attributed the saturation to the lack of social isolation. “We recognize that the situation of our health services is very difficult, because people get sick at the same time. It was an alert that we used to do from the beginning. The lack of greater social isolation, about 70%, has made people sick. people in Pernambuco, seek health services at the same time and this has led to an overload. ”

Longo says there is already one queue per vacancy in the ICU. According to him, “health professionals have to make decisions about who to take to intensive care first.”

Also overburdened, Rio opened 287 ICU-specific beds for suspected or confirmed patients. And almost all (94.8%) are already occupied, according to the Department of Health. Considering not only coronavirus-specific beds, but the entire state health network in Rio, the ICU bed occupancy rate is already at 85%, and has been growing rapidly. Just over two weeks ago, the folder says, the rate was 63% and there is a queue of 369 patients. Rio plans to open a 400-bed field hospital in Maracana – 80 in the ICU in early May. Another 1,400 are expected to gradually open.

First to see the collapse of its health system and the scene of hundreds of burials in collective ditches, the Ministry of Health of Amazonas reports that it does not have data on beds in the ICU of the entire state network, symptomatic in a country facing a underreporting of cases. In Manaus, 89% of covid-19 beds are in use. Governor Wilson Lima (PSC) said he would tighten social isolation rules in a bid to stop the outbreak.

With an 87% occupation, Ceará foresees the gradual creation of 403 new vacancies, according to the purchase of equipment and the availability of professionals. In the Fortaleza region, the scenario is even more serious: 97%.

In São Paulo, the epicenter of the disease in the country, the occupancy rate for beds intended exclusively for covid-19 patients is 68.7%; in the metropolitan area, the situation is worse, with 89% completion and patients will be transferred to the interior. In recent weeks, the State has opened 1,881 exclusive ICU beds for covid-19 in SUS. It also established three field hospitals in Pacaembu, Anhembi and Complexo do Ibirapuera, which will open this Friday. Together, they add up to 2,268 beds, almost all of low and medium complexity.

Within states, increasing demand for beds also creates logistical challenges. “Patients who need an ICU are being referred to reference municipalities and already have a waiting list,” says Wilames Freire, president of the National Council of Municipal Health Secretaries. “They stay in semi-ICU, UPA (Soon Assistance Units) clinical beds or intermediate hospitals until the vacancy leaves.”

Professor of Health Management at Fundação Getulio Vargas (FGV), Walter Cintra Ferreira classifies the scenario as “worrying”. “An ICU with 90% occupancy means it is full. Those with 90% have a queue because, when a patient leaves, the bed has to be disinfected and there is time for it to be taken care of. It is necessary to take seriously the government, especially the government. ” federal government. It is not a situation that can be solved simply by increasing beds or waiting for miracle drugs. ”

An ICU bed, he says, depends on specialized equipment and the purchase of equipment, so the focus should be on preventing the spread of the disease and creating alternatives for the rapid care of infected people. “Diseases are not fought in the hospital, which is the last fortress. When he arrives at the hospital, the battle is already half lost. We have to mobilize society as a whole to achieve measures to contain transmission and have a bed center single. ICU, public or private, and a single line, “says Cintra. The State Last week it showed that the Jair Bolsonaro administration has no control over the number of ICUs occupied in the country.

In normal situations, the occupation of 95% to 100% of ICUs is part of the routine of hospitals, says Gonzalo Vecina, professor at the Faculty of Public Health of the University of São Paulo (USP) and columnist for the State. But that should change in the crisis. “Working with the full occupation of the beds is normal, because there is rotation; it is done with programming. In the epidemic, you never know what the next moment will be like. We are in the ascending phase of the curve and we have not reached the peak. Yes does not fall, it will be difficult not to. crash system “/ *ERIKA MOTODA, FELIPE RESK, FERNANDA BOLDRIN, MARIANA HALLAL, PAULA FELIX and RENATA OKUMURA