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“Delta zero one, code 36. Female, 74 cousins, possible Covid, QAP? QTH Morumbi region,” says a hissing voice, on the radio frequency of Samu (Mobile Emergency Service).
The call is to help a 74-year-old woman in Paraisópolis (southern part of SP), with symptoms of Covid-19, such as fever, dry cough and lack of taste. A team specially dressed for this type of occurrence, with an apron, face shield, mask and gloves, goes to the scene.
As it is an irregular numbering of the road, the vehicle sometimes goes through the nearby streets without seeing the patient’s relatives. The old woman’s relatives make an appointment with Samu at a nearby market, which serves as a reference point, and finally help arrives.
Such cases now take at least half the time of Samu’s simple ambulances, those without a doctor, estimate the first to respond. This is when there are more serious situations where patients, after days with the disease and without treatment, suddenly worsen and help comes too late.
Samu attended 5,998 cases of suspected or confirmed cases between March 1 and April 24, an average of 4.6 per hour, according to administrator Bruno Covas (PSDB) released last week. Overall, the city says there was a 30% increase in calls in April.
Until the last week, doctors at the service were still in charge of witnessing all the deaths, a reversed move after discovering that precious work was saved to save lives. Now they focus only on hospital transfers.
According to the first responders heard by Sheet, a relevant part of the people served has a profile similar to that of the retired Anísia Moreira dos Santos, 74, whose attendance was accompanied by the report. In addition to the elderly, they live on the outskirts of the capital or in retirement homes, in houses where it is very difficult to maintain social isolation.
Anísia tries to stay home, but she goes to the market and the bank. She has more direct contact with the two children with whom she lives, in a neighborhood where the streets are always full of people.
Anísia’s daughter, Josefa dos Santos Souza, 41, says that what raised suspicions of coronavirus is that the mother is usually not ill. In addition, all the symptoms coincide with those of the virus. “Since yesterday, he has lost his taste and cannot eat,” she says.
After some questions, to which Anísia responds by complaining about her bitter mouth and pain, the rescuers decide that she will be hospitalized. She walks away, supported by Samu’s employees, down the narrow alley where she lives.
According to the state government, people over 60 years account for 73.6% of deaths in São Paulo. However, in peripheral neighborhoods, there is a higher rate of younger people among deaths than in wealthier regions.
“We deal with cases of people who spend a few days with the disease at home, thinking that they will improve, and suddenly they are found by relatives who are already dead,” says a doctor from Samu.
For specialists, poor populations find it difficult to follow chronic disease treatments and balanced diets. In situations that are often worse than the peripheral population, the homeless are also frequent Samu patients, on suspicion of coronaviruses.
The city council of the capital has centers established only to serve this audience. This week, a 44-year-old woman, a crack user, had complications in her condition and was transferred to the University Hospital, at USP.
It would be a simple case for the service group, but in practice, it starts before the event and ends much later. Whenever there is a code 36 for suspected coronavirus cases, rescuers should look like an apron, gloves, face shield, and mask.
At the end of the service, the work is greater, since it is necessary to disinfect the ambulance, so that they and other patients are not contaminated.
With patience, a nurse and an assistant rub a cloth on each corner of the vehicle and a hypochlorite solution, while the doctor completes the patient’s file. This part of the job can only take up to an hour.
It’s time to get rid of professionals having more attention. This is when there is an increased risk of contamination. Many rescuers suspect that they have already contracted the disease. “I think I have it,” says a nurse. “We will never know,” says another professional.
A doctor also claims that without testing, the same person can end up in quarantine more than once, embezzling the images. Also remember that, in the way things are happening today, deceased people have priority evidence over active workers.
The government recently said that health and safety professionals will undergo rapid tests.
Whoever is in charge of Samu fears the disease because he knows how sudden its evolution can be. The rescuers have already died among their own. Hematologist Paulo Fernando Moreira Palazzo, on duty at Samu, died in early April, after two weeks with symptoms of coronavirus. Just before he died, he told his friends that he was fine.
Other losses from service are employees of a risk group, who are on leave. The city has hired outsourced doctors, but those who work at Samu say they are not enough.
The service should have 122 ambulances that operate daily, they say. The estimate of the employees is that more than 40 are arrested for lack of professionals.
In January, the city expanded the city’s fleet and promised that 122 ambulances would begin circulating this year. Health Secretary Edson Aparecido stated that during the epidemic, Samu has had new increases in equipment: recently, six light teams were hired and there are still more.
Aparecido also said that after the reorganization of the Samu system last year, widely criticized by rescuers for closing mobile bases and placing them in equipment such as hospitals, the system improved. “The reorganization is consolidated and Samu is integrated with the health system,” he said.
The fear of rescuers is that what is now a very busy job on the busiest days will turn into chaos at the peak of the pandemic. In particular, due to cardiac arrests, which require advanced equipment with doctors. On weekends, according to them, there are only three in the entire city.
Advanced equipment is essential in extreme cases, which require resuscitation of patients with cardiac arrest or who need to be intubated.
On the other hand, one of the bottlenecks that took the most time with this type of ambulance with doctors was the requirement to certify deaths at home, the task they won during the pandemic, previously carried out by the SVO (Service Death Check). According to the Department of Health, the number of cases of the type attended by the service went from 445 in February to 453 in March. In April, there was a jump to 632, an increase of 40%.
As of June 28, the agency is no longer required to certify deaths and six new health teams would begin performing the death reporting service at home.
