The federal government delivered 17.5% of the ICU’s rented beds that promised to face Covid-19 | Coronavirus

According to the folder G1, “the shortage of respirators on the international stage” is the reason for the failure to deliver.

The ministry even claims that one of the notices to buy the material had no interested companies due to a lack of respirators in the market. (See details below).

According to government data, until April 24, 15 states (Acre, Alagoas, Amapá, Amazonas, Ceará, Espírito Santo, Goiás, Maranhão, Mato Grosso, Paraíba, Piauí, Rondônia, Roraima, Sergipe and Tocantins) and the Federal District had not received beds.

The beds, which would be specific to combat Covid-19, were announced on March 12 by the then executive secretary of the ministry, João Gabbardo, who said they would be delivered according to the needs of each state.

“ICU bed rented means [que] there is no such bed working in the hospital, the hospital needs to expand care, intensive treatment, transform a certain area and says: “here we are going to place 10 more beds in the ICU”. So if the manager [municipal] ask the Ministry saying ‘look, here in São Paulo I need to put another 10 beds in that place. Demand is exceeding our service capacity ‘, the Ministry activates this tender and, in a week, at most in ten days, when it is very distant – in São Paulo it is much faster – this bed will already be working, with all the necessary inputs. The hospital will only enter with medical and nursing staff, so the bed can work quickly. These are for the coronavirus, “said Gabbardo at the time.

But the delivery did not satisfy the growth of the disease in Brazil. Until Tuesday (21), the bed occupancy rate in the ICU in Ceará, for example, was 100%. In Amazonas, it was 96% until Thursday (23). No state received beds, according to government data.

Other federation units, such as Paraná, Rio Grande do Norte and Santa Catarina, despite having less than half of the intensive care beds occupied, received new beds from the federal government.

The states of Bahia, Minas Gerais and Rio Grande do Sul were also included, with just over half of the beds occupied, as well as Pernambuco and Rio de Janeiro, which had occupancy rates of over 70%.

When asked about the distribution, the Ministry of Health stated, in a note, that “the distribution of beds takes into account criteria such as the number of cases, the local population and the number of beds installed”, and that “all states must receive at least one kit, which has 10 adult ICU beds, and it is up to local managers to provide physical space to assemble the beds. ”

The beds planned by the Ministry of Health are, in fact, “kits” that include various materials for the care of patients with Covid-19, including respirators. Initially, the government sought out stakeholders to provide the first 1,000 of the 2,000 commitments.

On March 17 and 20, contracts were signed with two companies For supplies of these kits, including transportation:

• RTS Rio S / A, based in Rio de Janeiro, which was responsible for delivering 200 beds These were delivered and destined for São Paulo, Rio de Janeiro, Minas Gerais and Rio Grande do Sul. According to the Ministry of Health, “the initial relocation of the first beds to these states was based on the epidemiological curve, in addition to the immediate structure provided by the local administrators to assemble the team. “
• São Paulo-based LifeMed, which was to deliver 340 beds. The company claims that so far 200 have been delivered. In the ministry’s account, 150 have already been distributed (see table above), with 140 working. The government notice says the other 50 are waiting for the states’ interest, “waiting.”

When a third tender was launched, providing for the purchase of the other 460 beds in the first batch, there were no companies interested.

“The suppliers did not appear due to the shortage of respirators on the international stage, one of the items that is part of the bed kit,” said the folder. Since then, there have been no new calls.

Questioned by G1, the agency said that the installation of the 10 beds that were delivered in Pernambuco but are not yet working is the responsibility of the state. The G1 He contacted the state health department, but did not return until the publication of this report.

The inequality in the distribution of beds is not surprising for the health worker Ligia Bahía, from the Federal University of Rio de Janeiro (UFRJ) and the economist Pedro Amaral, from the Federal University of Minas Gerais (UFMG).

Pedro explains that most of the federal investment in health is made through parliamentary amendments and, therefore, the need for health follows less and the politics more. He has studied the distribution of beds in the Brazilian health system for more than ten years.

“The political weight of the northeastern and northern states has always been less, so they put fewer parliamentary amendments on the budget and receive less equipment,” he explains.

Ligia recalls that “Brazil is a huge country that has always focused on the richest cities, the richest states. The northern region, the Amazon, is completely devalued,” says the UFRJ health officer.

“They no longer had ICU beds in Amazonas. All the people who suffered a heart attack needed ICU beds in the postoperative period, due to complications of the neoplasm, they no longer had ICU beds. What the pandemic does is clarify and once, “says Ligia. Manaus is the only Amazon city with intensive care beds.

According to Pedro, the problem of beds in Brazil is not the quantity, according to the Ministry of Health, there are 55.1 thousand, half of them in SUS, but their distribution throughout the territory. “There was always enough, but there was always a queue. Some regions always had very low occupancy rates, and others above 100%, because they do not receive the number of beds,” he says.

• The opening of the field hospital in Roraima has already been postponed three times

He says previous studies have already predicted that the states of Amazonas, Ceará and Pernambuco would have problems sooner. This is because, according to Ligia’s evaluation, if the supply of beds in the ICU in these places was already low before the pandemic, “if there were an increase in demand, they would be the first to collapse,” explains the economist. .

And, in Amazonas, there is another aggravating factor, experts say: the lack of professionals. There is a crisis that is not just about teams. The team does not work alone, “says Ligia, who also remembers the failure to pay the Amazon health teams last year.

“We see the news: doctor, nurse who dies,” adds Pedro. The distance is very intense in this group. You can have the bed, the equipment, the respirators; if you can’t take the professionals, it won’t do. ”

Enable SUS beds

In addition to rented beds, the government also promised to accelerate the process of enabling beds in the ICU in the Unified Health System (SUS). Enabling a bed means that the hospital can now charge the Ministry of Health the amount of the patient’s daily stay.

Until this Friday (24), the Ministry of Health had rated 1,740 beds to combat the pandemic. The government says that the investment is R $ 255 million.

The qualification of the beds depends on an initial investment by the states, according to the Ministry of Health, such as respirators. Thereafter, the portfolio realizes the funds. On April 8, the government determined that the daily amount that each Covid-19 patient would be admitted to the ICU would be R $ 1.6 thousand. Before, this amount was R $ 800.

“SUS depends on the articulation between governments, states and municipalities. Certainly there were requests from the governments of the North region, from the governor of Amazonas, even desperate requests, from the mayor of Manaus, but there is a game of forces that favors some states” , explains Ligia Bahia, from UFRJ.

“In reality, it will always favor states that can advance on their own. As São Paulo advanced. São Paulo was already the state that had enough CTI beds and managed to expand the network more than the states that have the least. The resource El The federal government is the only one that can be redistributive. São Paulo, with its ‘budget’, will put money in São Paulo, “explains Ligia.

“What the federal government had to do was have a very large contribution of resources, which it did not have. The promises of the Ministry of Economy to transfer resources to the Ministry of Health were not kept,” he says.