On April 13, the World Health Organization (WHO) announced that the Covid-19 pandemic continues to be a "Public Health Emergency of International Importance” (PHEIC, Public Health Emergency of International Concern). This Easter Sunday (17/04), contrary to the WHO decision, the Minister of Health Marcelo Queiroga announced on national radio and TV that he will issue a normative act to close ESPIN (Public Health Emergency of National Importance ), putting an end to the state of emergency due to the Covid-19 pandemic. Queiroga justified the decision based on the favorable epidemiological situation, the good vaccination coverage of the population and the assistance capacity of the Unified Health System (SUS). However, the justification for this measure is different: 2022 is an election year!
The removal of the ESPIN status may impact several actions to combat the spread of the disease, such as border control, establishment of quarantine, adoption of a vaccination passport and masks in closed places, carrying out tests to diagnose Covid-19 in pharmacies, teleworking and telemedicine. It can also affect disease control measures, such as, for example, expanding hospital beds, purchasing hospital supplies and materials on an emergency basis, mobilizing servers, applying vaccines approved by Anvisa on an emergency and temporary basis, such as CoronaVac (only vaccines from Pfizer/BioNTech, AstraZeneca/Oxford and Janssen/Cilag have definitive registration), use of medicines such as sotrovimab, evusheld and paxlovid, which only have emergency use authorization approved by Anvisa.
In order for vaccines and medicines against Covid-19 to continue to be used, Anvisa would have to extend the authorization for their emergency use when the normative act is published. In note published on April 18, the Agency reported that the Ministry of Health has already requested an extension of emergency use for one year. Approval of the request still depends on analysis by Anvisa's Collegiate Board. Most likely, ESPIN will not be revoked immediately and we will have a period of a few weeks between the issuance of the ordinance and the actual date to mark the end of the Public Health Emergency.
Vaccination and surveillance - Thanks to the advancement of vaccination, the epidemiological scenario is favorable, but we are far from the end of the pandemic. Brazil registered 65 deaths caused by Covid-19 in the last 24 hours, reaching a moving average of 98 deaths in the last seven days. Since the beginning of the pandemic, the disease has claimed the lives of just over 662 thousand Brazilians (a number that does not take into account underreporting). According to data from civil registry offices, Covid-19 is the disease that kills the most in the country. The number of cases has been falling, but we still registered 10.393 new cases in the last 24 hours, with a moving average of 14.252 cases in the last seven days.
To date, 88,3% of the vaccinatable population, aged five or over, has taken the 1st dose of the vaccine and 81,4% of the population aged five or over has taken the 2nd dose or a single dose. However, vaccination coverage of people aged 18 or over who took the booster dose is just over 51,8%. Regarding childhood vaccination, since the start of the campaign in January 2022, only 56,2% of children aged 5 to 11 years have taken the first dose and just over 28,9% have taken the second dose. The country needs to advance in childhood vaccination and the application of booster doses to people aged 18 or over, in population testing and genomic surveillance programs, which will allow the identification of the spread and transmission routes of the virus and new variants of concern.
It is also important that CoronaVac is approved by Anvisa for vaccinating children aged 3 to 5 years. After the opinion of medical societies and studies sent by the Butantan Institute, Anvisa requested new data about CoronaVac for children aged 3 to 5 years:
1. Data demonstrating the protection provided by the CoronaVac vaccine in the pediatric population after at least 2 months, ideally after 3 months, of complete vaccination with the 2-dose primary scheme, in a scenario where the Ômicron variant predominates;
2. Protocol for studying the effectiveness of the CoronaVac vaccine in the pediatric population in Brazil that includes the evaluation of the duration of protection provided by the vaccine in the pediatric population;
3. Clinical study protocol to evaluate the immunogenicity and safety of the third dose or booster dose of the CoronaVac vaccine in the pediatric population (all age groups);
4. Integrated safety data presented in support of this application for expanded use, in a single report format with an overview of the safety of the CoronaVac vaccine for children aged 3 to 5 years;
5. Clinical report with updated data from the phase III clinical study (PRO-nCOV-3002-1), conducted in China for comparative assessment of immunogenicity in children and adults;
6. Clinical report with updated efficacy, safety and immunogenicity data from the phase III multicenter study, conducted in South Africa, Chile, Malaysia and the Philippines, to evaluate the immunogenicity, safety and efficacy of the Covid-19 vaccine (Vero Cell ), inactivated (CoronaVac®) in children and adolescents aged 6 months to 17 years.
Um study phase 4 of Fiocruz Minas, involving 1.587 vaccinated people, showed the importance of a booster dose with the Pfizer/BioNTech vaccine for those who took two doses of CoronaVac, in a heterologous vaccination schedule. The data indicate the importance of the protective response induced by CoronaVac after two doses and how this response becomes even more robust after applying a booster dose with the Pfizer/BioNTech vaccine, protecting against the Delta and Ômicron variants. Even for elderly people over 60 years of age, where antibody levels between the fifth and seventh months after the second dose were lower than in people between 18 and 30 years of age, the Pfizer/BioNTech booster dose restores the immune response.
The Fiocruz study also highlights the value of hybrid immunity, as participants who had Covid-19 and were later vaccinated showed higher antibody levels after vaccination, when compared to volunteers who were not infected. Other study of Fiocruz's VigiVac project, published in the magazine Lancet Infectious Diseases, shows the effectiveness of the four vaccines against Covid-19 in use in Brazil (Coronavac, AstraZeneca, Janssen and Pfizer-BioNTech) in increasing protection against serious outcomes in people previously infected with Sars-CoV-2.
Although consistently falling, we still have a high number of cases and deaths. Let's be clear: only the WHO can decree the end of the pandemic. No country can downgrade the Covid-19 classification and determine the change of status from pandemic to endemic, whether through decrees, normative acts or ordinances. Brazil is not in a dome, isolated from the rest of the world.
For the entity, the Sars-CoV-2 virus continues to evolve and is considered unpredictable, with wide circulation and a high rate of transmission in humans, causing high levels of morbidity and mortality in more vulnerable populations in low-income countries, with a low rate of vaccination coverage and that there is still a risk of international spread. The WHO maintains the goal of vaccinating 70% of the populations of all countries by July 2022, with priority given to health professionals, the elderly and at-risk groups. To date, 65% of the world's population has received at least one dose, which represents 11,47 billion doses of vaccines administered. Also according to the WHO, 64 countries, including Brazil, have reached 70% vaccinations. However, only 15,2% of the most vulnerable populations in low-income countries have received at least one dose and there are 21 countries with vaccination coverage below 10%, including countries in conflict zones.
Current epidemiological scenario - Due to advances in vaccination coverage, the epidemiological scenario has been improving significantly in Brazil, with a reduction in the occupancy of intensive care units (ICUs) for Covid. Data Fiocruz Covid-19 Observatory Bulletin, released on 08/04/2022, show a downward trend in indicators of new serious cases, hospitalizations and deaths due to Covid-19, highlighting that, for the first time since May 2020, no Brazilian state surpassed the 0,3 mark deaths per 100 thousand inhabitants. Without a doubt, we are experiencing the best moment since the beginning of the pandemic, on March 11, 2020, but we cannot let excessive optimism contribute to an even greater relaxation.
Ômicron's new XE subvariant - Apparently, the previously feared recombination between the BA.1 and BA.2 sublineages of the Ômicron variant (variant Deltacron, which consisted of a mixture of the Delta and Ômicron variants. According to Fiocruz Genomic Network, the BA.2 sublineage, responsible for the increase in cases in Europe and East Asia, is becoming more frequent in Brazil. The tendency is for the XE variant to disappear, although constant monitoring and genomic surveillance are necessary. Vaccination must continue, as we cannot ignore the risk of new outbreaks and waves of Covid-19.
covid kit - Chloroquine, ivermectin, nitazoxanide and azithromycin, drugs proven to be ineffective against Covid-19, remain in use best seller list in Brazil. Considering only medicines sold in pharmacies, 97 million units were sold in 2021 and 102 million in 2020, compared to just 40 million units in 2019. In other words, the Covid kit scam makes a profit!
Definitely, charlatanism and cheating have no limits in Brazil and the denialist discourse of anti-vaccine scoundrels and defenders of the Covid kit has become a discourse of power. And this disinformation production machine will continue to defend the Covid kit, as there are many financial interests and political dividends. This looks like what psychologists call the illusory truth effect: a lie told a thousand times does not become true, it only seems credible to some people due to intense repetition.
Several serious, gold standard, randomized clinical studies, with a placebo group, show the ineffectiveness of ivermectin. One Brazilian study very robust recent publication, published in The New England Journal of Medicine (30/03/2022) showed that people who took ivermectin and later tested positive for Covid-19 performed worse than the group that only received the placebo. One Editorial recent in the magazine British Medical Journal (BMJ) highlights the ethical scandals and fraud behind studies that showed some possible benefit with ivermectin.
How long will this cheating last?
