Collapse in health cannot be trivialized
12 months have passed since the first case of COVID-19 officially diagnosed in Brazil. Since then, more than 10 million cases and 250 thousand deaths have been recorded, including the country in the morbid and sad list of those with the highest number of deaths and number of infected people in absolute numbers. A year after confirming the first case of infection by the new coronavirus, Brazil has been going through the worst phase of the disease since the end of 2020, with a moving average of more than a thousand deaths per day, heading in the opposite direction to the rest of the world, whose contagion curves are falling. The country faces a scenario of hospital collapse and is implementing an immunization plan that has only managed to vaccinate 3,5% of the population to date, with the majority having only received the first dose.
In this unusual context, the Clinical Hospital of the State University of Campinas (Unicamp), a regional tertiary reference, began to be responsible for the diagnosis and treatment of COVID-19 from the beginning of the pandemic and was actively included in the state regulatory system. Between December 2020 and January 2021, the average occupancy of ward beds exclusively for COVID-19 remained at 80%. However, from the first week of February, the infirmary beds remained fully occupied, reaching the mark of 100% of beds. At the same time, the beds allocated to the ICU COVID-19 have maintained an average occupancy of 85%, reaching the 95% mark last week. It should be noted that since February 22, 10 new ICU beds have been opened specifically for COVID-19, totaling 30 exclusive beds for the care of critically ill patients with respiratory failure and hemodynamic instability.
It is essential to reiterate that Unicamp's HC meets the State's regional demands. Thus, in recent weeks, of the beds (ICU and infirmary) directed to the treatment of patients COVID-19 45% are occupied by residents of Campinas and 47% by residents of all the other 42 municipalities that make up DRS-7. When stratified by type of care unit, 59% of ICU occupants COVID-19 adults come from Campinas and 35% from other municipalities in DRS-7, while of the infirmary beds, 43% and 51%, respectively, are occupied by patients from Campinas and from other municipalities in the region. It should be emphasized that, as it is a tertiary hospital, whose responsibilities extend to more serious situations (urgency and emergency, care for oncology patients, complex surgeries and solid organ transplantation) in which the only possibility of serving the population is the Hospital de Clínicas da Unicamp, the remaining 27 non-COVID ICU beds have shown constant 100% occupancy.
Similarly, since January 2020, the Women's Hospital (CAISM) has been preparing to face COVID-19. New routines were implemented to adapt the care of women and babies to the new reality, establishing specific infirmary and intensive care flows and areas for the care of suspected symptomatic patients, in order to guarantee safety and quick access to reception and diagnosis. Numerous deliveries of infected patients are being carried out safely for the mother, newborn and family members. Care for women with COVID-19 undergoing treatment for gynecological cancer remains unchanged. This is done without failing to serve, with quality and care, non-infected patients with oncological, gynecological, obstetric morbidity and those in need of neonatal care, always focusing on the safety of users and workers.
Following the same guideline, the Digestive System Diagnostic Center (Gastrocentro) actively maintained endoscopic examinations, taking all the precautions recommended by the World Endoscopy Organization (WEO). These recommendations made it possible to optimize and make endoscopic practice safe for doctors and patients. At the same time, the Hematology and Hemotherapy Center (Hemocentro) adapted its structure to continue receiving volunteer donors with maximum safety, guaranteeing a safe blood supply for the HC, CAISM and more than 40 hospitals in the region. Another important measure was the targeting of plasma produced at Unicamp for Manaus and, more recently, for Araraquara, as a contribution to alleviating the critical situations experienced in these regions.
In addition to the healthcare units on the Barão Geraldo campus, the University manages regional hospitals and AMES. The Sumaré State Hospital (HES) and the Piracicaba Regional Hospital (HRP), since March 2020, have been on the list of reference hospitals for COVID-19, with HES and HRP contributing, respectively, with 24 ICU beds and 34 infirmary, in addition to 40 beds for intensive care and 22 beds for COVID-19 patients in a clinical ward, specifically intended for this purpose. To this end, there was physical readjustment and implementation of protocols following the recommendation of the Ministry of Health. These beds were kept active until September 2020. As of January 2021, HES proposed to the State Department of Health (SES) the opening of new ICU and infirmary beds, with this proposal being analyzed.
It should be noted that the contractual goals of the Specialty Medical Outpatient Clinics (AME) with the SES were maintained during the pandemic, establishing new patient flows and the health care necessary to protect patients and workers.
Unicamp, in fact, began to follow the first scientific evidence in relation to COVID-19 and its causative agent months before the first case of the disease arrived in the country. This early monitoring made it possible to develop an action plan based on the guidelines of the World Health Organization (WHO), with an emphasis on the dissemination of information and preventive guidelines. It also allowed the early organization of the Community Health Center (Cecom) to care for suspected cases of students, faculty and staff at the University, with an important role in collecting samples for testing and strict epidemiological surveillance of registered cases.
On March 12, 2020, As soon as the pandemic was declared, COVID-19 by the Director-General of the World Health Organization, the University diligently went ahead in relation to the State Government and other Brazilian public universities, announcing the suspension of part of face-to-face activities and establishing working groups to define contingency plan. These measures were later extended for an indefinite period, given the need to maintain isolation and social distancing due to the worsening of the health crisis in COVID-19.
However, the lack of control over the transmission of the new coronavirus in Brazil led to the emergence of variants, apparently more transmissible and with more serious manifestations, affecting younger age groups. Mutations in the virus are common and expected, especially when transmission control is inadequate. With scarce resources to implement genomic surveillance, capable of identifying the emergence of new variants, the country is unable to control the circulation of mutations. These can even put vaccination at risk, as many immunizers have proven to be less effective when tested with new strains of the new coronavirus.
Once this serious situation has been established, the ability to protect your people, an obligation inherent to the role of federal, state and municipal administrators, becomes fundamental. Not exempting themselves from their responsibilities and duties within the scope of their territories, this functional obligation gives governments the authority to adopt or maintain restrictive measures during the coronavirus pandemic. COVID-19, such as the imposition of social distancing, the suspension of face-to-face teaching activities, restrictions on commerce, cultural activities and movement of people, and lockdowns, among others. This was assured by the Federal Supreme Court. But that has not been what has been seen. Omission, insecurity, scientific denialism, lack of commitment to the truth and political use of such a serious situation should not be understood as normal.
The vaccine and increasing the number of intensive beds are important and necessary. However, these measures will not change, in the short term, the explosive increase in the number of cases and mortality currently observed, as well as the natural history of this disease. There is a need to complete the vaccination of millions of Brazilians, especially the most vulnerable, and this takes time. Therefore, it is necessary for authorities to assume their responsibilities and work in an organized and integrated manner, with the recommendation of urgent and indispensable measures, such as the use of masks, social distancing, reduction of activities that cause crowding and restriction of movement. Unfortunately, these are the only and effective measures we have left at the moment.
As a public institution committed to teaching, research, extension and assistance, Unicamp considers that the serious moment the country is going through, in which thousands of lives are lost due to the lack of an integrated national plan to combat the pandemic, cannot be trivialized . Voluntary apathy is as virulent as occasional denialism. Both drugize society and cause deaths that could have been avoided. Given this scenario, and in respect for the thousands of bereaved families, Unicamp reiterates its commitment to collaborate with the authorities and society in overcoming this dramatic stage in our history, in defense of life and social well-being.
Dean of Unicamp
Campinas, March 03, 2021.
