Covid-19: The change in the profile of people affected by the severe form of Covid-19 led the city of São Paulo to change its strategy to fight the disease: now, the orientation is to seek a Health Unit as soon as the symptoms of infection appear.
The protocol change in São Paulo is due to three factors: critically ill patients have become younger – most are between 20 and 54 years old; the worsening of the disease is being faster and more sudden and the length of hospital stay for patients is increasing. According to Edson Aparecido, Municipal Health Secretary of the São Paulo capital, the decision took into account two hypotheses, to be confirmed soon: the disease would be getting worse faster and becoming more lethal.
Information from the government of São Paulo shows that before, 80% of the hospitalized patients in serious condition were elderly, while today 60% of the contingent of hospitalizations occurs among people between 30 and 50 years old. Doctors and researchers believe that the blame is for the P. 1 variant, which has been shown to be up to 2.4 times more transmissible than other strains of the virus in a recent international study published in the journal Science, with the participation of the Faculty of Tropical Medicine (IMT) of the Faculty USP Medical School (FMUSP).
Is it really P.1’s fault?
The P.1 variant has mutations in the genes that encode the spike – a protein that allows the Sars-Cov-2 virus to enter cells -, facilitating infection. Currently, it is estimated that 80% of the cases in greater São Paulo are due to this variant.
A study by Fiocruz, carried out in February 2021, points out that adults affected by Covid-19 caused by the P.1 variant have a viral load up to ten times higher than those who carry the original version of the virus – which does not necessarily mean an increase in the severity of the cases, but in theory, it can increase the transmissibility of the disease, according to virologist José Eduardo Levi, a participant in the international study, in a recent interview with the BBC.
Does early care help?
So far, scientific studies have shown that there is no effective early treatment for the new coronavirus. According to the Municipal Health Secretary of São Paulo, the early care adopted in the capital has two other reasons: to offer treatment before it is too late and to better manage the supply of beds, avoiding the collapse of the health system.
According to the Secretariat, the ICU beds in the capital rose during the pandemic from 575 to 1,430 and the infirmary beds went from 2,000 to 3,600. Even so, São Paulo currently has 88% of beds occupied, while the average length of stay has risen from seven to ten days to around 14 to 17 days.
For Suzana Lobo, president-director of the Brazilian Association of Intensive Care Medicine (Amib), the health system of most Brazilian cities is unable to replicate the model currently proposed by the city of São Paulo. Recently, the association collected data from almost half of the 55 thousand ICU beds in Brazil and verified a 40% increase in the intubation procedure, in addition to a 17% increase in the admission of patients up to 40 years old in ICUs. “I don’t believe that anyone who has symptoms will get medical care, because there are a lot of people. Many people. How is it that everyone who has symptoms in Brazil will get a doctor today? I don’t know if the system has the capacity for this “, says Lobo, Amib’s CEO.