Study details COVID-19 spatiotemporal dissemination pattern in Brazil

Publicação: 8 de May de 2021

A study shows that there was a great variety in the quality of the response to the pandemic, and this is a typical mark of problems of omission and error of the federal government, considering that the Health Ministry and Unified Health System are the main ones in charge of measures that aim to mitigate the regional inequalities in health policies

Using daily data on cases and deaths provided by the state health departments, the research concluded that there was a variation in patterns between states and municipalities that reflects the diversity of policies to combat COVID-19 or the absence of them   Ilustração © Ildo Nascimento

A study coordinated by demographer Márcia Castro, professor and director of the Department of Global Health and Population at Harvard University, in the United States, attributes to the Brazilian government part of the responsibility for the seriousness of the pandemic in Brazil. Entitled “Spatiotemporal pattern of COVID-19 spread in Brazil“, the paper that mapped out the spread of COVID-19 in Brazil between February and October last year, was published in the same week that the Federal Senate was preparing a Parliamentary Commission of Inquiry (CPI) to investigate the responsibility for mistakes in responding to the pandemic. The research was signed by 10 scientists from Brazil and the United States.

Dr. Castro explains that the study makes a detailed analysis of the spatio-temporal pattern of dissemination of COVID-19 in Brazilian territory, analyzes the occurrence of spatial and temporal clusters, and quantifies and compares the process of internalization of cases and deaths in each state. “When analyzing indicators of agglomeration, trajectories, speed and intensity of propagation of COVID-19 to the interior, combined with policy measures, the study shows that there is no single narrative that explains the spread of the virus in the states of Brazil”, points out the researcher.

Also according to the demographer, the study reflects on five factors that contribute to this complexity and why the country has done so badly in combating the pandemic. The first is the size and inequality of Brazil, with disparities in the quantity and quality of health resources (for example, hospital beds, doctors) and income. The second problem is a dense urban network that connects and influences municipalities through transportation, services and business that has not been completely interrupted during the peak of cases or deaths. The third factor is the political alignment between governors and the president, who played an important role in the beginning and intensity of the distancing measures adopted – cities and states governed by allies of the president took less action, and ideological polarization politicized the pandemic with consequences for adherence to control actions. The fourth ingredient is the failure to test and monitor the pandemic allowing the virus to circulate undetected for more than a month (results proven in at least one state, Ceará), with several cities having started to record high deaths from COVID-19 before the discharge of cases, partly as a result of the lack of well-structured genomic surveillance. The fifth element is the lack of synchrony in the measures of distance and containment of the virus – cities imposed and relaxed measures at different times, based on different criteria, facilitating the spread.

Although no single narrative explains the diversity in dissemination, a general failure to implement immediate, coordinated and equitable responses in a context of strong local inequalities has fueled the spread of the disease. Asked how Brazil has become the epicenter of the disease in the world, Dr. Castro is categorical in stating that it was a succession of mistakes and missed opportunities that accumulated leading to the chaos we face, and that resulted (and continues to result) in a huge (and preventable) loss of lives. “Lack of federal coordination, lack of mass communication, lack of a message and action based on science, no effective incorporation of the family health strategy in the response, minimizing the importance of the virus, promotion of drugs without proven efficacy, among others”, she highlights. The list is long, admits the Harvard professor. For her, Brazil, with the Unified Health System (SUS), Primary Care with the capillarity of the family health strategy, the National Immunization Program (PNI), internationally recognized for its efficiency, the network of researchers and institutions academic and research that it has, should not be on the list of countries that have given the worst response to the pandemic.

Based on previous studies, the study shows that there was a great variety in the quality of the response to the pandemic, and this is a typical mark of problems of omission and error of the federal government, considering that the Ministry of Health and SUS are the main ones in charge for measures aimed at mitigating regional inequalities in health policies. “There is a lesson in how the federal government’s failed coordination broke the integrated health pact during a public health emergency”, laments the director of Harvard University’s Department of Global Health and Population.

So, what worked in the fight against COVID-19 in Brazil? Dr. Castro emphasizes that the collaboration between researchers, the networks that were created to generate knowledge and the efforts created to capture and make data available were fantastic. The public engagement of scientists, bringing detailed and easy-to-understand information to the population is also commendable”, she says. The researcher also recognizes the local examples of mayors and governors who took the right actions at the right time. The study coordinated by her points out Ceará as one of the states that most reaped positive results by adopting a set of more intense preventive measures to contain the pandemic, investment in health, through the practice of rigid social isolation to social actions. The economic measures adopted by the state ended up being a great differential, compared to other states that did not have this initiative.

Finally, the study recalls that Brazil is currently experiencing the worst moment of the pandemic, with record numbers of cases and deaths and on the verge of the collapse of the hospital system and warns of the immediate adoption of a coordinated national response. The research also points out that the variant P.1, detected for the first time in Manaus and more contagious, deepens the situation of chaos in the country. Failure to prevent this new round of propagation may facilitate the emergence of variants of concern (VOCs), isolate Brazil as a threat to global health security and lead to a completely preventable humanitarian crisis.

Unfortunately, the chaos of public health also highlighted the Brazilian ills, bringing hunger back. The pandemic demonstrated that health and economy cannot be separated, but the problem is that the policy has been transformed in such a way that the perspective on health/science has become partisan and, thus, accepting scientific findings or not has become a matter of having whether or not certain political affiliation. The pandemic also revealed that local inequalities persist in causing many families to enter the poverty line and in bringing hunger to countless Brazilians who are already suffering, tired and sick. For the specialist in Global Health and Population, a real and true commitment is needed to face the structural inequalities that have always been present in Brazil. “Without a social agenda that focuses on inequalities, without a serious commitment to achieve the sustainable goals of the millennium, this situation does not change”, says Dr. Marcia Castro.