Brazil Covid-19: Town in Sao Paulo state says it could be forced to take patients off ventilators as cases spike nationwide

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Coronavirus cases are surging in Brazil, and the country’s health systems are increasingly overwhelmed. In nearly every state across Brazil, occupancy rates in intensive care units (ICUs) are at or above 80%. Some of them are at or above 90%, and a few have have exceeded 100% occupancy, forcing them to turn some patients away.

State governors, city mayors and local medical personnel now say they are running out of supplies to treat even the Covid-19 patients who have been allocated precious ICU beds. Stocks of medicines that facilitate intubation could vanish in the next two weeks, according to a report from the National Council of Municipal Health Secretaries. And Brazil’s National Association of Private Hospitals (ANAHP) has predicted that private hospitals will run out of medicines necessary for intubating Covid-19 patients by Monday.

In the coastal town of Sao Sebastiao, in Sao Paulo state, Mayor Felipe Augusto this weekend resorted to public appeals for more supplies from the state government.

“Our stock lasts until Monday, and will only be used for patients already intubated. The problem is that the lack of these drugs demands extubation — that is, you will have to remove this patient who is in a serious and intubated condition and switch to breathing masks. A huge risk,” the mayor told CNN affiliate CNN Brasil on Saturday.
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Doctor Juan Lambert, head of Sao Sebastiao’s biggest hospital, told CNN on Sunday that 10 Covid-19 patients are intubated in his hospital, and that the state government had bought them time by sending a week’s worth of supplies after Augusto’s plea circulated in the media.

“Thank God the secretariat reached out and made us a priority in the distribution of supplies.” Lambert said.

But with the entire country stretching to accommodate skyrocketing new cases, even the wealthiest state in Brazil may not have much more to offer. On Saturday, Sao Paulo state health department predicted that public hospitals’ stocks of drugs used for intubation would only last another week.

In an official statement to CNN, the department said it had been demanding “express and urgent measures” from Brazil´s Health Ministry. The ministry did not respond to repeated requests for comment.

A national crisis

According to a CNN analysis, nearly a quarter of global Covid-19 deaths over the past two weeks occurred in Brazil. At least 294,042 people in the country have died since the pandemic began.

Last week, Brazil’s National Front of Mayors (FNP) sent a letter to President Jair Bolsonaro and the health ministry asking for “immediate measures” from the federal government to provide sedation medications and oxygen for intubated patients who have Covid-19 and other illness.

“It is unreasonable for people, Brazilian citizens, to be driven to such desperate deaths by ‘drowning in the dry’ or to have to be tied up and maintain consciousness during the delicate and painful process of intubation and throughout the period people are kept intubated,” the letter says.

The Federal Pharmacy Council (CFF) also warned there was evidence of the shortage of neuromuscular blockers, sedatives, and other drugs used in intensive care, like midazolam, essential for humane and safe intubation.

These were not the first such warnings. In August 2020, a report by the National Health Council — an agency linked to Brazil’s Health Ministry — described the risk of a drug shortage amid the pandemic.

“The shortage of these drugs puts at risk the entire structure planned for health care during the pandemic…because even with available beds, without these drugs, it is not possible to perform the procedure, which may cause the entire system of health to collapse,” wrote Council President Fernando Pigatto, council president.

A call to change tactics

Bolsonaro, who celebrated his 66th birthday on Sunday, has seen rising public disapproval ratings as Covid-19 persists in the country. A survey by the Datafolha polling institute last week showed a 54% disapproval of his handling of the pandemic.

The President has refused to endorse lockdown measures, arguing that he is protecting citizens’ liberty and the country’s economic health. His administration has also said that state-level officials are empowered to take precautionary measures.

However, Bolsonaro announced last week that his government had filed a lawsuit to block governors and mayors from imposing certain restrictions, after several adopted curfews and other strict measures. “This is a state of siege, which only one person can decree — me,” he said.

More than 500 prominent Brazilian bankers, economists and politicians on Sunday published an open letter in the country´s biggest newspapers asking the federal government to rethink its approach to the pandemic.

“This recession … will not be overcome until the pandemic is controlled by competent action by the federal government. This underutilizes and misuses the resources at its disposal, including ignoring or neglecting scientific evidence in the design of actions to deal with the pandemic,” wrote the bankers and economists.

“We are at the threshold of an explosive phase of the pandemic and it is essential that from now on public policies are based on data, reliable information and scientific evidence,” the letter read.

CNN’s Hira Humayun and Caitlin Hu contributed to this report.

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