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Leitos de UTI no Hospital Ronaldo Gazzola, na zona norte do Rio de Janeiro

The diseases associated with post-Covid-19 syndrome should be the bottleneck of public health

Intensive care beds at Ronaldo Gazola Hospital, in northern Rio de Janeiro, during the Covid-19 pandemic
Photo: Wilton Júnior / Estadão Content (10.2021)

the different Neurological sequelaeThe heart, lung, kidney, and metabolic disorders that appear in people diagnosed with Covid-19, are what scientists call Long Covid Syndrome or Post-Covid SyndromeIt should become a challenge to health systems around the world.

This is because the syndrome is characterized by a set of signs and symptoms that Can go on For more than three months after a diagnosis of Covid-19 leads to the need for treatment and rehabilitation – temporary or for life.

Research published in Nature Magazine In April, he indicates that the prolonged COVID-19 virus is expected to have a major impact on the health system United State (USA) in the coming years. A survey conducted by the University of Washington, USA, of 87,000 people infected with the new Coronavirus, confirmed that despite it being a respiratory virus in the beginning, the consequences of SARS-CoV-2 can affect nearly all organ systems of the body.

The authors evaluated 379 diagnoses of potentially associated diseases Covid-19 in the United States of America (See the table). For these patients, 380 classes of drugs were prescribed and 62 types of laboratory tests administered. In light of this percentage, the study coordinator, Ziyad Al-Ali, wrote that “it is not an exaggeration to say that the long-term health consequences of Covid-19 will be the next major health crisis in the United States.”

The prolonged effects of Covid-19
The prolonged effects of Covid-19
Photo: ART / CNN Brasil

Another long-term study on Covid with 47,000 patients from the NHS, the UK’s public health system, showed that nearly a third of Covid-19 patients admitted with the disease had been brought back to hospital, and one in ten died of the consequences it caused. Of infection.

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Research highlighted the need for Multidisciplinary treatments. “Diagnosing, treating and preventing post-Covid syndrome requires integrated approaches rather than device or disease-specific approaches,” said the document, signed by statistician Daniel Ayubkhani from the United Kingdom’s National Statistical Office (ONS).

Non-Brazilian influences

There is still no data on the consequences of post-Covid syndrome in Brazil, but experts have consulted them CNN We think it can increase the burden on One Health System (SUS)“People are really short of beds, professionals and equipment,” says epidemiologist Gulnar Azevedo e Silva, president of the Brazilian Public Health Association (APRASCO).

An epidemiologist confirms that SUS has the necessary infrastructure to help cases Post-Covid SyndromeHowever, in order to meet the increasing demand, it is necessary to have more resources.

Silva recalls that there are cuts to the health budget for 2021, which, according to her, should put the Covid-19 pandemic control department at risk. “The biggest concern is the proposed health financing, which is less than the 2017 funding [R$ 127 bilhões, segundo o governo Federal]Which was not really enough, and not studying all the circumstances of the epidemic, in addition to other factors that will affect, ”he says.

a 2021 Ministry of Health budget 125 billion Rials, R $ 2.3 billion less than expected. The value is also lower than portfolio spending in 2020, which exceeded R $ 160 billion.

The president of APRASCO confirms this Hospital storage Due to the epidemic, it reduced patients’ demands and delayed treating patients cancer Chronic patients who underwent surgery had appointments canceled or postponed. Silva says these residents will suffer more from a lack of resources if the number of people suffering from the consequences of the Covid-19 virus increases.

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It concludes that “there are no conditions for hiring more doctors, nurses and physiotherapists who can provide specialized assistance, and then follow-up and focus on primary care.”

For Gustavo Mata, a researcher at the Oswaldo Cruz Foundation’s School of Public Health (Fiucruz), Brazil should follow the example of countries preparing for new needs, such as those in the United Kingdom, Germany and the United States, which he first encouraged Social distancing Today they are investing in universal vaccination to contain the virus.

The crisis we are experiencing is not only a health crisis, but also affects several dimensions of Brazilian social protection, including the health system. We need to respond to that, and plan to anticipate the long-term impact of Covid, ”he says.

SUS’s preparation for this new reality should include at least two common actions, notes the researcher. The first includes containing cases of Covid-19 through vaccinationSocial distancing, reopening the economy and epidemiological social spaces, through regionally and nationally coordinated measures.

The second is to create a contingency plan to restore and strengthen the health system in Primary interest And in protection and security systems, through social programs, since then The epidemic affects the poor population the most.

“We need health safeguards at levels closer to the population to avoid overburdening hospital care. This involves investments in primary care. This is the only way to avoid more surgeries and deaths,” he says.

What does the Ministry of Health say?

In a note sent by e-mail to CNNThe Ministry of Health stated that the 2021 budget was sent by the executive authority, while respecting the minimum calculation rule for health application.

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During this exercise, extraordinary funds were opened to confront the epidemic, with a total amount of R $ 10.9 billion. In addition, the extraordinary appropriation for 2020 of R $ 21.6 billion has been reopened for the acquisition of vaccines, “according to the transcript.

In terms of patient care in the Covid-19 recovery period, the ministry stated that SUS has 226 specialized physical and intellectual rehabilitation (CER) centers providing assistance to patients recovering from Covid-19 in 26 states, in addition to 38 orthopedic workshops and eight Itinerant. I also said that Federal government Transfer approximately R $ 50 million per month for maintenance and rehabilitation of these services.

The portfolio states that, in November 2020, it launched a Post-COVID-19 Rehabilitation Project (REAB) in five SUS hospitals in every region of the country: Municipal de Contagem Hospital (MG), Hospital de Palmas (TO), hospital base. Brasilia (DF), Fortaleza General Hospital (CE) and General Workers ’Hospital (PR). REAB showed a 26% increase in patients’ development regarding motor and functional independence. The memo says ten more public hospitals will take part in the project later this year.

In terms of investments in primary care, the Ministry states that in 2020, the Previne Brasil program has transferred approximately R $ 20.8 billion to municipalities and the Federal District to maintain primary care assistance services. It concludes that “an increase of 12% compared to 2019. In 2021, more than R $ 5 billion have already been transferred in the form of exceptional credit”.