Brazil's public healthcare system (SUS) is an advantage in the fight against the coronavirus, say experts.

From Brasil de Fato - The structure of Brazil's Unified Health System (SUS) gives it an advantage in tackling the new coronavirus compared to other countries, such as the United States, which rely on the private sector to diagnose and care for those infected, according to experts in the field.

“National public health systems offer an advantage to society and the state, which is the ability to develop a coordinated campaign and response. Unified systems are a network that, even with fragmentation like in Brazil with states and municipalities, is much less fragmented than in the United States, where the government had to coordinate private services,” says public health physician Gastão Wagner de Sousa Campos, former president of the Brazilian Association of Collective Health (Abrasco).

Effectiveness in combating COVID-19, the disease linked to the new virus, however, depends on more investment in infrastructure and integration of the Brazilian public system, says Gastão. “If the epidemic grows, as predicted, there are shortages, mainly of doctors, and a lack of basic health units. What needs to be done is to invest resources,” says Gastão.

On Wednesday (13), the Minister of Health, Luiz Henrique Mandetta, met with Congress to request the release of R$ 5 billion to be used against the coronavirus. Although the presidents of the House and Senate have signaled that they will accept the appeal, there is still no decision on how to release the money.

Following Mandetta's request, Economy Minister Paulo Guedes said this Friday (13) that he will request the release of another R$ 5 billion, totaling R$ 10 billion, for actions to combat the epidemic.

According to Gastão Wagner, the first steps to prevent the global pandemic from spreading to Brazil are to invest in hiring more healthcare professionals – not just doctors –, increase the number of beds in intensive care units (ICUs), and strengthen the laboratories that test for the disease.

Gastão says that, since most cases are not serious, diagnosis is paramount to avoid major harm to the population. “Since 80% of coronavirus cases are not serious, but diagnosis is necessary, it’s very important to get a diagnosis so that people can self-isolate at home. We recommend that people stay home from work, from school, that they don’t go out. They should stay isolated at home.”

For diagnoses to be quick and accurate, it is necessary that, in addition to well-equipped laboratories, there is good primary care. The Bolsonaro government, however, dismantled the main program for providing doctors to health centers, the Mais Médicos program.

Now, in the face of the crisis, the government has launched a call for applications to hire 5.811 doctors for the program. Wagner believes there may not be enough time for these professionals to work during the peak of the coronavirus pandemic. "I don't know if they will succeed, because Brazilian doctors are mostly specialists, they don't want to work in primary care. It's very difficult to find doctors for primary care in Brazil, even paying an average salary."

SUS

Infectious disease specialist Nancy Bellei, from the University of São Paulo (USP) and consultant for the Brazilian Society of Infectious Diseases, emphasizes that, although the structure is not ideal, the SUS (Brazilian public healthcare system) has the capacity to serve the population.

For this to happen, she says, the actions of each hospital or health unit need to be defined dynamically, according to the specific characteristics of each location.

“Hospitals need to have a plan to understand their reality. A hospital in the interior of Maranhão might not have to suspend anything or do anything, because perhaps a patient with severe coronavirus will never arrive there, nor will there be a large influx that would require suspension. On the other hand, you have hospitals that will have situations that cannot be suspended. You have burn wards. You will continue to have burn victims. You have neurosurgical wards. You will continue to have accidents. So it depends a lot on the characteristics of each hospital,” he explains.

Nancy emphasizes that the alarm surrounding the coronavirus does not reflect the reality observed in healthcare services so far. "Despite the news that cases are exploding, in practice we are not seeing that. We are seeing a number of international patients arriving at private hospitals and getting tested. In primary care, we are not seeing an explosion yet."

According to the infectious disease specialist, medical actions must be coordinated with communication efforts by authorities to avoid an unnecessary collapse of the healthcare system. She assures that, for now, there is no need for drastic measures, such as canceling elective surgeries in all hospitals.

“The very people connected to official agencies who released the news that caused this explosion should correct the way they speak, because I noticed that, from yesterday to today, universities closed, events were canceled, and people sought emergency care, all because of an explosion that, in practice, is not happening,” says Nancy. “This panic, this information about an explosive epidemic, is a disservice to the population,” she adds.