The identification of the zero-coronavirus patient in Brazil has motivated the creation of a network of coordinated actions to prevent the virus from spreading rapidly in the country. Although the only confirmed Brazilian case comes from outside, health authorities and researchers are trying to trace the behavior pattern of the coronavirus in a tropical country, something unpublished so far. The authorities also expect that its possible dissemination in Brazil will be slower than in the countries of the northern hemisphere because of the summer, a time when temperatures are higher - an adverse environment for the coronavirus - and when people tend to be less agglutinated in enclosed spaces than in winter. If until then the Brazilian Government carried out controls mainly on people from China, the epicenter of the epidemic, now it also considers the flow of tourists from Europe, where the disease has been gaining strength in recent days. It is also prepared to make available masks and other supplies in health centers of all States to anticipate the likely increase in demand. At the moment, there are at least 20 possible cases that are being investigated in the country and the Ministry of Health promises to issue daily communications to inform about the status of the problem.
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It is not by chance that São Paulo, the Brazilian megalopolis with a high flow of Brazilians and foreigners, has been the gateway to the coronavirus in Brazil. The zero patient with the disease COVID-19 is a 61-year-old businessman who lives in the capital of São Paulo, but had visited northern Italy on a 12-day work trip. The man returned to Brazil on Friday on a flight with a stopover in Paris. Without presenting any symptoms, on Sunday he had a family meal that was attended by about 30 people. It was not until Monday when he showed up at a private hospital to present symptoms such as fever and cough, common even in cases of infection with other respiratory viruses currently circulating in Brazil. When communicating to the doctor his passage through Italy, a country that had entered the list of dissemination of the disease, he was tested for the coronavirus.
The employer is now in home isolation because he has mild symptoms of the disease, and the international protocol states that only those with a more serious clinical picture should remain admitted. At home, the zero patient uses a mask, avoids being in the same room as his wife, and the garbage he produces is separated from the rest. Teams of the National Agency for Health Surveillance, the Ministry of Health and the City of São Paulo are also in contact with the 30 relatives who were with the infected patient, in addition to the eight passengers who were in a radius of up to two seats of the Businessman on the plane. The indication is that, if any of them have fever or respiratory symptoms (such as nasal congestion and discharge, cough or shortness of breath), go to a health center. These people are not in quarantine, but they are recommended to avoid agglomerations and to take the same preventive care as the rest of the population: wash their hands frequently, stay hydrated and eat a healthy diet.
The alert generated by the confirmation of the first case of coronavirus has led the Government of the State of São Paulo to form an emergency committee, with experts prepared to dialogue with both federal, state and municipal health authorities, as well as with authorities from other areas, in if necessary. There is still no data on how exactly the group will act in practice, but infectologist David Uip, coordinator of the committee, states that São Paulo is prepared to deal with COVID-19, a disease that arises from a genetic modification of the coronavirus. “What we are dealing with here today is not a novelty. We go through the [virus] H1N1 and other viral infections for many years, ”says Uip. The infectologist also ensures that the São Paulo bed system, of which 7,000 belong to the intensive care area, is sufficient to meet a possible increase in demand for the coronavirus.
The Minister of Health, Luiz Henrique Mandetta, has announced a tender for the hiring of 1,000 emergency beds for intensive treatment centers if necessary, reports from Brasilia Afonso Benites . The minister also said that, within a week, all Brazilian states will receive masks and other supplies that the Government has already acquired. The minister has also assured that the current moment is not in panic, but in preparation to report possible cases in a context in which summer and the tropical climate can contribute to a slower spread. Although new cases can be confirmed in the coming days, Mandetta argues that the pattern of the virus observed in China gives clues about the transmissibility and low lethality of the coronavirus. "The severity of the disease is moderate to mild," says Health Surveillance Secretary Wanderson Kleber de Oliveira.
“There is no reason to panic, but we have to be alert because everything can change,” adds the Secretary of Health of São Paulo, Alberto Kanamura. The official explains that an infected patient is more likely to transmit the coronavirus when he shows the symptoms, and that several studies show that, during the winter, in the countries of the northern hemisphere, an infected gets to transmit the disease to an average of three people . To mitigate panic, Kanamura compares this ability to spread with measles, where the average transmission of a patient amounts to 20 people.
The virologist Gúbio Soares - who is part of the Institute of Health Sciences of the Federal University of Bahia and developed a rapid test that can identify the coronavirus in about three hours - it seems difficult for the virus to spread through Brazil at the same rate as in countries like Italy. “The warm climate of the country does not help its spread in the middle of summer. People's saliva and respiratory drops also dry quickly. I don't think there is an uncontrolled dissemination in Brazil, ”he says.
Soares says that the public health system is preparing to respond to a possible spread of the disease since January, but suggests that the government anticipates and asks Parliament for authorization of more funds, in case it was necessary to allocate resources to buy equipment and supplies in an emergency situation. The experience of other countries shows that there is a group more susceptible to coronavirus, such as those over 60, immunosuppressed or people with comorbidity (such as those transplanted, untreated HIV carriers and cancer patients).
In this context, the Government has decided to anticipate vaccination against other respiratory viruses circulating in the country, such as Influenza and H1N1. Starting in March, vaccines will come with new components for common modifications of such viruses, according to the Ministry of Health. The virologist Soares says that this will be an important action to prevent coinfections, with the contraction of more than one virus that could aggravate clinical conditions. The infectologist David Uip also sees positive the measure at this time in which the country is about to suffer the return of seasonal viruses. "With this, the prevalence of at least three viruses, two Influenza A and one B is decreased," he explains.
Minister Luiz Henrique Mandetta also wanted to take advantage of the case of coronavirus in Brazil to ask the World Health Organization to consider the disease as a pandemic, which occurs when a virus is no longer concentrated in specific territories. This measure would imply recognizing that the disease simultaneously infects people around the world and would make it possible to expand the alert list of countries for this disease.
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