Brazilians who claim to have contracted Covid are twice the official figure

One in four Brazilians aged 16 or over says they have been diagnosed with Covid since the beginning of the pandemic, which represents about 42 million people infected, according to a survey by Datafolha. The number is almost double the total number of officially registered cases in the country.

The survey was carried out by telephone on January 12 and 13, with 2,023 people aged 16 and over in all Brazilian states. The margin of error is plus or minus two percentage points.

According to the survey, 25% of those interviewed said they had taken a test that confirmed the infection by the virus, which means 41.95 million people infected since March 2020. The official records, collected by the press consortium, added up, until this Thursday ( 13), 22.8 million confirmed cases for the disease throughout the pandemic period.

The official data on positive cases gathered by the consortium refer to all ages. Datafolha’s data only indicate infections in those over 16, which points to an even greater underreporting in the country’s statistics.

For experts heard by the leaf, the difference between the numbers is not surprising, since the country has problems in the systematization of infected data.

After almost two years since the beginning of the pandemic, Brazil does not even have a standard for sending test data with positive results to be counted by the federal government, say experts.

Added to this is the high number of rapid tests for Covid-19 carried out in pharmacies or mobile units that have not been included in official statistics, problems in the information systems between municipalities, states and the Ministry of Health, and even the lack of encouragement. of the teams for the notification of positive cases.

“Official cases represent only the visible tip of the iceberg. The submerged part, the cases not captured by official statistics, is much larger. This is due to a failed testing policy”, says epidemiologist Pedro Hallal, coordinator of the Epicovid-19 study. .

“People’s money was used to produce placebo, chloroquine, and not to invest in tests or masks, which are things that really work to stop the pandemic”, he adds.

Datafolha data also point out that underreporting has increased in the country. According to the survey, 3% of respondents said they had Covid in the last 30 days, which represents 4 million people. The number is six times what the official records of the period indicate, which account for 621,530 positive cases, according to the press consortium.

According to experts, the increase in underreporting in the last month is related to the blackout of data that has occurred in the country since the Ministry of Health’s systems were brought down by hacker attacks in December, and also to the arrival of the omicron variant.

Infectologist Esper Kallás, professor at USP and columnist for leaf, explains that, as it is highly transmissible, the ômicron has contaminated both people who have already had Covid and those who have already been vaccinated against the disease, so the trend is towards an increase in underreporting. “Government data always fall far short of reality.”

Datafolha’s research also shows that the number of people with symptoms that may be of Covid in the last 30 days is high —​​much higher than those who say they have contracted the virus and received a positive test.

Of those interviewed, 30% said they had a cough and stuffy nose (which represents 50.3 million people), 22% reported having a fever (36.9 million) and 9%, shortness of breath (15.1 million), in the period.

Despite the high percentage of people with symptoms, only 17% of respondents say they have been tested for Covid. For specialists, this is due to the unavailability of supplies and the absence of a clear recommendation for testing suspected cases. The result is the detection of the virus only in the most serious cases and/or requiring hospitalization.

The survey also shows that the highest proportion of people who test positive for the disease are among those with the highest income. Among those earning more than 10 minimum wages, 37% said they had tested positive for the virus. Among those who have an income of up to 2 minimum wages, 19% were detected with Covid.

Younger people also report being more contaminated. In the 16-24 age group, 28% said they had tested positive for Covid. Among those aged 25 to 34, it was 29%. Between 35 and 44 years, 31%. The proportion drops to 25% for those aged between 45 and 59, and 14% for those aged 60 or over.

Sanitary doctor Claudio Maierovitch, from Fiocruz in Brasília, says that testing in Brazil has not been used to control the disease, that is, to isolate people, advise on quarantine or any other surveillance strategy.

“Testing is just for accounting. What we expect from health surveillance or epidemiological surveillance is being reduced to counting cases. the information is not useful, people stop feeding the bank. This happens in several information systems”, says Maierovitch, who has presided over Anvisa and was director of communicable disease surveillance at the Ministry of Health.

Experts explain that a good testing policy, like the one adopted in the United Kingdom and Germany, involves care testing (of people with symptoms or who have had contact with someone who is sick), sampling (to identify asymptomatic) and genomic surveillance ( to identify variants). “In each of the three, Brazil is a failure”, summarizes Hallal.

For Wallace Casaca, coordinator of ​Info Tracker, without the data of infected people, Brazil manages the pandemic blindly and, therefore, is unable to adopt measures to avoid the chain of transmission of the virus.

“There is no reliable view of the virus in the country and we can only understand the size of the problem when hospitalization and death data explode, which is when there is very little to be done”, he says.

For epidemiologist Paulo Lotufo, a professor at USP, underreporting is yet another chapter of poorly explained things in the management of the Covid pandemic in Brazil. “Where are the numbers?”

A requirement from the Ministry of Health may also explain part of the underreporting of cases. Since August 2021, the folder has asked for the inclusion of the batch number and the name of the manufacturer of the antigen tests for the notification of cases identified through them on the e-SUS Notifica platform.

Since then, the number of positive and negative results from these tests has plummeted. The effect of the new rule mainly affects the registration of mild symptomatic cases that can help to understand the transmission of the coronavirus.

Sergio Mena Barreto, president of Abrafarma (an association of large drugstore chains, where rapid antigen tests are offered), says that the units never failed to send notifications, but find it difficult to register due to lack of standardization in the country.

“We are obliged to send notifications, but we do not know how this information is processed, since each municipality and state has different rules. In some places, we must inform the health authority of the municipality or the state, others release it directly to the Ministry of Health. Brazil has a patchwork of this rule and we don’t know what treatment is given to the data from these tests”, he says.

According to data from the association, this Thursday alone (13), the country’s pharmacies carried out 86,000 Covid tests, with a positivity of 39.25%, which means the identification of 33,755 infections. The number would represent 30% of the cases officially recorded by the states. However, it is not possible to know if this data is in fact within the official records.

How are positive cases reported in Brazil?

• Since April 2020, public and private laboratories are required to notify the Ministry of Health of all Covid diagnostic test results within 24 hours;
• All test results, whether positive, negative or inconclusive, must be reported;
• Compulsory notification applies to whatever testing methodology is used, rapid antigen tests, RT-PCR or antibody tests, such as IgM and IgC;
• The ordinance of the Ministry of Health, which regulates the rule, says that “laboratory tests carried out by private laboratories must be made available to local SUS managers for updating and conclusion of the investigation. The text does not make it clear to whom these results must be sent , nor how local managers should treat this data
• Since then, each state and municipality has interpreted the rule in its own way, which has prevented the standardization of the forwarding of tests carried out in the country’s private network.
• According to Abrafarma, there are municipalities that authorize drugstores and laboratories to make the direct notification to the RNDS (National Health Data Network), a platform of the Ministry of Health created in May 2020 to collect Covid data. Others, however, require the notification to be made to the municipal health surveillance
• There are cases in which municipalities provide a link to the digital notification, but there are cases in which notifications occur manually. There is still a lack of standardization on the type of data to be sent. Some municipalities, for example, only accept to receive information about positive tests