Brazil accumulates problems in testing series at the time of the high of the omicron

The explosion of Covid-19 cases in Brazil with the advancement of the omicron variant has once again exposed gaps in the national testing strategy. Clinics, pharmacies and public services cannot meet the demand for diagnosis.

With delay, the government began to discuss the use of the self-test at home, a product distributed for months in other countries.

Experts say that there is a large underreporting of cases in Brazil. Official data show 22 million infections since the beginning of the health crisis, that is, about 10% of the population.

A Datafolha survey published this Saturday (15) showed that one in four Brazilians aged 16 or over says they have been diagnosed with Covid since the beginning of the pandemic. There are 42 million people infected, almost double the total number of cases officially registered in the country.

A study by the University of Washington projects a higher number: 47% were infected in Brazil at least once until the 3rd. There would be about 98 million infected.

The institution considers several points in the modeling, such as official data with daily data from the social network, displacement by geolocation, virus circulation rate and population size.

Epidemiologist Fatima Marinho, who is part of the network of researchers that sends Brazilian data to the University of Washington, said that official numbers from Brazil are underreported because of low testing.

“People will not be tested if the offer is not wide. In Brazil, due to low testing, only the most symptomatic and the most serious cases are detected”, said Marinho.

“With the simultaneity of the influenza A epidemic [H3N2] and the omicron variant, without available tests, it is difficult to distinguish between one disease and another”, he said.

Almost two years after the beginning of the pandemic, the Jair Bolsonaro (PL) government is still struggling to consolidate a testing policy. The Ministry of Health even neglected to buy supplies and let the “gold standard” exams, the RT-PCR, expire.

Minister Marcelo Queiroga (Health) is betting on the delivery of antigen tests, a model considered fast and effective. The idea is to distribute around 30 million units in January.

The data collected by the American university consider the estimate of infections among symptomatic and asymptomatic people. In the latter case, the patient can transmit the virus even without showing signs of the disease.

For epidemiologist Pedro Hallal, Brazil does not have a testing policy for Covid-19.

“Brazil performs tests as an assistance, almost randomly, without any criteria. In addition, there is a huge inequality in testing. Poor people have less access to tests, although they are at greater risk of Covid-19”, he said.

The Ministry of Health said in a statement that it has delivered more than 27 million RT-PCR tests, in addition to 43 million antigen tests.​

Medical entities such as Abrasco (Brazilian Association of Collective Health) demanded from the federal government and from Anvisa a broader testing policy and the permission to carry out self-tests in Brazil.

These organizations point out that even patients with symptoms of Covid may not be isolated due to lack of diagnosis.

In a note released on Wednesday (12), Abramed (Brazilian Association of Diagnostic Medicine) warned of the risk of lack of necessary supplies in Covid-19 exams. The entity recommended prioritization of tests for patients “according to a severity scale”.

The state health secretaries charged Queiroga more money to open mass testing points. The proposal is a contribution of R$ 4 per test sent by the ministry to each state or municipality.

Anvisa wants to release the self-test at the beginning of this week. Queiroga signaled that the government should not deliver home exams to the SUS.

“Brazil is a very heterogeneous country, with many contrasts. The allocation of this resource for acquiring self-tests, distributing them to the general population, may not have resulted in the public policy that we expect,” the minister told the press on Friday. (14).

Experts point out that the self-test would help to face this new phase of the pandemic. But they say that planning and education is needed for the population.

The University of Washington also projects that the peak of infections in this scenario of omicron prevalence in Brazil should occur in February.

The country is estimated to have 2.3 million cases daily by February 3, in the worst case scenario. However, when the projection takes into account the third dose for the population and the use of a mask, this number is reduced.

In the worst-case scenario, the survey also projects 30,000 deaths from Covid from January 3 to May 1.

“We expect a peak [de infecções] and severe cases, with stress on the health units, but not such a great impact on mortality. States with lower vaccine coverage will experience higher case severity and higher mortality, the vaccine is protecting against death,” Marinho said.

“The demand for an emergency room will increase to the point of exhausting the care capacity, the vaccine has insured ICU hospitalization and death, but the excess of patients in hospitals may have a negative impact on the hospital fatality rate”, he said.

The government even let about 7 million incomplete sets of RT-PCR tests stranded at the end of 2020, with short validity.

Anvisa renewed the useful life of these exams for another four months. The government rushed to dump the stock and even tried to push a batch of 1 million almost expired exams to Haiti.

When he took over the Ministry of Health in March last year, Queiroga promised to bet on rapid antigen tests. Only in September did the government launch a campaign for the mass use of these products, providing for the delivery of 60 million units made at Fiocruz.

Of this volume, the minister promises to deliver 30 million in January 2022, when demand at health centers explodes.

In November 2021, the government repeated failures and stockpiled 1.2 million exams that would expire that month. Members of the folder say that most of this batch won.

The ministry said the exams had not expired, but did not release data on inventory.

Pressured by the omicron, Saúde still wants to buy 4 million diagnostic tests that detect both Covid and influenza A and B.

For Hallal, a good testing policy should have at least three layers.

“The first would be assistance, which identifies cases early through the health service by tracing the contacts of confirmed cases and assisting in the isolation of suspects”, he said.

Second, the epidemiologist also advocates sample testing, to map the percentage of the population infected at different times of the pandemic. In this way, it is possible to identify the bottlenecks of care testing, he said.

The third point is to strengthen genomic surveillance and identify which versions of the virus are circulating.

“In each of the three points, Brazil has a vexing performance. A testing policy takes some time to be planned and put into practice,” said Hallal. “If it continues at this rate, our testing for the omnin will start after the variant wave has passed,” he said.