Medical entities act to maintain guidance against ‘Covid kit’

Specialists and medical societies that participated in the elaboration of the guideline against the use of the so-called ‘Covid kit’ in the SUS (Sistema Único de Saúde) will present an appeal to the Ministry of Health against the decision to archive the text.

The idea is to try to overturn the veto without going through the Ministry’s Secretary of Science and Technology, Hélio Angotti, responsible for stopping the publication of the document. The guideline had been approved by Conitec (National Commission for the Incorporation of Technologies in the SUS).

For this, instead of submitting an appeal to the secretary, as traditionally has to happen, they will send it directly to the office of Minister Marcelo Queiroga.

If they cannot reverse the veto, experts are already talking about going to court.

The appeal must be signed by Amib (Association of Brazilian Intensive Medicine), SBI (Brazilian Society of Infectious Diseases), SBPT (Brazilian Society of Pulmonology and Tisiology) and AMB (Brazilian Medical Association).

The president of Conass (National Council of Health Secretaries), Carlos Lula, called the rejection of the text “absurd beyond measure”. “A Ministry of Health against science. Unbelievable,” he said.

USP professor Carlos Carvalho, responsible for coordinating the studies that led to the elaboration of the guidelines, will also sign the review request.

Carlos Carvalho said he will file an appeal asking for a review of the rejection of the guidelines. The doctor said that the working group will send this document directly to the Minister of Health, Marcelo Queiroga.

For him, many of Angotti’s arguments are “reheated”, as they had been presented and refuted in previous moments. The Secretary of Science and Technology questioned the methodology used by the specialists, the technical rigor of the studies and even possible conflicts of interest of the group.

However, these points were clarified in April, with the presence of Angotti, according to technicians who followed the discussions. In subsequent meetings on the topic, representatives of the secretary were also present.

“As long as he didn’t touch sensitive areas, there was no problem. Suddenly he decides to say that the guidelines are not good. If we didn’t help, it was to warn, because we work voluntarily”, said Carvalho.

“We’ve been presenting since May [as diretrizes], if the rigor and the document were not good, why let it continue?”, also evaluated the coordinator of the group of experts.

Angotti rejected three chapters of Covid’s hospital guideline, all unanimously approved by Conitec. In addition, it filed the text on outpatient treatment, approved by seven to six in the same collegiate.

as showed the leaf, the pro-chloroquine wing of the Ministry of Health tried to boycott the discussion at Conitec. Now, the same group wants to remove from the command of the commission the servant Vania Canuto, who voted in favor of the text that contraindicates hydroxychloroquine, among other medicines.

Canuto’s exoneration, however, drags on. Minister Queiroga wants to avoid this weariness and tries to convince her to resign, which should not happen.

In addition to this impasse, the government has until January 24 to present to the STF a position on Covid treatment guidelines. For these reasons, Angotti published the rejection of the opinions approved by Conitec.

The ministry’s stance was classified as “denial” by Conass, which expressed “dismay” at the decision.

“Another denialist ‘innovation’ of federal management. Given the significant increase in Covid-19 cases due to the Ômicron variant, it is unacceptable that Brazil still does not have such guidelines in place”, informed the council of health secretaries.

Maicon Falavigna, co-coordinator of the Covid-19 Outpatient and Inpatient Treatment Guidelines, said it was inexplicable to leave health professionals without adequate guidance, and patients, in turn, at the mercy of poor clinical-assistance practice.

“I see the position of the Ministry of Health as quite incongruous. While the minister’s speech was always waiting for Conitec’s decision, we have seen the Secretariat of Science and Technology and Strategic Inputs, whose manager is indicted by the CPI [da Covid], going against Conitec’s decision.”

Published in the Official Gazette, Angotti’s decisions were for the non-approval of three of the four chapters of the proposal for the Brazilian Guidelines for Hospital Treatment of the Patient with Covid-19. It also rejected the text on outpatient treatment.

In addition to rejecting treatment with ineffective drugs, such as hydroxychloroquine, these opinions addressed methods of pain control and sedation of patients on mechanical ventilation, and dealt with hemodynamic assistance and vasoactive drugs.

Almost two years after the beginning of the pandemic, the ministry published only one guideline, in June 2021, on the use of oxygen, orotracheal intubation and mechanical ventilation of patients, prepared by the same group of experts.

There are also some manuals from the folder on medical procedures for Covid, in addition to a note published in 2020 that guides the use of hydroxychloroquine. But these documents did not go through Conitec, an agency that serves precisely to evaluate treatments for the SUS.

The directive, if approved, would not have the power to prohibit doctors from using the “Covid kit”, but it would represent a defeat for the denialist banners of the Jair Bolsonaro (PL) government. This is because it would be a Health orientation against the use of ineffective medicines.